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CECs in Norway - Recommended by Parliament

History

Clinical Ethics Committees were established as a planned experiment at three Norwegian hospitals in 1994 and when this experiment was evaluated in 1998 it was recommended that they should be introduced in all Norwegian hospitals.
This recommendation was taken forward by the Health and Social Affairs Department of the Norwegian government and approved by the Norwegian parliament in 2000, although no date was set for when the committee would have to be established.
In the mean time the Norwegian health care system had been reorganized into regional hospital trusts, and the requirement is now for each hospital trust to have a clinical ethics committee which means that one committee may cover more than one hospital.
Committees are at the end of 2003 in existence in approximately 2/3rds of all trusts.

Composition and function

The composition and function of the committees vary somewhat. All have 8-10 members, most members are either doctors or nurses (slightly more doctors than nurses), and most committees also include the hospital priest (Norway has an established Lutheran church). Some committees have a lawyer member, some an ethicist, some a lay member, and some a representative of the hospital administration.
All committees are appointed by the hospital executive.
The functions of the committees also vary. All do retrospective case review of ethically problematic cases, most develop policies (e.g. do not attempt resuscitation policies), and some engage in ethics consultation concerning ongoing cases. Most committees are also involved in planning and delivering ethics education in the hospital.
It was initially believed that the committees would be overwhelmed with cases, but one of the problems that have emerged is that very few cases are referred to the committees, and that these come from a very narrow range of clinical practice.

Coordination

The Centre for Medical Ethics at the University of Oslo has been given the task of supporting and coordinating the committees. This function is funded by the Health and Social Services Department and is also planned to include further research on the function and effectiveness of the committees.
The available support includes start-up advice and help, an annual 2 day conference, and longer term the development of a resource web-site.

Challenges

There are 3 main challenges that face existing Norwegian clinical ethics committees:

  • defining their role
  • getting a sufficient number of cases referred for discussion
  • getting commitment to implementation of the policies that are developed

All of these are interconnected and it will be interesting to see how they are overcome during the next 5-10 years when the committees become firmly embedded in the health care system.

A further challenge at the political level is to decide whether more uniform guidelines should be produced concerning composition and function of committees, and whether the committee system should be extended beyond hospitals, for instance to nursing homes.

Søren Holm
Professor of Medical Ethics
Centre for Medical Ethics, University of Oslo

and

Professorial Fellow in Bioethics
Cardiff Institute for Society, Health and Ethics