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010 “Ethics Consultation” and “Clinical Ethics Committees“ (CECs) in Medicine: Entirely “experimental” and not yet “fit for purpose”
  1. M Stratling1,2,
  2. B Sedemund-Adib2
  1. 1University Hospital of Wales, Anaesthetic Department, Cardiff, UK
  2. 2Luebeck University, Department of Anaesthesiology, Luebeck, Germany

Abstract

Background Internationally multiple initiatives are under way (e.g. Germany, Switzerland, UK) to recommend “Clinical Ethics Consultation” and “Clinical Ethics Committees“ (CECs) in guidelines.

Objectives These aim to improve ethical discourse and decision making in medicine.

Methods Appraisal of available evidence and literature [1].

Results For CE-Consultation, mostly CECs are implemented. Empirically their acceptance is poor, despite a large “demand”. Historically this international paradox is stable (“failure to thrive phenomenon”). Repeated initiatives and “re-brandings” can be identified. They made no tangible difference. Theories and methods are heterogeneous, patchy and contradictory. Their efficacy is unproven. A multitude of issues concerning quality, competence, qualifications, relevance, transparency, independence, conflicts of interests and legitimacy are unresolved.

Discussion From the perspective of clinically and scientifically oriented Ethics in Medicine, present CE-Consultation represents a “cluster” of highly “experimental” tools, techniques and methods. The available evidence consistently suggests grave deficits. In developing medical guidelines and recommendations, professional bodies are duty-bound to adhere to robust, evidence-based processes. Applying such criteria, CE-Consultation and CECs fail to meet all requirements. The apparent intention to apply a “double-standard” to promote a “laudable” medico-“ethical” intention raises grave (not least ethical and scientific) concerns. These are presented and discussed in detail.

Reference 1. Strätling M. (2012) MedR 30: 428–436.

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