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Appendix A3

Issues for a CEC to consider in developing policies and guidelines

Does the CEC wish to have a role in developing policy and guidelines?

This is usually given as one of the core functions of a CEC and can be a way for the committee to influence practice on a trust wide level. However it can be very laborious and time consuming if a committee meets infrequently, and may leave little time for other functions that the committee members may see as more important. If policy and guideline development are to be part of the CEC’s role then the committee needs to clarify how it will carry out this role.

Options:

  1. The committee develops, or plays a significant role in developing, specific policies or guidelines which are accepted and ratified by the Trust Board, e.g. DNAR guidelines, consent policy.
  2. The committee reviews existing hospital policies and comments on the ethical considerations of these policies.
  3. The committee has input into the development of policies and guidelines drafted by other committees, e.g. resuscitation committee.
  4. The committee identifies areas where there is a need for a policy or guideline and either develops this or instigates development by another more appropriate committee.

Each option has advantages and disadvantages and the exact role of the committee will depend on where it fits within the structure of the Trust.

General considerations

There are some general considerations which will be applicable to whatever role the committee takes in guideline and policy development.

  1. Is the policy / guideline developed / considered by the whole committee or will sub-committees be used?
  2. If the policy / guideline is primarily developed by another committee, what feedback will the CEC have on its input, and on the subsequent dissemination and evaluation of the policy / guideline?
  3. If the policy / guideline is developed primarily by the CEC, how much consultation will there be with clinicians and other members of staff affected by the policy, what authority will the policy have and how will implementation and evaluation be achieved?

The process of policy/guideline development

  1. Identify the objectives of the policy / guidelines and summarise these
  2. Identify the underlying ethical principles that inform the policy / guideline
  3. Consider the application of the principles in relevant specific cases in order to formulate recommended procedures that will form the core of the policy / guideline.
  4. Consider any legal frameworks in which the policy / guideline must sit.
  5. Consider similar guidelines drafted by other institutions such as professional bodies and other CECs in order to refine or enhance the policy / guideline.
  6. Consult outside the committee.
  7. Aim for clarity in the final document; clarity in the definition of terms, clarity in describing the underlying ethical principles and clarity in setting out procedural steps.

Useful sources of existing guidelines

BMA guidelines www.bma.org.uk/ap.nsf/Content/Hubethics

GMC guidelines www.gmc-uk.org

Examples of CECs that have developed guidelines on the following issues:

Guidelines CEC names
  Wirral Hospitals NHS Trust
  Nottingham City Hospital NHS Trust
CPR/DNR guidelines Oxford Radcliffe Hospital NHS Trust
  Royal United Hospitals Bath NHS Trust
  St Mary’s NHS Trust
  St Mary’s NHS Trust
Withdrawal and withholding of life sustaining treatment The Royal Hospitals NHS Trust, London
  Wirral Hospitals NHS Trust
  Oxford Radcliffe Hospital NHS Trust
Advance directives Nottingham City Hospital NHS Trust
  Wirral Hospitals NHS Trust
Consent to treatment Nottingham City Hospital NHS Trust
  Royal Hospitals NHS Trust, London
Presence of relatives at CPR attempts Royal Hospitals NHS Trust, London
Retention of tissues and organs post mortem Royal United Hospitals Bath NHS Trust
Blood transfusion in Jehovah’s witnesses Royal United Hospitals Bath NHS Trust
Clinical alert policy (for investigations on infectious patients) Wirral Hospitals NHS Trust
Clinical confidentiality and the media Royal Hospitals NHS Trust, London

Copyright of Appendix A3 is held by The Ethox Centre