Madam, – As a senior clinician in the Adelaide and Meath Hospital at Tallaght and teacher/researcher in medical ethics, I am writing to clarify that the views of Dr Fergus O’Ferrall and the Adelaide Hospital Society on clinical ethics committees as reported (Home News, December 22nd) do not mirror those of the healthcare workers at the hospital, or reflect the important role of our research ethics committee (based on site) which provides oversight for research in Tallaght and St James’s hospitals.
It is possible that the wider public may equate the Adelaide Hospital Society (one of the three foundations making up the hospital, and contributing less than 30 per cent of the board members) with the hospital, which is not the case: and there are nuances to clinical ethics committees which may not be immediately apparent to those who are not medically qualified, such as Dr O’Ferrall.
In international terms, clinical ethics committees are seen as a resource to be used as advice to an individual clinician, who can choose to accept or reject this advice after due consideration. If used, they are called in by the treating doctor, and therefore it is inappropriate to consider them to be “second-guessing” the treating doctor.
Indeed, the institution of clinical ethics committees as a support to clinicians was a part of the first wave of the Irish hospital accreditation programme a few years ago, and was under active consideration at Tallaght Hospital at that time. In the international medical literature, reservations about clinical ethics committees arise not from erosion of clinical independence but rather from doubts as to whether a committee of variable composition can provide useful and focused advice in nuanced cases.
Finally, practice and procedures at the Adelaide and Meath Hospital are the same as in any Irish hospital, as is the degree of confidentiality, and it is neither helpful nor accurate to portray some form of exceptionalism in our practice.
Confidentiality is a highly important but relative value (those with doubts might just think of how much Harold Shipman would have appreciated 100 per cent confidentiality!) and it is to all our benefits that it is overviewed to a certain extent by audit, accreditation, research ethics committees and state agencies such as the coroner. – Yours, etc,