Healthcare Ethics Committees Research Articles

ROL DOCENTE DE LOS COMITÉS DE ÉTICA ASISTENCIAL Y LOS COMITÉS ÉTICO CIENTÍFICOS

The Health Care Ethics Committees and the Scientific Ethics Committees are mainly respon­sible for advising clinicians in making complex decisions, and for reviewing, correcting and approving scientific work projects, respectively. In general, these committees devote little time to teaching and dissemination, areas in which, by sharing their experience and knowledge, they can contribute enormously to generating a culture of ethical reflection, both in the health care setting and in teaching and research. This article examines how both types of committees can improve knowledge and understanding of ethics and bioethics in their institutions, in university teaching and in the community. It begins with a brief review of the milestones that led to their emergence. Subsequently, its functions are reviewed, both from a theoretical point of view and in legislation. Finally, it is proposed in which areas and in what way Health Care Ethics Committees and Scientific Ethics Committees can develop a teaching and community outreach function, promoting values such as respect, care, altruism, rigor, honesty and justice.

Healthcare workers’ perception of the usefulness of a healthcare ethics consultation service

Background and objectiveClinical ethics consultation services (CEC) have arisen from Healthcare Ethics Committees (HEC) to address ethical conflicts in real-time. Our aim was to determine the perception of usefulness of a CEC service among healthcare workers one year after its creation as well as to assess changes in trends in the use of the CEC and HEC between 2015 and 2021. Materials and methodsThis observational, cross-sectional study was based on a standardized survey of healthcare workers at an urban tertiary care hospital. The results were also compared to those from an identical survey conducted in the same population in 2015. ResultsA total of 213 professionals participated (mean age 44 ± 11 years, 69% women). The professionals were more familiar with the HEC than the CEC service (94% vs 61%; p < 0.001). Forty-five individuals (21%) had consulted the CEC since its implementation; 95% of them found the consultation useful. Physicians knew about and used the CEC more than other groups of professionals. The degree of knowledge of the HEC increased significantly by 2021 compared to 2015 (94% v. 76%; p < 0.001). Some areas for improvement identified were the need for greater dissemination of the service, guaranteeing institutional resources to maintain the service, and encouraging greater participation from different professional groups. ConclusionsKnowledge of the institutional HEC and CEC services has increased in recent years among healthcare workers, who considered the CEC service to be useful for addressing ethical conflicts in daily practice.

Percepción de utilidad entre profesionales sanitarios de un servicio de consultoría ética clínica

Background and objectiveClinical ethics consultation services (CEC) have arisen from healthcare ethics committees (HEC) to address ethical conflicts in real-time. Our aim was to determine the perception of usefulness of a CEC service among healthcare workers one year after its creation as well as to assess changes in trends in the use of the CEC and HEC between 2015 and 2021. Material and methodsThis observational, cross-sectional study was based on a standardized survey of healthcare workers at an urban tertiary care hospital. The results were also compared to those from an identical survey conducted in the same population in 2015. ResultsA total of 213 professionals participated (mean age 44±11 years, 69% women). The professionals were more familiar with the HEC than the CEC service (94 vs. 61%; p<0.001). Forty-five individuals (21%) had consulted the CEC since its implementation; 95% of them found the consultation useful. Physicians knew about and used the CEC more than other groups of professionals. The degree of knowledge of the HEC increased significantly by 2021 compared to 2015 (94 vs. 76%; p<0.001). Some areas for improvement identified were the need for greater dissemination of the service, guaranteeing institutional resources to maintain the service, and encouraging greater participation from different professional groups. ConclusionsKnowledge of the institutional HEC and CEC services has increased in recent years among healthcare workers, who considered the CEC service to be useful for addressing ethical conflicts in daily practice.

