Do Tanzanian hospitals need healthcare ethics committees? Report on the 2014 Dartmouth/Penn Research Ethics Training and Program Development for Tanzania (DPRET) workshop

Abstract

Like researchers, clinicians (i.e. nurses, physicians and other healthcare providers) face complex ethical issues in the delivery of patient care in Tanzania. However, there are few resources to aid those faced with making difficult ethical decisions in clinical practice. Healthcare practitioners must individually handle clinical ethics problems that arise within their respective clinics, hospitals or other settings, making decisions based on their own beliefs about what is morally right or wrong, when no ethics committee or ethics support system exists. This can lead to frustration, dissatisfaction and high turnover of the clinicians who are critical to the country's infrastructure and overall quality of healthcare. Healthcare ethics committees (HECs) are common within US hospital-based institutions, and assist clinicians, patients, families and others with difficult ethical problems that arise in patient care delivery. An analysis of data from 300 HEC chairpersons in the USA, for example, showed that the most successful functions reported by HEC members were patient, family, community and provider education and conflict mediation. [1] Additionally, the most frequent clinical issue that HEC chairpersons reported, and also the one best handled, was that of making end-of-life decisions (including 'do not resuscitate' , advance directives and withdrawing and withholding treatment), which remains a ubiquitous issue in many healthcare institutions. In their survey of 600 US general hospitals, Fox et al. [2] also identified reported goals of ethics consultations as intervening to protect patients' rights, addressing conflicts, discussing ethical issues with staff and providing moral support as needed, among other issues. Moreover, in a randomised trial of 551 patient cases in the USA in 2001, the majority (87%) of healthcare professionals, patients and families claimed that ethics consultations in the intensive care unit (ICU) were beneficial in alleviating conflict, and perceived as facilitative. [3] The majority of patients and surrogates also indicated that they would seek an ethics consultation again, and recommend it to others. This same study investigated the effects of ethics committees on duration of stay in the ICU, and on prolonged non-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Clinical Ethics Committees in Africa: lost in the shadow of RECs/IRBs?

“…When participants were questioned about whether they had established CECs or CESs in their institution, the majority (85.3%) had not. This could be because there are limited resources to establish CECs in developing countries, including Africa, where clinical ethics is not a priority [19,20,23]. Africa bears a double burden of infectious and non-infectious diseases, thus posing a challenge to already weak healthcare systems.…”

“…It is also concerning that, in Africa, ethics deliberation is mainly emphasised in the context of research but not in clinical practice. This is because research ethics is the most developed aspect of bioethics in Africa, with substantial investment and support from international funders from resource rich countries [23,24]. These funders support clinical research in Africa on local populations but do not include healthcare or clinical ethics in their research awards or capacity development initiatives [24,25].…”

“…In many countries in sub-Saharan Africa such as in Ethiopia [2], Tanzania [23], and Nigeria [25], knowledge of clinical ethics is quite limited among HCPs in the clinical setting [2,26]. The lack of bioethics training is often a contributing factor to the limited knowledge among HCPs that leaves them unprepared to respond to complex ethical dilemmas.…”

“…The lack of bioethics training is often a contributing factor to the limited knowledge among HCPs that leaves them unprepared to respond to complex ethical dilemmas. The allocation of scarce resources is also seen as challenging for HCPs who must make difficult ethical decisions [2,23,27]. The above-mentioned challenges have also been observed in other developing countries such as Malaysia [28], Nepal [29], and Latin-America [30].…”

“…The above-mentioned challenges have also been observed in other developing countries such as Malaysia [28], Nepal [29], and Latin-America [30]. The reality is, with limited knowledge, resources, poor infrastructure, lack of commitment from government and poverty, HCPs find themselves forced to make decisions based on their beliefs or skills, with no ethics support services or committee in place [23,27].…”