‘Transparency’ raised on Covid-19 ethical framework process

The need for “consistency and transparency” was raised at a HSE board meeting when discussing a framework document on clinical decision-making in a pandemic, which was produced by a subgroup of the national public health emergency team (NPHET).

“The board considered the ethical framework, the process by which it was developed, the need for consistency and transparency, and how it is going to be communicated to the public,” according to minutes of the board’s 27 March video conference.

“The board discussed the process by which the ethical framework was developed, mindful that it too has a governance role to protect the health of the population. It noted that, as the HSE is a participant in the NPHET/DoH [Department of Health] led process, the board expects it can input into important matters being considered by NPHET which are connected to its governance role.”

It was noted at the meeting that the document was a “broad ethical framework” and not a policy or guidance document.

“The process by which the framework has to be to implemented is key and the board will need to ensure that employees have workable guidelines. It was agreed that the chair and the CEO would discuss the board’s view with the Minister to ensure the board can engage with the NPHET working group on ethical considerations and input appropriately into further necessary guidance documents.”

Two days previously, at a special Covid-19 meeting held by the HSE board, the ethical framework document was also discussed.

“The board emphasised it expected that it should be engaged with before policy guidance impacting the HSE is put in place and noted correspondence had issued to the Secretary General on this matter,” according to minutes.

Board member Prof Deirdre Madden had reviewed the NPHET document on behalf of the board. She noted that “as a framework, it was not directed to clinical staff who will be involved in making decisions regarding the prioritisation of critical care resources in the context of Covid-19”,  the minutes outlined.

At the meeting, Chief Clinical Officer Dr Colm Henry confirmed that a NPHET sub-group was preparing another guidance document applicable to the particular situation where resource scarcity arises and rationing decisions had to be made. This document has since been published.