T Meulenbergs J Vermylen and P T Schotsmans
Ethics committees are the most important practical instrument of clinical ethics in Belgium and fulfil three tasks: the ethical review of experimental protocols, advising on the ethical aspects of healthcare practice, and ethics consultation. In this article the authors examine the current situation of ethics committees in Belgium from the perspective of clinical ethics. Firstly, the most important steps which thus far have been taken in Belgium are examined. Secondly, recent opinion by the Belgian Advisory Committee on Bioethics with regard to ethics committees is presented and the activities of Belgian ethics committees are discussed. Finally, the option to bring research ethics and clinical ethics under the roof of just one committee is criticised using a pragmatic and a methodological argument. Concomitantly, the authors build an argument in favour of the further development of ethics consultation.
Abbreviations: HEC, healthcare ethics committee; IRB, institutional review board; REC, research ethics committee
J Med Ethics 2005;31:318-321.
Clinical ethics is characterised by an essentially practical orientation: identifying, analysing, and solving ethical problems that arise in the daily healthcare practice.1 To achieve this objective two instruments have been developed and implemented in recent years: healthcare ethics committees and ethics consultation. Healthcare ethics committees or hospital ethics committees (HECs) interpret relevant practical experiences out of the clinical setting in a normative way and provide ethical orientations that can lead to the achievement of optimum healthcare.2 The task of HECs therefore consists of orientating and supporting healthcare workers in dealing with the ethical aspects of healthcare practice. HECs should be distinguishes from research ethics committees (RECs) or, in the United States, institutional review boards (IRBs) which review the protocols of human experimentation by verifying whether the rights, safety, and wellbeing of participating subjects are protected. More general ethical problems linked to clinical tests are not considered part of the REC’s tasks.
Ethics consultation is a second practical instrument of clinical ethics and concerns the patient related activity of clinical ethics whereby healthcare workers, patients, and their family are supported in identifying, analysing, and solving ethical conflicts which arise in the clinical setting.3 Different models of ethics consultation exist according to the eligibility for requesting an ethics consultation, the integration of the consultation service in the hospital, and the availability of ethics consultation. The common attribute of ethics consultations is their limited scope: the assistance is limited to one specific case in which ethical problems appear.