Proposal of an informed consent form to obtain audiovisual material from patients

An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Developing a conversation about identifying community needs to embrace wellbeing through social prescribing interventions: a qualitative study

BackgroundPrevious evidence suggests that co-production and co-design are effective approaches to engage stakeholders in the development and implementation of social prescribing (SP) interventions within community settings. SP initiatives can be enhanced from the outset, by drawing on stakeholder knowledge to design services that improve health and wellbeing outcomes for community members. The aim of this qualitative study was to engage with the residents of the Nantlle Valley, a rural community in North West Wales, UK, to gather perceptions regarding the need for co-design, co-produced SP interventions to meet the wellbeing needs and requirements of the community. In line with the Well-being of Future Generations Act (Wales) 2015, the current study also aimed to gather knowledge that would shape the sustainable development of SP interventions creating positive wellbeing outcomes for the future. MethodsA purposeful, convenience sample (n=16 in total; 12 identified as female and four identified as male) of community members (white British) who were residents of the Nantlle Valley were recruited by various means including emails and Facebook notices, and data were collected using focus groups. Drawing from the principles of citizen assembly deliberations and future design in developing sustainable strategies, a novel approach was applied to the focus groups. This included conducting two focus groups, the “Today Group” deliberated on the wellbeing of the community today, and the “Legacy Group” deliberated on the wellbeing of future generations in developing SP interventions. Ethical approval for this study was granted by Bangor University's Healthcare and Medical Sciences Academic Ethics Committee (2020–16850) on 11th January 2021. Due to the COVID-19 pandemic restrictions, the participants were sent an electronic consent form to return before the focus group and their verbal consent were also recorded at the beginning of each focus group. FindingsThe focus groups were conducted online between Feb 22, and Feb 25, 2021, due to social restrictions because of the COVID-19 pandemic. The results of the focus groups indicated a need for additional SP interventions. The Today Group discussions identified concerns such as a sense of self-enforced social exclusion among less economically privileged individuals living in the community, which has remained unaddressed for generations The Legacy Group participants expressed views that community projects would be essential to sustaining communities for future generationsin the Nantlle Valley. It was clear that unaddressed social and economic needs influencing the determinants of health had been made worse by a weakened economy due to the effects of the COVID-19 pandemic. InterpretationHaving a co-produced design approach might empower community members to take ownership of their own community in terms of generating solidarity by having health and social services together in one wellbeing hub. The long-term thinking approach could lead community members to feel they are the guardians of the future and are responsible for instilling a desire to preserve communal endeavours for sustainable, inclusive, and cohesive communities in the NV FundingEuropean Social Fund through a Knowledge Economy Skills Scholarships (KESS2 East) Studentship.

Treatment of Non-Muscle Invasive Bladder Cancer with BCG: Implications for the SARS CoV-2 Pandemic

Background: Hypotheses defend BCG being able to have an impact on the course of COVID-19 disease, decreasing the rate of infections and their severity. Objective: To determine if the incidence and severity of COVID-19 are less in patients who receive adjuvant treatment with intravesical BCG for non-muscle invasive bladder cancer and if the number of instillations are influential. Methods: All the participants treated with intravesical BCG between January and June-2020 were analysed, researching if they had been infected, and comparing them with the infection rate in the general reference population of our Hospital. Ethical Aspects: The Healthcare Ethics Committee of the Hospital approved the study and informed consent forms were delivered to patients treated with BCG in order to authorize the use of their data in this study. Statistical Analysis: OpenEpi (Link) statistical analysis was carried out by means of 2×2 tables applying the chi-square statistic and Fisher test for qualitative variables. Results: 117 patients, 23 women (19.7%) and 94 men (80.3%), received treatment with BCG. The mean age was 72.12 years; all ≥50 years. Seven in induction phase, 6 weeks, and 110 in 1-year maintenance, 3 weeks to 3, 6 and 12 months, excluding those that had &lt;4 instillations. Three patients (2.56%) were infected with moderate disease that required admission to the ward. None in the Intensive Care Unit. In the general population, 8558 (5.7 %) were infected. 2015 (1.35%) required admission to the ward and 185 (0.12%) in the Intensive Care Unit. There are no statistically significant differences in the infection rate. Neither was there any in the incidence of moderate or severe disease nor in the incidence of disease between the different phases of the intravesical treatment. Conclusion: We have not been able to demonstrate that intravesical BCG impacts the incidence rate or the severity of COVID-19.

