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Educational Resources: Appendices

Appendix A8

Role of a clinical ethicist

It is not uncommon for clinical ethics committees to include amongst their membership an academic ethicist, or to have links with academics working on ethical issues and based in a local university department of philosophy, law, theology or medicine. In some settings, even where there is not in fact an ethics committee, academic ethicists have developed good relationships with clinicians and other health professionals and have been willing to provide input into the discussion of cases. Many of the leading academics involved in research and teaching in medical ethics have for many years been contacted by health professionals facing difficult ethical issues and have offered ad hoc support and advice about ways of thinking such ethical problems through.

In recent years, one or two academic ethicists have developed closer relationships with clinical practice and have begun to practice what might be called the role of a ‘clinical ethicist’. As it has with ethics committees, this work has taken the form of support and advice rather than decision-making. It is as yet relatively uncommon for this work to be funded through the trust itself but in one or two cases some such funding has been available. What might a clinical ethicist do? To a great extent this will depend upon the needs of the particular clinical setting and upon the skills and experience of the ethicist. At the Oxford Radcliffe Hospitals Trust (ORHT) clinical ethics support mirrors to some extent the roles taken on by clinical ethics committees. That is, as an ethicist I have some educational role, some input into cases and some input into the development of policy. My role as the ethicist at ORHT takes something like the following form:

1. Supporting the clinical ethics committee.

I am a member of the clinical ethics committee, providing ethics input and helping to set the agenda. My relatively close relationship with the clinical setting means that I am able to identify and act as a collecting point for ethical issues and cases that might be suitable for discussion at the ethics committee. The availability of an ethicist makes it possible for the clinical ethics committee to provide relatively timely and flexible responses to health professionals. The clinical work of the ethicist can also act as a useful indicator of areas of practice in which there might be the need for policy development or education.

2. Case consultation

I run a monthly one-hour discussion in the clinical genetics unit at which ethical issues and cases arising during the past month are discussed in a multidisciplinary group of doctors, counsellors and nurses. I also run a similar discussion group for the cardiology genetics team. In addition to these regular sessions, I provide ad hoc support in any clinical areas that wants it. In many cases the team simply wants someone who can facilitate a one-off discussion about a particularly problematic issue. In some cases this leads on (as in genetics) to a more long-term involvement. In addition to genetics and cardiology, I have provided ethics support in Intensive care, to the resuscitation team, prenatal testing, the Women’s Centre, Neuro ITU, the Retained Organs Group, Paediatrics, among others. In many cases the ethical issues can be resolved locally, in others I am able to act as a link person encouraging access to the clinical ethics committee.

3. Education

The long-term input of an ethicist into a clinical team, in addition to helping with particular cases, has an educational and development function, helping health professionals to develop the awareness and skills they need to identify and address ethical issues in their own right. In addition to this, I have encouraged and participated in the educational activities of the committee. For example, running one hour open training sessions on ethical issues for members of trust staff on issues such as consent, confidentiality and so on.

4. Policy and guidance

In many cases, difficult ethical issues arising in practice can lead a clinical team to consider developing a new policy. The ethicist can play a role in helping a team to think through the broader ethical issues presented by a case and to think through the ethical implications of new policy initiatives and changes in practice. Similarly, with policy and guidelines developed externally (whether nationally or at the level of the trust) the ethicist can help clinical teams to consider the ethical implications.

Copyright of Appendix A8 is held by The Ethox Centre.

Michael Parker
Professor of Bioethics, The Ethox Centre, University of Oxford