The structure, function and deliberative processes of Australasian clinical ethics committees

Abstract

Since the mid 20th century, healthcare delivery expanded from a service largely provided by individual practitioners to a complex system of services provided by multidisciplinary teams of professionals. This changing structure of healthcare delivery brought about a complex array of ethical issues in helthcare. As the ethical questions posed became increasingly complex, Clinical Ethics Committees (CECs) emerged as mechanisms to review ethical dilemmas and provide assistance and safeguards for patients and providers. In Australasia there is no apparent consensus on the method required for CECs to competently deal with ethical issues, thus indicating a need for some form of 'quality assurance' that the moral reasoning of CECs meets society's expectations. This study undertakes an analysis of CECs from Australia and New Zealand. In addition, CECs from the United Kingdom were invited to participate in order to provide some international comparison. The aims of this thesis are to 1. Describe the characteristics of participating CECs. 2. Identify the principal activities that CECs are currently engaged in. 3. Understand the processes by which CECs come to believe they are making good decisions/ recommendations. A central aim of the thesis is to provide recommendations designed to aid CECs in the assessment of their performance in order to ensure that their moral reasoning meets society's expectations. Two study instruments were specifically designed to achieve the aims of the thesis. The first instrument provides a structural analysis of participating committees, including committee activities and evaluative processes in place. The second instrument provides individual CEC members' views on a range of issues pertaining to the strucure, activities and deliberative processes of their committee. I believe that this type of approach, not previously undertaken, can, by examining areas of dissonance between what currently obtains for CECs and what committee members consider to be best practice, enhance our understanding of the processes of CECs. Following critical evaluation of the findings, the thesis provides a number of recommendations pertaining to the structure, activities, and, the evaluative and deliberative processes of CECs, culminating in the formulation of a set of guidelines, designed to assist CECs operate at their optimum level.