Minutes of the meeting held on 2nd February 2006
Tue, 2 May 2006
PLFN (06) 8th meeting
NUFFIELD COUNCIL ON BIOETHICS WORKING PARTY ON CRITICAL CARE DECISIONS IN FETAL AND NEONATAL MEDICINE: ETHICAL ISSUES
Minutes of the meeting held on Thursday 2nd February, 2006
PRESENT: Professor Margaret Brazier OBE (in the Chair); Professor David Archard; Professor Alastair Campbell; Professor Erica Haimes; Professor Linda Franck; Ms Bonnie Green; Dr Monica Konrad; Professor Neil Marlow; Professor Catherine Peckham CBE; Dr Stavros Petrou; Dr Philippa Russell CBE; Ms Anne Winyard; Professor Andrew Whitelaw
APOLOGIES: Professor Charles Rodeck
SECRETARIAT: Professor Sandy Thomas; Dr Catherine Moody; Catherine Joynson; Caroline Rogers; Harald Schmidt; Julia Trusler
INTRODUCTION
1 Professor Brazier welcomed the members of the Working Party and thanked Professor Archard for chairing the previous meeting. The focus of the day’s business was upon the draft Report, on which feedback had been received from the Council. Following the meeting, fact-finding discussions would be held with a number of healthcare commissioners and managers.
MINUTES OF THE SEVENTH MEETING
2 The minutes were approved as a final version, subject to some minor changes, as was the note of the meeting with Dr Fisher (Antenatal Results and Choices).
Matters Arising from meeting on 10th November 2005
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Verbal
3 Professor Brazier reported back on her telephone discussion with Dr Behrman, the chair of the US Institute of Medicine (IoM) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. The Report of the IoM Committee was expected in May, 2006.
Draft Report:Feedback from the Council meeting
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4 Professor Brazier provided the Working Party with feedback from the Council meeting held on 18th January 2006, a written summary of which was tabled for members. The Council wished the Report to be kept fairly short. Advice had been provided on overall presentation and specific comments made on each chapter.
Structure and content of the Report
5 The Working Party discussed the feedback then considered the best way to reorder the different chapters of the Report for maximum accessibility and impact. Several models were put forward, including the suggestion of developing existing or new scenarios not only from a clinical or ethical perspective as at present but also from family, social and legal viewpoints. Another proposal was to shorten the introduction and present the background and ethical framework for the Report in separate chapters before the different scenarios were discussed. For the scenario chapter, three sections should be developed, on the fetus, the borderline of viability and the child with limited prognosis. The titles were provisional only.
6 The practical consequences of the decision to restructure were discussed. The Working Party decided that the report should be restructured before peer review, which would entail a delay. The publication date would also need to be put back. The Secretariat agreed to plan a new timetable to allow a decision to be taken on whether restructuring the Report would be feasible and the Working Party agreed to give Professor Brazier and the Secretariat together the authority to decide which structure should be used.
7 Some suggestions were made on issues where additional ethical perspectives could be brought out in the Report. These included the accuracy of detection of fetal abnormalities, the primacy of the mother’s views, issues around the use of IVF techniques and the high rise in multiple births, associated with abnormalities, prematurity and disability, fetal growth restriction and whether morally it was better to deliver the baby or to let nature take its course (which could entail death), assessment of pain, fetocide, maternal refusal of interventions. There was a brief discussion on general areas that had been omitted or required further development.
8 Finally, a cautionary note was sounded on the use of scenarios and examples. Sometimes these were used simply to illustrate a point, but sometimes, they led the reader down a particular avenue of thought, by ‘begging a question’. The Working Party needed to ensure that the arguments presented in the Report were balanced.
Conclusions and Recommendations
9 Professor Brazier outlined the current proposals for conclusions and recommendations which were developed further during the meeting. The Secretariat agreed to circulate the draft list for further comment.
Analysis of Consultation Responses
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10 Comments were made on the analysis. The request was made that no-one should be specifically named in the document. Members agreed to send any further comments to the Secretariat.
Peer Review
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11 Members noted that the Council had broadly approved the proposals for peer reviewers and had suggested three possible alternatives. A final and reserve list of peer reviewers was agreed, including one additional reviewer from the field of nursing.
Work Plan
Feedback on two recent fact-finding meetings
Plans for future fact finding meetings
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12 The work plan would be revised in light of the earlier discussion on restructuring the Report. The draft note of the fact finding meeting to Ickburgh School would now be sent to Mrs Sullivan, the Head Teacher, for comments before finalisation. Professor Brazier reported back verbally on the visit hosted by Espace Ethique and the CCNE in Paris, where members of the Working Party had found it very useful to discuss critical care decision making with French ethicists and neonatologists. A note of the visit would be circulated for comments in due course. It was agreed that a small number of members should visit the Council for Disabled Children at its headquarters based in Islington, at a date to be arranged. A visit to a school for disabled children in the Northwest also needed to be arranged. Finally, plans were in hand for a visit to the Netherlands.
13 Professor Archard led discussions at the end of the meeting to prepare for the meeting with healthcare commissioners and managers, on resource considerations in neonatal care.
Any other business
14 Representatives of ECSITE would attend the meeting on 6th April to update members on the workshops with schools.
The next meeting will take place at 11.00 am on Thursday 6th April 2006
Last Updated Tue, 30 May 2006