Bioethical Concerns During the COVID-19 Pandemic: What Did Healthcare Ethics Committees and Institutions State in Spain?

Objectives: Each new wave of the COVID-19 pandemic invites the possible obligation to prioritize individuals' access to vital resources, and thereby leads to unresolved and important bioethical concerns. Governments have to make decisions to protect access to the health system with equity. The prioritization criteria during a pandemic are both a clinical and legal-administrative decision with ethical repercussion. We aim to analyse the prioritization protocols used in Spain during the pandemic which, in many cases, have not been updated.Method: We carried out a narrative review of 27 protocols of prioritization proposed by healthcare ethics committees, scientific societies and institutions in Spain for this study. The review evaluated shared aspects and unique differences and proffered a bioethical reflection.Results: The research questions explored patient prioritization, the criteria applied and the relative weight assigned to each criterion. There was a need to use several indicators, being morbidity and mortality scales the most commonly used, followed by facets pertaining to disease severity and functional status. Although age was initially considered in some protocols, it cannot be the sole criterion used when assigning care resources.Conclusions: In COVID-19 pandemic there is a need for a unified set of criteria that guarantees equity and transparency in decision-making processes. Establishing treatment indications is not the aim of such criteria, but instead prioritizing access to care resources. In protocols of prioritization, the principle of efficiency must vary according to the principle of equity and the criteria used to guarantee such equity.

Structural Justice Ethics in Health Care

Structural Justice Ethics in Health Care

Current overview of assistance bioethics committees in Chile

The article examines and analyzes the functioning of healthcare ethics committees in Chile. For this, through an extensive bibliographic review, parameters were established that allow indicating improvements to the system that regulates the Ethical-Assistance Committees (CEA) in the Latin American nation, based on a case study that corresponds to the University of Chile.

Getting Real: The Maryland Healthcare Ethics Committee Network's COVID-19 Working Group Debriefs Lessons Learned.

Responding to a major pandemic and planning for allocation of scarce resources (ASR) under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of the Maryland Healthcare Ethics Committee Network (MHECN) in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies.

Clinical Ethics Consultation: current European models and novel approaches in Spain

To date, healthcare ethics committees (HEC) have been the only ethics consultation model in the hospital setting in Spain, though their usefulness for ethical conflict resolution in daily practice has been questioned. Individual clinical ethics consultation (CEC) is a complementary ethics consultation model, which has proved efficacious in real-time ethical problem-solving. Although CEC is widely used in North America, its implementation in Europe is still marginal. In this document we present the general characteristics of CEC services, comparing their potential advantages and risks to those of HECs. We will then share relevant European experiences in CEC, as well as review the few CEC initiatives in Spain. Finally, we will share our recent CEC implementation strategy in a national, medium-sized, teaching hospital. We will summarise the minimum requirements that such a CEC service must meet in order to carry out its consulting activity: organisational flexibility, well-trained professionals, with sufficient clinical experience, economical support, and organisational dependency on HECs.

Patient centred care in diagnostic radiography (Part 2): A qualitative study of the perceptions of service users and service deliverers

IntroductionThere is growing awareness of the importance of patient centred care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents, but there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services in order to develop measurable indicators of PCC. MethodsThis project was funded by the College of Radiographers Industry Partnership Scheme. Ethical approval was granted by the University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 2 of the project, which was a series of focus groups and telephone interviews to enable deeper discussion and exploration of PCC. Situational vignettes were used to promote discussion and debate and encourage suggestions for PCC approaches. Audit tools to assess engagement with PCC were developed at individual and organisational level. ResultsFour focus groups and six telephone interviews were carried out in total. Focus groups were held in a variety of locations to promote attendance. Telephone interviews were used to capture participants who could not attend a focus group in person. Disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. Perceived levels of care and the effectiveness of communication appeared to be the key influences on whether PCC was delivered. ConclusionIt is evident from the results of Stage 1 and Stage 2 that we have some way to go before we have parity in how care within diagnostic radiography is perceived, experienced and delivered. Audit tools and an educational toolkit are offered as ways to support increased PCC within diagnostic radiography practice. Implications for practiceSeveral service improvements and audit tools are offered to support the increased delivery of PCC.

