Lack of independent bioethical advice is cause for concern

Amongst the multitude of challenges the Covid-19 crisis has posed society are issues of serious ethical concern. Early in the pandemic, the fear was that healthcare would be rationed due to hospital services being overwhelmed. This prompted the creation of documents to help inform ethical decision-making and, generally, to set out principles of care for what was and is an unparalleled situation.

In Ireland, the Department of Health published a document entitled, Framework for Ethical Decision-Making, in March 2020. According to the Department, the document was intended for policymakers and healthcare planners and providers in acute and community settings. It was also designed to assist clinicians in implementing the ethical principles in their clinical practice.

“It is not designed to guide individual clinical decisions, but to assist healthcare workers in thinking through the difficult decisions that will need to be made,” the Department said at the time.

The Medical Independent (MI) reported in May 2020 that Consultant Neurologists Prof Orla Hardiman and Prof Colin Doherty produced another document to help guide decision-making in acute settings. Prof Hardiman told MI that she “was concerned that we had not generated a national set of guidelines for decision-making in the acute setting (who would be brought to ICU and who wouldn’t)”.

“There has been quite a bit of variance around the country in this process. Although the Department of Health has generated an ethics framework, I did not think that it went far enough into specifics.”

The document was sent to the Department for consideration, but has not yet been adopted as part of official guidance.
As the pandemic has continued, other issues have arisen, which have a bioethical dimension. Perhaps the foremost of these is vaccination. The development of an equitable framework for vaccine priority generated controversy as many patient groups felt the initial plan was unfair.

Following a review of the evidence, and an analysis of underlying conditions that may increase the risk of developing severe disease or death from Covid-19, the national immunisation advisory committee recommended the revision of the vaccine allocation strategy. The deficiencies in Ireland’s bioethical infrastructure are the subject of a feature in this issue.

The Irish Council for Bioethics, an independent body to consider ethical issues resulting from rapid developments in medicine, was closed in October 2010 after only eight years in operation. The national advisory committee on bioethics, which had narrower terms of reference than the Council, was created in 2012. As MI previously reported, it has not met since 2015. In the early weeks of the Covid-19 crisis, a pandemic ethics advisory group was established to assist the national public health emergency team in its work. However, that too has been stood down.

The Department of Health does have an internal bioethics unit. But the continued lack of independent advice in the area is of concern. It is not only issues related to the Covid-19 pandemic that are affected. Assisted human reproduction, advance healthcare directives, and organ donation, are just some of the many other examples.
The pandemic, however, has underlined how bioethical questions are not abstractions and have very real consequences for healthcare services and society at large.