Doctors and clinical ethics committees: friends or foes?

Abstract

German and French abstracts see p. 49 & 50 Background: Whose interests should a hospital clinical ethics committee (CEC) serve? This is a particularly important question in conflicts regarding life and death decisions. This question has been raised in Norway by clinicians, politicians and lay people. Method: A retrospective evaluation of six high conflict cases discussed in CECs, all dealing with forgoing life prolonging treatment to children. The information about the cases is taken from media coverage. The focus is on reasons for conflict and on the role of the CECs. The author was involved in the CEC discus- sion of four of the six cases. Findings: Parents' distrust in the medical judgments seemed to be an important reason why conflicts developed. In addition value conflicts were obvious, but value aspects sometimes could be covered by clinicians in medical facts. When advice was given in the CEC, they all supported the doctors' decision. The child's best interest was the focus of the CEC. In only one of these cases did the CEC's discussion seem to have had practical consequences. Conclusion: The most important function for a CEC is to secure that value issues are recognized and dealt with in a competent way. Neutrality issues cannot be ignored in the work of the CECs. Lay CEC members, open and systematic working procedures, transparency of arguments and early involvement of all involved parties including the patients and / or next of kin in the discussion seem to be important in order to address neutrality issues.