460 - Unmet needs and loneliness perception among elderly people with chronic diseases

Introduction:Unwanted loneliness is a public health issue due to its high prevalence among elderly people (20-40%) and its relation with morbidity and mortality. There is no clear strategy for addressing this problem given the diversity of needs and resources people with feelings of loneliness have.Objective:Identify the needs and resources of elderly people with chronic conditions and feelings of loneliness by comparing the patient’s outlook with that of their primary healthcare professional.Methods:Observational, cross-sectional, descriptive pilot study using theoretical convenience sampling at 5 health facilities in Barcelona (Spain), performed between October and May 2020. Of 159 people selected, 42 were identified to have feelings of loneliness (UCLA &lt; 30) who agreed to participate in the study and their care needs were analysed using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire. A descriptive and comparative analysis (Kappa coefficient and discrepancy percentage) of needs was performed using the outlook of the patients and their healthcare professionals. Data was analysed using SAS assuming a 5% significance level. A qualitative analysis was also performed to understand the relation between the feeling of loneliness and needs across 24 care areas (environmental, social, psychological, and physical). The study was approved by the IDIAP Jordi Gol Healthcare Ethics Committee (19/138-P).Findings:The needs perceived focused on physical health, distress, companionship, and relationships (30% to 41.7%). Professionals showed a severe lack of knowledge regarding housing, home care, relationships, and social services (22% to 48%). The qualitative analysis revealed the relation between the feeling of loneliness and the irreversible losses of those close to the patient, along with insufficient support and understanding during the aging process, and feelings of abandonment and guilt. Meanwhile, other notable aspects include the need of independence and resistance towards starting activities requiring commitment and travel. Caring for others and mobility and sensory restrictions act as extra barriers.Conclusions:This study enables the needs of people with feelings of loneliness to be identified. Discrepancies between them and their healthcare professionals were recorded, in turn providing direction regarding which areas need to be improved when designing patient-focused primary healthcare approaches.

Effect of Rectal Ozone (O3) in Severe COVID-19 Pneumonia: Preliminary Results.

The aim of this study is to evaluate the effectiveness of rectal ozone (O3) in COVID-19 patients with severe pneumonia admitted at Hospital Universitario Santa Cristina, Madrid. In a before-and-after study, four patients admitted with severe bilateral pneumonia due to COVID-19 were treated with rectal ozone and confirmed with (+) RT-PCR for SARS-CoV-2 and evaluated afterwards. The analyzed outcome variables were as follows: (a) clinical improvement (O2 saturation and O2 supply); (b) biochemical improvement (fibrinogen, D-dimer, urea, ferritin, LDH, IL-6, and CRP); (c) radiological improvement. The treatment protocol consisted of 5 sessions (1 session/day) of intra-rectal ozone, applied in a volume of 100 mL and a concentration of 35 μg/mL. The Protocol was previously approved by the Hospital’s Health Care Ethics Committee (CEAS) (Report 15/4/2020) for compassionate use in the face of this exceptional pandemic situation, and prior informed consent was obtained from the patient/legal representative. The patients improved oxygen saturation, as observed by the lower number of desaturations and the lower supply of O2. Biomarkers of inflammation decreased (fibrinogen, D-dimer, urea, ferritin, LDH, IL-6, and CRP). Finally, the radiological signs of bilateral viral pneumonitis improved between 1 and 2 grades based on Taylor’s radiological scale. Rectal ozone decreases O2 supply and improves O2 saturation, decreases inflammation biomarkers, and improves Taylor’s radiological grade in patients with severe COVID-19 pneumonia. Rectal ozone is a safe, effective, cheap, and simple alternative capable of acting on the SARS-CoV-2 virus, and it is presented as an adjunctive therapeutic option to consider in the management of severe bilateral COVID-19 pneumonia.

