A sound knowledge of medical ethics is essential to the good practice of medicine, yet conclusive evidence exists that doctors need help with ethical problems, writes Daniel Sokol of Imperial College London.
About a fifth of NHS acute trusts currently have a clinical ethics committee. Although these provide a valuable service in drafting hospital policies and helping doctors resolve ethical dilemmas, most are ill suited to respond to the immediate problems that doctors encounter in their daily work.
In contrast, many hospitals in North America have full time clinical ethicists as well as clinical ethics committees, who can be called on by staff or patients for help in medico-ethical matters.
Studies have shown that ethics consultations are associated with reductions in time spent on ventilators and days in hospital, and that most doctors and nurses who have used the service find it helpful. Clinical ethicists could also contribute to the continuing medical education of healthcare staff in medical ethics through lecturing and private consultations, adds the author.
In light of all the evidence, we now need to introduce clinical ethicists in hospitals in the United Kingdom, he says. Doctors cannot possibly deal with all the ethical problems they encounter in their professional lives, nor can they be expected to analyse complex ethical issues, and to know how similar cases were handled elsewhere.
"Clinical ethics committees cannot alone cope with the demands of ethically troubled doctors at the coalface. The use of clinical ethicists would represent an important step forward," he concludes.
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Contact: Emma Dickinson
edickinson@bmj.com
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BMJ-British Medical Journal
31-Mar-2005