Can clinical ethics committees be legitimate actors in bedside rationing?

Morten Magelssen,Kristine Bærøe

doi:10.1186/s12910-019-0438-y

Morten Magelssen, Kristine Bærøe

Open Access

https://doi.org/10.1186/s12910-019-0438-y

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Journal: BMC Medical Ethics	Publication Date: Dec 1, 2019
Citations: 3	License type: open-access

Affiliation: University of Oslo, University of Bergen

Abstract

BackgroundRationing and allocation decisions at the clinical level – bedside rationing – entail complex dilemmas that clinicians and managers often find difficult to handle. There is a lack of mechanisms and aids for promoting fair decisions, especially in hard cases. Reports indicate that clinical ethics committees (CECs) sometimes handle cases that involve bedside rationing dilemmas. Can CECs have a legitimate role to play in bedside rationing?Main textAided by two frameworks for legitimate priority setting, we discuss how CECs can contribute to enhanced epistemic, procedural and political legitimacy in bedside rationing decisions. Drawing on previous work we present brief case vignettes and outline several potential roles that CECs may play, and then discuss whether these might contribute to rationing decisions becoming legitimate. In the process, key prerequisites for such legitimacy are identified. Legitimacy places demands on aspects such as the CEC’s deliberation process, the involvement of stakeholders, transparency of process, the opportunity to appeal decisions, and the competence of CEC members. On these conditions, CECs can help strengthen the legitimacy of some of the rationing decisions clinicians and managers have to make.ConclusionsOn specified conditions, CECs can have a well-justified advisory role to play in order to enhance the legitimacy of bedside rationing decisions.

Highlights

Aided by two frameworks for legitimate priority setting, we discuss how Clinical ethics committee (CEC) can contribute to enhanced epistemic, procedural and political legitimacy in bedside rationing decisions
On specified conditions, CECs can have a well-justified advisory role to play in order to enhance the legitimacy of bedside rationing decisions
On the basis of criteria for legitimacy of clinical decisions with priority-setting consequences and roles that CECs might play in case consultations involving priority setting issues, we have shown that CECs have the potential to increase the legitimacy of such decisions

Summary

Main text

Reasonable clinical judgments and aspects of legitimacy Bærøe’s framework for reasonable clinical judgments with priority-setting consequences consists of six requirements on clinicians and one requirement on the self-regulation of the medical profession, requirements that will be explained briefly. The CEC can take on the role as a dialogue partner and assist decision-makers in structuring their reflection towards reasonableness according to all requirements 1–6 in Bærøe’s framework This presupposes that CEC members collectively possess the relevant competence in priority setting criteria and connected moral arguments and political theory to guide . This would for example require that stakeholders’ concerns are voiced, they will have to be listened to and their concerns addressed in ways that give stakeholders reason to consider the conditions for the process fair [16] In this respect case 1 appears to showcase an asymmetry in the CEC’s treatment of the patient and spouse on one hand and health professionals and managers on the other.

Background

Conclusions