Clinical and Organizational Ethics: Challenges to Methodology and Practice.

The day-to-day work of clinical ethics consultants and healthcare ethics committees can easily become overly routine. Too much routine, however, comes with a risk that morally important practices will be reduced to mere bureaucratic formalities, while practitioners become desensitized to ethically significant distinctions between cases. Clinical ethics consultation and organizational ethics must be set within the broader social and cultural context of the healthcare environment. This practice requires looking beyond mere legal compliance and the routinely false assumption that there are unambiguous ethical norms that easily govern clinical ethics and hospital policy formation. Together the essays in this issue of HEC Forum challenge readers to rethink taken-for-granted assumptions regarding patient care, physician obligation, clinical ethics consultation, and organizational ethics.

The first nationwide study on facing and solving ethical dilemmas among healthcare professionals in Slovenia.

Healthcare professionals (HCPs), patients and families are often faced with ethical dilemmas. The role of healthcare ethics committees (HECs) is to offer support in these situations. The primary objective was to study how often HCPs encounter ethical dilemmas. The secondary objective was to identify the main types of ethical dilemmas encountered and how HCPs solve them. We conducted a cross-sectional, survey-based study among HCPs in 14 Slovenian hospitals. A questionnaire was designed and validated by HCPs who were selected by proportional stratified sampling. Data collection took place between April 2015 and April 2016. The final sample size was n = 485 (385 or 79.4%, female). The response rates for HCPs working in secondary and tertiary level institutions were 45% and 51%, respectively. Three hundred and forty (70.4%) of 485 HCPs (very) frequently encountered ethical dilemmas. Frequent ethical dilemmas were waiting periods for diagnostics or treatment, suboptimal working conditions due to poor interpersonal relations on the ward, preserving patients' dignity, and relations between HCPs and patients. Physicians and nurses working in secondary level institutions, compared to their colleagues working in tertiary level institutions, more frequently encountered ethical dilemmas with respect to preserving patients' dignity, protecting patients' information, and relations between HCPs and patients. In terms of solutions, all HCPs most frequently discussed ethical dilemmas with co-workers (colleagues), and with the head of the department. According to HCPs, the most important role of HECs is staff education, followed by improving communication, and reviewing difficult ethical cases. Waiting periods for diagnostics and treatment and suboptimal working conditions due to poor interpersonal relations are considered to be among the most important ethical issues by HCPs in Slovenian hospitals. The most important role of HECs is staff education, improving communication, and reviewing difficult ethical cases.

Patient centred care in diagnostic radiography (Part 1): Perceptions of service users and service deliverers

IntroductionThere is growing awareness of the importance of patient centered care (PCC) in health care. Within Radiography in the UK, elements of PCC are embedded within professional body publications and guidance documents. However, there is limited research evidence exploring whether perceptions of PCC are equivalent between those delivering (radiographers) and those experiencing (patient) care. This study aimed to address this gap by determining compatibility in perceptions of PCC between those using and those delivering radiography services. This is the first step in developing measurable indicators of PCC in diagnostic radiography. MethodsA multi-method two stage approach was undertaken using survey and interview data collection techniques. Ethical approval was granted by University of Derby College of Health & Social Care Ethics committee. This paper reports Stage 1 of the study, the online, cross sectional survey. Participants were asked to indicate their level of agreement to a series of attitudinal statements using a 5-point Likert scale. Statements were paired, but not co-located to increase validity. Participants were invited to provide free text comments to supplement their responses. Stage 2 of the project is reported separately. ResultsSurvey responses were received from all 3 participant subgroups. A minimum response rate of 30 participants per sub-group was set as a target. Response rates varied across subgroups, with only radiography managers failing to meet the expected response threshold. Wide disparity between perceptions of service users and those delivering radiography services on what constitutes high quality PCC was evident. ConclusionIt is evident that there is still work required to ensure parity between expectations of service users and deliverers on what constitutes high quality PCC. Implications for practiceFurther work is required to identify measurable service delivery outcomes that represent PCC within radiographic practice.

