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Appendix A6

Protocol for emergency referrals to a clinical ethics committee

Code of Conduct for the Leeds Teaching Hospitals Clinical Ethics Committee

Members of the Committee are expected to:

1. Respect patient confidentiality.

They are expected to act responsibly in handling oral or written communication about individual patients, and to take all reasonable precautions to protect patient confidentiality.

2. Respect the rights of patients to be involved in decisions about their care.

They should take account of the competence of patients to be involved in such decisions, and of the position of those close to the patient.

3. Be honest and act with integrity.

The best interests of individual patients should be their first concern, though they may also need to consider wider interests. If the individual responsibilities of committee members result in conflicts of interest, these should be acknowledged and taken into account in the work of the committee.

4. Respect the views of other committee members, and colleagues.

The committee will seek to achieve agreement, but differences of opinion should be acknowledged and recorded.

5. Refer matters beyond the scope of the committee to the appropriate body.

This may include medico-legal questions, and matters concerning the quality of clinical care, and appropriate advice should then be sought.

6. Maintain awareness and understanding of clinical ethical issues.

This should involve the pursuit of appropriate educational opportunities, with the encouragement and support of the Trust.

7. Promote the awareness of ethical issues involved in the work of the Trust.

This should include the sharing and mutual understanding of specific professional guidance on the ethical standards of clinical practice.

8. Promote the fair and equitable treatment of patients and their carers.

The committee should encourage the Trust and its staff to treat patients and their carers in a fair and equitable manner.

References:

1. Code of conduct for NHS Managers. Department of Health 2002.

2. Code of Professional Conduct. Nursing and Midwifery Council. 2002.

3. Good Medical Practice. General Medical Council. 2001.

Terms of Reference of Clinical Ethics Consultation Groups

1. Establishment of each group to be in response to a request for advice about an individual clinical case or cases within the Trust.

2. Requests for such advice to be made to the chair of the Committee, who will be responsible for co-coordinating the response.

3. If a full Committee meeting is imminent, then requests for advice may be presented to the full Committee, but more urgent requests may require a response before the next meeting.

4. The establishment of a Case Consultation Group will depend on the complexity of the presenting problem, the time required to establish the group and the agreement and participation of the referring clinician.

5. Requests for urgent clinical ethical advice may need to involve the early participation of individual members of the Committee, at the discretion of the chair of the Committee. Whenever a Clinical Ethics Case Consultation Group is established, the group should include the following participants, depending on the availability of Committee members:

  1. Chair, or member nominated to chair the group
  2. Clinician involved in Clinical Risk management
  3. Lay or Academic member of the Committee
  4. Where possible, CEC member from relevant medical specialty
  5. Where possible, CEC member from unrelated medical specialty

6. The work of each Case Consultation Group will be reported to the next meeting of the full Committee.

7. The Case Consultation Groups will be responsible directly to the Clinical Ethics Committee, and therefore to the Clinical Governance Action Group.

Clinical Ethics Case Consultations Algorithm

A clinician with an ethical dilemma will either present their problem to the CEC Chair or a CEC member, if a CEC member they would then discuss the matter with the CEC Chair. The CEC Chair would then:

  1. Establish a clinical ethics case consultation group
  2. Present tha case and associated clinical ethical issues
  3. Consider the case-spcific legal issues (e.g. PVS)
  4. Consider the relevant professional guidelines
  5. Consider the need for specialist advice (e.g. Psychiatry)
  6. Take advice from individual members of the case consultation group

The Chair would then:

  1. record the advice given
  2. report the case to the main CEC meeting
  3. hold follow up meetings as required

Copyright of Appendix A6 is held by Leeds Teaching Hospitals Clinical Ethics Committee

Jim Eccles
Leeds Teaching Hospitals Clinical Ethics Committee
Clinical Ethics Committee Case Consultations Algorithm