Clinical ethics support services are an established feature of health care in the US and Canada
and are becoming so in the UK, France, Belgium and elsewhere in Europe. They are yet to be
widely established in NSW or elsewhere Australia. Clinical ethics support typically involves the
provision of expert ethics input into clinical education, policy development and the care of
individual patients, particularly where this involves value, rather than clinical, or scientific,
conflict. Ethics support is generally provided by an individual consultant, an ethics committee
or some combination of the two. In its case consultation function, expert support is intended
to clarify the values that are in tension and through promoting open and inclusive discussion,
facilitate consensus on the appropriate next steps. Internationally, the guidance and
recommendations issued by a support service on a particular case are, in most cases, advisory
and not binding.
Advocates argue that clinical ethics support is necessary because contemporary clinical work
takes place in a technologically, socially and ethically complex environment. The medical
encounter has become far more open to scrutiny and is accountable to a more diverse public
holding often quite different interests, ideas and values. In a more pluralist society,
professional training, professional codes and institutional polices aren’t sufficient to establish
ethical practices and procedures or resolve the ethical dilemmas that arise in the care of
individual patients. The ethics expertise provided by an ethicist or a panel of ethically trained
clinicians is necessary to astutely appraise the values and arguments and generate consensus.
Without such expertise the ethicality of practices cannot be assured.
Clinical ethics support is intended to promote ethically sound clinical and organisational
practices and decision-making and thereby contribute to health organisation and system
The under-developed state of clinical ethics support in Australia and NSW prompted NSW
Health, in partnership with the Centre of Values Ethics and Law in Medicine and the Centre
for Health Law and Governance , to ask:
1. Do changes to the environment in which clinical practice occurs mean there is a need
to change the way we deal with ethical dilemmas?
2. Is more formalised support for clinicians, when making difficult and possibly
controversial ethical decisions, desirable or warranted?
3. If it is agreed that clinical ethics support should be enhanced, what model is most
appropriate for local conditions?