Making the (Business) Case for Clinical Ethics Support in the UK

Abstract

This paper provides a series of reflections on making the case to senior leaders for the introduction of clinical ethics support services within a UK hospital Trust at a time when clinical ethics committees are dwindling in the UK. The paper provides key considerations for those building a (business) case for clinical ethics support within hospitals by drawing upon published academic literature, and key reports from governmental and professional bodies. We also include extracts from documents relating to, and annual reports of, existing clinical ethics support within UK hospitals, as well as extracts from our own proposal submitted to the Trust Board. We aim for this paper to support other ethicists and/or health care staff contemplating introducing clinical ethics support into hospitals, to facilitate the process of making the case for clinical ethics support, and to contribute to the key debates in the literature around clinical ethics support. We conclude that there is a real need for investment in clinical ethics in the UK in order to build the evidence base required to support the wider introduction of clinical ethics support into UK hospitals. Furthermore, our perceptions of the purpose of, and perceived needs met through, clinical ethics support needs to shift to one of hospitals investing in their staff. Finally, we raise concerns over the optional nature of clinical ethics support available to practitioners within UK hospitals.

‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

“…Regarding why they sought the specific mode of support: to obtain validation for the approach selected (9), required some particular action to be taken (7), gaining a new perspective (7), recommendations required (5), for legal protection (5) and because mediation was needed or it was considered the right path to follow. Most participants felt 'satisfied' (13/26) or 'very satisfied' (6/26) with the outcome of the consultation, though suggestions to improve satisfaction included: streamlining the decisionmaking process (7), changing knowledge, attitudes or understanding of family members (5) or changing the socio-cultural environment (4), law or regulations (3) or institutional policies (3). 1/5 DGH/GP centres had access to formal ethics supporta retired clinical ethicist who they could call informally for advice.…”

“…The structure, function and interventions vary markedly between, and even within, different institutions, i.e., clinical ethics committees (CEC), clinical ethics consultants, rapid reviews, moral case deliberation and ethics rounds. 5 In the USA, there is a requirement for hospitals to have a mechanism in place to consider ethical issues that arise. 6 In the UK, there are currently no such requirements.…”

Clinical ethics support services in paediatric practice: protocol for a mixed studies systematic review on structures, interventions and outcomes

“…Traditionally, four main CESS functions have been described; clinical case consultation, education, institutional policy development and research. 3 9 Multiple models of CESS have been described, including individual ethical case consultation, clinical ethics committees, individual ethicists, moral case deliberation, ethics rounds and ethics discussion forums. 1 10–12 Informal provision of clinical ethics support has also been reported.…”

Clinical ethics support services during the COVID-19 pandemic in the UK: a cross-sectional survey

“…[17][18][19] At the time of writing (July 2021), the UKCEN website lists 44 committees and groups, 20 suggesting that numbers have dwindled. There is evidence that making a business case for a CESS before the pandemic was onerous and unappealing, 21 and issues with the constitution and operation of CESSs sometimes made them unapproachable or invisible to those who might use their services. 22 In response to the increased and unprecedent demand for clinical ethics support during the pandemic, established CESSs have adapted their services, 3 4 and new ethics provision has been set up.…”

“…At the time of writing (July 2021), the UKCEN website lists 44 committees and groups, 20 suggesting that numbers have dwindled. There is evidence that making a business case for a CESS before the pandemic was onerous and unappealing, 21 and issues with the constitution and operation of CESSs sometimes made them unapproachable or invisible to those who might use their services. 22 …”