CLINICAL ETHICS COMMITTEES: ADVISORS, ADJUDICATORS, OR MORE?
Mathavi Senguttuvan1, Sumytra Menon1, Centre for Biomedical Ethics (NUS) Singapore 1Centre for Biomedical Ethics (NUS), Singapore Singapore
Abstract
Clinical Ethics Committees (CECs) have come a long way from being introduced as decisional fora of last resort, particularly in cases comprising life-and-death situations. Transcending the original function of case-based consultations, CECs are now involved in several processes supporting ethically suitable healthcare practice at the individual and institutional levels, including formulation of hospital policies and guidelines, education, and training professionals to evaluate ethical challenges. However, recent legislative changes in Singapore to the governance framework for CECs raise larger questions about the nature of a CEC’s role and the implications of carrying out these functions in relation to cases of ever-increasing complexity.
In Singapore, every acute hospital service must appoint a CEC. The Healthcare Services Act 2020 mandates CEC review of certain prescribed medical treatments, such as innovative therapy on compassionate grounds and other treatments presenting higher risk and controversy. Failure to bring up the relevant case to the CEC or providing the prescribed medical treatment if the CEC remains unsatisfied about its ethical appropriateness, constitutes an offence punishable under the law. This suggests a degree of finality to CECs’ decisions in these cases and confers upon them an adjudicatory position. The potential legal liability of CECs for their decisions is uncertain and untested. The Healthcare Services Act provides no avenue for appealing the decision of a CEC. We analyse these changes amidst larger normative reflections on what the role of a CEC should be and discuss concerns about the transfer of decisional authority and potentially misplaced responsibility on the CEC.
Biography
Mathavi Senguttuvan is a Research Associate (CENTRES programme) at the Centre for Biomedical Ethics, National University of Singapore and a lawyer by training. She is simultaneously pursuing a Ph.D. with the centre. Her research focus is on postcolonial discourses on vulnerability, migration, and health disparities, particularly in the infectious disease setting.
Dr Sumytra Menon is Deputy Director of the Centre for Biomedical Ethics, Co-Director of the CENTRES initiative instituted to develop educational activities in clinical and transplant ethics and enhance ethics committees’ capabilities. A lawyer by training, her particular research interests are in healthcare decision-making, mental capacity law, and end-of-life issues.