scholarly journals COVID-19 underscores the important role of Clinical Ethics Committees in Africa

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Keymanthri Moodley ◽  
Siti Mukaumbya Kabanda ◽  
Anita Kleinsmidt ◽  
Adetayo Emmanuel Obasa
Keyword(s):  
Qualitative Study ◽  
Clinical Ethics ◽  
Ethics Education ◽  
Healthcare Professionals ◽  
Ethical Dilemmas ◽  
Ethics Committees ◽  
Ethical Challenges ◽  
Clinical Ethics Committees ◽  
Study Results

Abstract Background The COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa. Methods Twenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses. Results Kenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking. Conclusions This study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.

scholarly journals Challenging misconceptions about clinical ethics support during COVID-19 and beyond: a legal update and future considerations

2021 ◽  
pp. medethics-2020-107092
Author(s):  
Joe Brierley ◽  
David Archard ◽  
Emma Cave
Keyword(s):  
Clinical Ethics ◽  
Ethics Committees ◽  
Treatment Decisions ◽  
Street Hospital ◽  
Clinical Ethics Support ◽  
Great Ormond Street Hospital ◽  
Clinical Ethics Committee ◽  
Ethics Support ◽  
Clinical Ethics Committees

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.

scholarly journals Clinical Ethics Committees in Africa: lost in the shadow of RECs/IRBs?

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Keymanthri Moodley ◽  
Siti Mukaumbya Kabanda ◽  
Leza Soldaat ◽  
Anita Kleinsmidt ◽  
Adetayo Emmanuel Obasa ◽  
...  
Keyword(s):  
Research Ethics ◽  
Clinical Ethics ◽  
Healthcare Professionals ◽  
Descriptive Analysis ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
Limited Information ◽  
African Countries ◽  
Online Questionnaire ◽  
Clinical Ethics Committees

Abstract Background Clinical Ethics Committees (CECs) are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services (CESs) on the continent. Methods A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data were subjected to descriptive analysis and Fischer's exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics (p = 0.005). All participants were familiar with Research Ethics Committees (RECs), and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants (81.7%) were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed.

scholarly journals Living bioethics, clinical ethics committees and children's consent to heart surgery

2021 ◽  
pp. 147775092110341
Author(s):  
Priscilla Alderson ◽  
Deborah Bowman ◽  
Joe Brierley ◽  
Martin J. Elliott ◽  
Romana Kazmi ◽  
...  
Keyword(s):  
Clinical Ethics ◽  
Heart Surgery ◽  
Social Research ◽  
Ethics Committees ◽  
Companion Paper ◽  
Ethics Committee ◽  
Research Report ◽  
Discussion Paper ◽  
Clinical Ethics Committee ◽  
Clinical Ethics Committees

This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests and rights. Different approaches to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees.

First judgement on clinical ethics committees?

2021 ◽  
pp. archdischild-2021-321735
Author(s):  
Thor Willy Ruud Hansen ◽  
Reidun Førde
Keyword(s):  
Clinical Ethics ◽  
Ethics Committees ◽  
Clinical Ethics Committees
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