Establishing Institutional Ethics Committees in Australia: Challenges and Operational Procedures with Particular Attention to the New Reproductive Technologies
The ethical difficulties of modern health care are, for the most part, a result of new technologies - especially relevant are the New Reproductive Technologies. Increased costs, cultural emphasis on individual rights, uncertain or conflicting social values, and changing relationships among health care professionals all have dramatically changed hospital life and contributed toward modern predicaments. Recent changes in reproductive technology, for example, have altered control of fertility, childbearing, and child rearing. The newer aspects of reproduction such as contraception, abortion, fetal diagnosis, gamete and embryo donation, assisted conception, surrogacy and research on human embryos, all present major ethical challenges to individuals, governments and nations. However, it must be qualified that some of these topics such as contraception and abortion have been practiced since antiquity. Still, it is clear that medical questions require medical answers, but many of the most puzzling questions that health care workers currently face are not exclusively medical in nature. These questions are mostly about individual values, the personal meaning of life and death, and fairness or justice. Patients, doctors, nurses, social workers, religious advisers, hospital administrators, and society itself all need to take part in asking relevant questions and making decisions, which not only affect individual lives but, importantly, also shape social relations. Ethics committees represent an important response to that need for a broader range of thinking about critical health care decisions. Discussing ethical issues more openly and more frequently can lead not only to better decisions but also to better relationships among health care professionals. My experience of hospitals with ethics committees suggests that each institution will handle things a little differently; each will create a form that fits its own situation. In this publication, I am going to share my experiences on one of Sydney’s largest Institutional Ethics Committee (IEC). As one of the founding members of the IEC servicing the Royal North Shore Hospital and allied Northern Sydney Health community in 1990, we had to start from scratch devising the composition and constitution of our Committee, which subsequently assisted other institutions also in the process of establishing their individual IECs.
Since space does not allow for a full discussion of the varied and diverse ethical dilemmas considered, I have concentrated on one implemented directive relating to the new reproductive technologies - a discipline I have some expertise in.