Clinical Ethics

Clinical Governance is based on the principle that all health professionals share responsibility for safe and ethical professional practice. Clinical ethics is part of the provision of every day patient care. Health professionals, patients and their carers may have differing values and unresolved, these may impact upon clinical decisions and behaviours in healthcare settings. Clinical ethics is clearly an important part of effective Clinical Governance.

The discipline of Clinical Ethics provides a practical structured approach to assist health professionals in identifying, analysing and resolving ethical issues in clinical practice, so that they may make ethically relevant and lawful decisions.

Examples of where ethical issues may arise include:

Informed consent, competence and surrogate decision-making
Care of vulnerable populations such as the mentally or chronically ill
Advanced care planning
End of life decision making
Termination of pregnancy

Before Hunter New Engalnd Health (HNE Health) was established in 2005, two of HNE Health’s predecessor organisations (Hunter Area Health Service and New England Area Health Service) had well-established Clinical Ethics Committees and local processes for resolving ethical issues in clinical practice.

Members of the previous Hunter Health Area Clinical Ethics Committee worked with NSW Health to develop recommendations in relation to how clinical ethical decision-making should be approached in NSW hospitals, culminating in the development of the Policy Directive on Clinical Ethics Processes in NSW Health, which was issued in May 2006.

In 2007, HNE Health Clinical Governance led a review of the framework and committee structure for clinical ethics in HNE Health, in consultation with experts in the practice of clinical ethics. The resulting HNE Health Clinical Ethics Framework builds on existing expertise and commitment to clinical ethics across the area health service, and was implemented in 2008. The framework provides a means for existing expertise concentrated in the larger centres to be shared across HNEH.

The Framework’s committee structure consists of a HNE Health Clinical Ethics Committee, reporting to the Chief Executive, with provision for the future establishment of sector Clinical Ethics Reference Groups.

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The HNE Health Clinical Ethics Committee has primarily a governance function. Its roles are to develop (where required) or disseminate policies and guidelines relating to clinical ethics; to support staff education on clinical ethical issues; to monitor, report and evaluate clinical ethics activity in HNE Health; and to facilitate communication and networking between facilities and Clinical Ethics Reference Groups.

The Framework also proposes to enhance professional development and education in clinical ethics by further developing the relationship between HNE Health and the Clinical Unit in Ethics and Health Law (CUEHL). CUEHL, a multidisciplinary group that has developed an internationally recognised innovative and effective approach to teaching, is a collaboration between academics at the University of Newcastle, clinicians and other professionals from HNE Health and the Hunter community.

Until the membership of the Clinical Ethics Reference groups is established, advice about individual cases or ethical issues of concern can be sought from Dr Peter Saul, Senior Staff Specialist in the Adult and Paediatric ICU at John Hunter Hospital. Dr Saul is a member of the NSW Health Clinical Ethics Advisory Panel and Director of the Clinical Unit in Ethics and Health Law, University of Newcastle.

Contacts

Consultation: Dr Peter Saul, Telephone: 4921 4782, Speed Dial 68140 HNEH
Clinical Ethics Framework: Professor Anne Duggan, Associate Director Clinical Governance, Telephone: 4985 5446, Speed Dial 68414

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Clinical Ethics

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