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Role of clinical ethics committees
  1. GOSH Clinical Ethics Forum
  2. Research and Development Office
  3. Institute of Child Health
  4. Guilford Street, London WC1N 1EH, UK

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    Most clinicians encounter ethical dilemmas, the resolution of which produces tensions within the multidisciplinary teams that deliver much contemporary health care.1 Despite the growth of medical ethics and publication of professional codes of practice2 3 there is no clear consensus on how individuals, teams, and hospitals might obtain specific guidance in resolving the dilemmas they face. Indeed, current methods of resolving dilemmas may be ad hoc, unstructured, and subject to time constraints.4

    In North America health care ethics committees (HEC) have been established whose remit includes ethical debate and analysis of individual cases and topics, policy development, and education.5 Although 60% of US paediatric units have HECs, their role has been criticised and up to 33% may be inactive.6 UK experience with HECs is limited but interest is growing7 and a specific need has been identified in teaching and district general hospitals.4 7 8 In 1996 a clinical ethics forum (CEF) was established at Great Ormond Street Hospital NHS Trust in London in response to staff requests for a group having the following functions:

    • Confidential, multidisciplinary analysis and discussion of cases and topics away from the acute clinical setting

    • Informed contribution to the generation of guidelines for good ethical practice

    • Education of health care professionals in health care ethics.

    What follows is a brief critical account of the establishment, composition, and function of the CEF, which might be useful to others contemplating forming similar groups.

    Establishment, composition, management, and accountability

    The title “forum” was used to avoid the bureaucratic connotations of “committee”, and to emphasise the intention to provide a facility for considered, informed, and reflective discussion.9 The forum’s confidential, advisory, supportive, and non-prescriptive role safeguards clinical autonomy, protects the doctor–patient relationship, and facilitates participation and free discussion. Consultation is optional and there is no obligation to …

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