NHS GRAMPIAN

Minute of Meeting of the Grampian Clinical Ethics Committee

held on Tuesday 10 November 2009 in the

Committee Room, Foresterhill House at 5.00pm

AGENDA

PRESENT:

Dr Ruth Stephenson, Clinical Lead/Chair

Dr John Callender, Consultant Psychiatrist/Associate Medical Director

Dr Sarah Christie, Senior Lecturer in Law

Rev Fred Coutts, Hospital Chaplain

Dr Partha Gangopadhyay, Forensic Psychiatrist

Dr Stuart Hannabuss, Lay Member

Mrs Sue Kinsey, Lay Member

Ms Fenella Lewthwaite, Senior Physiotherapist

Dr Gordon Linklater, Consultant in Palliative Care

Dr Steven Lynch, General Practitioner

Dr Ed Paterson, Specialist Registrar in Respiratory Medicine

Mr Nick Renny, Consultant in Maxillo-Facial Surgery (From Item 4)

ATTENDING

Mrs Rosie Gauld, Administrator to the Committee

No / Item / Action
1 / Welcome and Apologies
The Chair welcomed Dr Callender and Dr Ed Paterson back to membership of the Committee and introductions were made round the table.
Apologies for absence were noted from Prof Neva Haites, Mr Scott Styles, Mrs Joan Stuart.
2 / Minute of Meeting held on September 2009
Copies of the Minute had been previously circulated with the agenda. The Minute was approved as a correct record.
3 / Matters Arising
3.1Constitution
Copies of the revised Constitution had been previously circulated
The Constitution had been submitted to Grampian NHS Board for ratification and approval was awaited.
3.2Clinical Ethics Teaching Day - Friday 4 September 2009
Members present agreed that it had been a worthwhile day. The Chair agreed to revise the documentation regarding case referrals for the next meeting. / RS
3.3CPD for CEC
Dr Stephenson indicated that she was planning to arrange some seminars for clinicians. Speakers were discussed. Hopefully this would be arranged for the beginning of next year and take place either in the Med Chi or Suttie Centre.
3.4Highlighting the Clinical Ethics Committee
The Chair asked members to consider ways of highlighting the Committee.
In the meantime, it was suggested that global communication to all General Practices/Consultants would be useful.
Dr Lynch also intimated that he would raise it at the next RCGP meeting. / All
RS
SL
4 / Informed Consent Policy
Discussion took place on the document entitled Policy for Obtaining Consent for Clinical Procedures and Healthcare Interventions, copies of which were previously circulated with the agenda.
Overall, members present thought that it was a very comprehensive, clear document. It was agreed that a quick reference guide would be helpful, as would cross-references between Sections. It was noted that the document would be available on the Intranet.
Other comments were:-
  • The section on Advance Directives and Advance Statements was very short and would benefit from references. The last sentence of that section should read ‘Competent patients can demand the withdrawal of life prolonging treatment.’ – delete the rest of the sentence. The whole section should be re-ordered.
  • Abbreviations should not be used
  • The demography should be an Appendix
  • It would be helpful if the section on witholding consent could refer to the section on children
  • It would be helpful to number the sections for ease of cross referencing
  • The document had been submitted to the Community Forum
Dr Linklater advised there were two workstreams going on at Scottish Government level in respect of Advance Directives and Advance Care Planning, ie Long term Conditions and End of Life. National guidance would be produced.
The Chair would write back with suggested amendments. / RS
5 / Clinical Ethics Case Consultations
Dr Stephenson reported that there was a Clinical Ethics Journal which produced a number of case consultation studies. Dr Ainsley Newson, Section Editor had e-mailed all Clinical Ethics Committees asking whether they wished to be involved in discussion.
Following discussion it was agreed that it would be a useful exercise for the Committee. To this end the Chair would contact Dr Newson indicating that the Committee members would be happy to participate and ascertain how the process worked and what kind of timeframe was required. / RS
6 / Sokol Paper
Copies of a paper had been circulated with the agenda - The Unpalatable Truth about Ethics Committees by Daniel K Sokol, Honorary Research Fellow in Medical Ethics, Imperial College, London
The Chair queried whether the Committee should respond, and if so, what kind of arguments should be put forward. The following comments were made:-
  • There was an identified need for teachingand CECsin relation to law/policy review/ethics
  • The article took the view that the Health Service was‘Hospital’ and not also primary care
  • Ethics Committees are relatively recent groups and it takes time for clinicians to engage in the process. Many were not aware that there was a Committee within NHSG
  • Would be interesting to know the structure of the other existing committees. They tended to cover a generic area of healthcare, although it was thought that many would be acute based.

  • There were 70 CECs – some for policy; case consultation; mental health; paediatric units

  • Need to be aware of the competencies of committee members in order to be able to address issues. It was noted there were varied skills within the Committee.

  • Minutes of the CEC used to be submitted to the Board but a letter outlining discussion was now presented. This letter should also be available on the CEC website.
  • There is no mention of resource allocation

  • It was noted that there was a need to raise awareness of the Committee by auditing clinicians in the area, starting in primary care. Mr Rennie agreed to look into this.
/ RS
7 / Item for Information
7.1Ethics Briefings
One paper was noted:-
(i)By E Chrispin, S Brannan, V English, R Mussell, J Sheather and A Sommerville – J. Med. Ethics 2009; 35; 715 – 71
8 / Other Competent Business
8.1Learning Disability Educational Meetings
Ms Lewthwaite intimated that she had suggested that a member of the CEC would speak to this group, and she would confirm dates of meetings with Dr Stephenson. / RS
8.2Teaching for the Board
Dr Stephenson reported that she had intimated to the Board that she would be willing to set up some form of teaching for the Board. A response was awaited. / RS
9 / Dates of Meetings in 2010
Noted as follows:
16 February: 16 March: 27 April: 25 May: 22 June: 14 September:
12 October: 9 November: 7 December
The venue had been changed to Summerfield House at 5.00 pm / Noted
10 / Date of Next Meeting
Tuesday 8 December 2009 at 5.00 pm in the Committee Room, Foresterhill House.

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