Map of ethics conflicts in chronic patient's hospitalization

The identification, priorization and anticipation of the ethics conflicts, allow the Healthcare Ethics Committees (HEC) a better approach to them, as well as the adoption of measures to prevent its appearance and/or its mitigation. For this purpose, we set ourselves the objective of knowing what they are in the present, how important they are, and what would be the future scenario to face. An qualitative structure research was made whit two focal groups whit the participation of nurses, nurse auxiliary and doctors from the hospitalization area, they also answer a future ethics conflicts Decalogue. The results were tested after by their importance level (Relevance-Frequency-Consistency). The medium age of the participants was 34,7 +- 15,4, whit a medium experience at work of 11,7 +- 15,4 years. A total of 40 ethics conflicts was identify grouped in 5 risk areas: professional, assistance, social, organizational and legal. From there 21 results the more important, between them we find patient abandonment, inexistence of internal performance protocols, patient and relatives false expectations waiting for non-assistance care, unnecessary care at the end of the life, lack of rules for family / caregivers, and ignorance of legality. The more important ethical dilemmas for the future identified by the personal will be patients in abandonment, the lack of sociohealth resources, conflicts with family / caregivers situation and lack of information for decision making at the end of the life. The ethical conflicts between the personal from a chronic patients hospital and the relatives/caregivers was identifying, the most important were prioritized, and futures were anticipated. In these scenarios, we highlight abandonment as the most important. A map of ethics conflicts is a good tool to identify risk areas for ethics conflicts, we see the difference between the ethics conflicts found in other kind of hospitals. The map of ethics conflicts need to be update periodically to keep the validity.

Community Outreach and Ethics Services

The core functions of health care ethics committees are consultation, education, and policy development. In order to better function in these areas, it is necessary for committees to take a proactive approach in relationships with the surrounding community. Local universities provide an opportunity for committee members to teach ethics courses as well as find new members with practical experience through internships and mentorships. Reaching out to local health care organizations regarding ethics consultations for patients and physicians is also beneficial. Community organizations may be interested in classes or consultations and can give ethics organizations an opportunity to learn more about recurring problems and concerns of the surrounding community. Finally, working with the local diocese builds lasting relationships that can increase understanding and respect between the committee, clergy, and lay people in the community.

Patients with hepatitis C lost to follow-up: ethical-legal aspects and search results.

data on the prevalence and characteristics of hepatitis C patients lost to follow-up are lacking. In addition, the identification of this population clashes with data protection regulations. the identification and contact protocol was submitted to the Health Care Ethics Committee. The protocol was based on anti-HCV serology test results for 2010-2018, which were obtained from the Microbiology Department. In addition, the situation of the patients in the hospital and regional database was analyzed, based on the following classification: a) chronic hepatitis C, if the last HCV RNA determination was positive; b) cured hepatitis C, if the last HCV RNA determination was negative after 12 weeks of treatment; and c) possible hepatitis C, if anti-HCV antibodies were positive with no result for HCV RNA. Lost patients were defined as those with chronic or possible hepatitis C and no follow-up in the Digestive Diseases or Internal Medicine Departments. The patients were contacted by postal mail and then by telephone, so that they could be offered treatment. the Ethics Committee considered that the protocol fulfilled the bioethical principles of autonomy, beneficence, non-maleficence and justice and that contact was ethically desirable. From 4,816 positive anti-HCV serology results, 677 patients were identified who were lost to follow-up (14.06 %; 95 % CI, 13.2-15.2). The mean age was 54 years, 61 % were male, 12 % were foreign born and 95 % were mono-infected. The study of each serology result took 1.3 minutes. One-quarter (25 %) of the losses corresponded to the Digestive Diseases and Internal Medicine Departments. Of the 677 losses, serology testing had only been ordered for 449 patients (66.3 %) and the remaining 228 (33.7 %) also had a positive HCV RNA result. a large number of patients with hepatitis C are lost to follow-up. Searching for and contacting these patients is legally and ethically viable.