Publications

1. Dittborn, Mariana, Cave, Emma & Archard, David (2021). Clinical ethics support services during the COVID-19 pandemic in the UK: a cross-sectional survey. Journal of Medical Ethics Published Online First: 09 November 2021. doi: 10.1136/medethics-2021-107818. A descriptive cross-sectional online survey was developed by the research team. The survey included questions on CESSs characteristics (model, types of support, guidance development, membership, parent and patient involvement) and changes in response to the pandemic. Invitations to participate were widely circulated via National Health Service institutional emails and relevant clinical ethics groups known to the research team.

Results: Between October 2020 and June 2021, a total of 53 responses were received. In response to the pandemic, new CESSs were established, and existing provision changed. Most took the form of clinical ethics committees, groups and advisory boards, which varied in size and membership and the body of clinicians and patient populations they served. Some services provided moral distress support and educational provision for clinical staff. During the pandemic, services became more responsive to clinicians’ requests for ethics support and advice. More than half of respondents developed local guidance and around three quarters formed links with regional or other local services. Patient and/or family members’ involvement in ethics discussions is infrequent.

Conclusions: The pandemic has resulted in an expansion in the number of CESSs. Though some may disband as the pandemic eases, the reliance on CESSs during the pandemic demonstrates the need for additional research to better understand the effectiveness of their various forms, connections, guidance, services and modes of working and for better support to enhance consistency, transparency, communication with patients and availability to clinical staff.

2. Brierley, Joe, Archard, Dave & Cave, Emma (2021). Challenging misconceptions about clinical ethics support during COVID-19 and beyond: Role, remit and representation. Journal of Medical Ethics 47(8): 549-552. The pace of change and, indeed, the sheer number of clinical ethics committees (not to be confused with research ethics committees) has accelerated during the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. The recent case of Great Ormond Street Hospital for Children NHS Foundation Trust v MX, FX and X ([2020] EWHC 1958 (Fam), [21]–[23] and [58]) has highlighted the importance of patient/family representation at clinical ethics committee meetings. The court viewed these meetings as making decisions about such treatment. We argue that this misunderstands the role of ethics support, with treatment decisions remaining with the clinical team and those providing their consent. The considered review by clinical ethics committees of the moral issues surrounding complex treatment decisions is not a matter of determining a single ethical course of action. In this article, we consider current legal understandings of clinical ethics committees, explore current concepts of ethics support and suggest how they may evolve, considering the various mechanisms of the inclusion of patients and their representatives in ethics meetings which is not standard in the UK.

3. Brierley, Joe, Archard, David & Cave, Emma (2021). Ethics Support in Paediatrics: Key Questions. Archives of Disease in Childhood. Published Online First: 29 November 2021. doi: 10.1136/archdischild-2021-322671. The need for local ethics advice during the COVID-19 pandemic has put a spotlight on clinical ethics committees (CECs) and services. In this review, we focus on paediatric CECs that raise both generic questions and specific issues. In doing this, we acknowledge the broader roles of education, research and staff support some bioethics teams have developed but focus on the main areas of clinical ethics support to clinical teams. We raise 12 questions about the role, remit and responsibilities of CECs, provide preliminary answers to these and set out the next steps for the development of ethics support both in paediatric practice and more generally.

4. Archard, David, Brierley, Joe & Cave, Emma (2021). Compulsory Childhood Vaccination: Human Rights, Solidarity and Best Interests. Medical Law Review Dec 6;29(4):716-727. In Vavřička and Others v the Czech Republic, the Grand Chamber of the European Court of Human Rights considered for the first time whether compulsory childhood vaccination can be compatible with the European Convention on Human Rights (ECHR). The majority found the Czech Republic’s vaccination policy to be ‘fully consistent with the rationale of protecting the health of the population’ and within the wide discretion (‘margin of appreciation’) given to Member States on health issues. The policy struck a fair balance between the protection of children against serious diseases and the protection of families from the consequences of refusal. Filed before the COVID-19 pandemic, the case will be of broad interest given the long-term political and legal debate around compulsory childhood vaccination. Whilst the UK is one of several European countries which maintain a voluntary vaccination programme, a growing number impose restrictions on voluntariness. Moreover, there is emerging evidence of a link between mandatory vaccination and a higher uptake of vaccinations and reduction in disease. We explore the reasoning in the judgment and its implications for children’s rights and in the debate around COVID-19 vaccination.

5. Brierley, Joe, Archard, David & Cave, Emma (2021). Clinical ethics support: Addressing legal uncertainties. Journal of Medical Ethics Blog. Clinical ethics support has adapted to embrace patient-centred care, to help clarify ethical matters in patient care and to occasionally help resolve disputes without recourse to the courts. The pace of change and, indeed, the sheer number of clinical ethics committees accelerated during the first wave of the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. In our recent article we set out several misconceptions. In this blog we focus on two of the most pressing issues and their legal provenance and implications: the nature of ethical advice and the relevance of patient representation in case consultations.