Portal de Periódicos da CAPES

Clinical ethics committee

1995; BMJ; Volume: 311; Issue: 7006 Linguagem: Inglês

10.1136/bmj.311.7006.667

0959-8138

Jim Thornton, Richard Lilford,

Palliative Care and End-of-Life Issues

An informal clinical ethics committee was set up to advise on ethical problems in prenatal diagnosis in Leeds.It was used twice in six months but was not called on again in the subsequent year, and we describe this experience.In North America similar committees are often used to advise on clinical moral dilemmas, and we review the published evidence from there and discuss some of the advantages and problems.Our committee's advice may have altered clinicians' actions considerably, but perhaps doctors in Britain are not yet ready to surrender this aspect of clinical autonomy.With the exception of those concerned with assisted conception, ethics committees concerned with clinical matters are little used in Britain.In contrast they play an important part in clinical practice in the United States and Canada.'4In our prenatal diagnosis practice we are occasionally faced with ethical dilemmas such as requests for feticide in the third trimester.Although the Human Fertilisation and Embryology Act allows this when there is a "substantial risk ... [of] ... serious handicap," we are unsure what is meant by serious in this context and uncertain how to act if parents and doctors disagree.7Such moral problems are increas- ingly common: we have recently considered requests for diagnosis of sex and paternity, for termination for cystic fibrosis or Duchenne dystrophy at residual risks below 1%, and for reducing multifetal pregnancy, often backed by the threat to terminate anyway if we refused.We therefore set up an informal advisory group to provide independent advice in such difficult circumstances.We report our initial experience and review the literature on the use of such committees in other countries.