Membership of a Clinical Ethics Service
A Clinical Ethics Committee (CEC) can provide an independent, rich, multi-perspective view, which can challenge, elucidate and inform the choices available to health professionals. In order to provide this, the CEC should consider the range of disciplines, experience and backgrounds that is needed.
CECs should also be mindful of equality, diversity and inclusion (EDI) commitments in their host organisation, and endeavour to uphold EDI policies and practices during recruitment, to ensure that the membership of CECs is appropriately diverse.
Many UK CECs tend to have 10-20 members. Membership will vary, but examples of typical membership include:
- Chair*
- Vice-Chair*
- Doctors, from different specialties
- Nurses, from different specialties
- Other healthcare professionals, e.g., allied health professionals, dieticians, pharmacists, psychologists
- A lawyer
- A medical ethicist or philosopher
- A chaplain or other faith leader/representative
- A patient or other user of the service
- Lay members, i.e., someone who is not a practicing healthcare professional
- Administrative support (to assist with circulating case referrals, preparing minutes, booking meetings, etc.)
* The CEC should ensure it has a Chair and a Vice-Chair. The Chair should be appointed (or, if elected by the CEC, approved) through local governance approval mechanisms. The Vice-Chair may act as Chair in their absence and/or may lead a particular aspect of the CEC’s work. The Chair and Vice-Chair are often – but do not necessarily need to be – clinicians.
Recruiting and selecting new members
CECs should develop a process for recruiting and selecting new members. The process should be designed to ensure that the CEC can meet the expected core competencies. The UK Clinical Ethics Network (UKCEN) recommends an initial exercise to assess the level of competency of potential new members of established committees.
The process should start with an application form, which details (for example):
- personal and professional details
- any relevant publications or presentations
- a statement of commitment to develop the core competencies
- details of training in clinical ethics and/or a willingness to participate in training
- an example of a personal response to an ethical dilemma
The applicant should also be expected to provide two structured references, which can assist the CEC is assessing the applicant’s personal attitudes.
CECs may thereafter wish to conduct a brief structured interview, before an application for membership is accepted.
Indemnification
The Clinical Ethics Committee (CEC) and all of its members should be indemnified, i.e., protected against possible legal liability for their actions.
It is possible that the advice issued by a CEC will be acted upon by the referring clinicians and, in hopefully rare circumstances, this might lead to later legal action from a patient or family member. Organisations should ensure that CECs are legally protected, i.e., the CEC and all of its members should be indemnified. Each organisation should arrange this, ensuring (in particular) that external members of the CEC are covered.
The UK Clinical Ethics Network (UKCEN) recommends that:
- CEC members who are not employed by the host organisation are covered, for example, via honorary appointments at the institution
- A CEC should not seek to provide advice outside its host organisation without the explicit agreement of that host organisation. The agreement should include assurance that such advice is indemnifiable. In general, such arrangements are possible between many NHS organisations