Minutes of the meeting held on 23 November 2006
Sat, 17 March 2007
6th meeting
NUFFIELD COUNCIL ON BIOETHICS
WORKING PARTY ON PUBLIC HEALTH: ETHICAL ISSUES
Minutes of the meeting held at the Nuffield Foundation 28 Bedford Square, London WC1B 3JS on Thursday 23 November 2006
PRESENT
Professor Sir John Krebs FRS (Chair)
Dr Raghib Ali
Professor Roger Brownsword
Professor Sir Kenneth Calman KCB FRCS DL FRSE
Professor Christine Godfrey
Professor Trisha Greenhalgh OBE
Professor Anne Johnson FmedSci
Professor Sally Macintyre OBE FRSE CBE
Professor Jonathan Montgomery
Ms Julia Unwin OBE CBE
APOLOGIES
Professor Tom Baldwin
SECRETARIAT
Dr Catherine Moody, Mr Harald Schmidt, Ms Catherine Joynson, Ms Caroline Rogers, Mrs Julia Trusler
INTRODUCTION BY THE CHAIR
1 The Chair welcomed the members of the Working Party, and noted that Dr Catherine Moody was now Acting Director of the Council. The focus of the meeting would be on the first draft of the policy chapter and on chapters 4 (infectious diseases) and chapter 7 (Fluoridation).
MINUTES OF THE FIFTH MEETING OF THE WORKING PARTY, AND OF THE FACT FINDING MEETING ON 26 OCTOBER
2 The minutes were approved.
DISCUSSION OF NEW CASE STUDY CHAPTERS
Chapter 4 – Infectious diseases
3 The current version of the Report included the first full drafts of Chapter 4 (infectious diseases) and Chapter 7 (fluoridation). Chapter 4 had been developed further by the Secretariat. The overall format and balance between ethics and science was welcomed, as the chapter was ’ethics-driven’ rather than ‘science-driven’. The draft also included several comments from respondents to the consultation, and generally it appeared that it would be useful if a similar format was used for the other case study chapters.
4 Concerning the section on vaccinations, the question was posed of whether the free-rider-problem had received too much attention. It was proposed to reduce its prominence, so as to avoid the perception that this was the only issue raised by vaccinations. A point that should be drawn out more fully related to the circumstances that might allow overriding the decisions of individuals.
5 Members then made several suggestions for revisions and/or additions: legal issues should be expanded, the efficacy of incentivising systems should be clarified, and the discussion of the MMR case should be shortened. Members then reviewed the mock recommendations which had been included in the draft chapter. These had been discussed in broad outline with a number of members, and were based on the ethical framework of Chapter 2.
CHAPTER 7 - FLUORIDATION/SUPPLEMENTATION
6 It would be useful to ensure that Chapter 7 had the same ‘ethics-driven’-structure that had been endorsed for Chapter 4. As in other Chapters, it would also be useful to review the use of consultation quotes to make certain that readers knew which views were simply ‘aired’ and which were endorsed, or criticised, by the Working Party. Given the current length of the Chapter, it would not be feasible to discuss in equal depth fluoridation and different forms of food supplementation.
7 Members reviewed the chapter and agreed on several issues that should be brought out more clearly: the degrees of coercion and their effect on the choice of individuals; the process for decision making about fluoridation programmes in political and democratic terms; the special role of children; the way scientific information was used tactically by both sides in the debate.
CHAPTER 3 – POLICY FRAMEWORK
8 Members welcomed the reorganised structure of the report, which meant that the ethics framework would be followed by a policy chapter which linked the rather abstract ethical principles to the case studies in a ‘from theory-to-practice’ manner. However, rather than calling the chapter ‘the policy framework’ a more appropriate title in view of its planned content was “Policy process and practice”.
9 Several options were discussed of how the material in the Chapter might be reorganised, and members agreed that paragraph 3.44 was important, as it might be used either as a starting or concluding point. The paragraph made it clear that there were two main background areas that fed into policy deliberations: first, ‘evidential’ matters (relating to evidence, risk, etc) and secondly, ‘non-evidential’ factors such as activities of NGOs, the press, of economic pressures. The material presented in the chapter was generally very useful, but should be reviewed to ensure an appropriate ‘flow’ and balance between the different sections, as several sections were too long (eg risk & evidence) or redundant.
10 Members agreed that it would be useful to add a section on economic considerations. A description of the way in which PCTs made decisions might also be added. The discussion about targeted and population-wide approaches was welcomed, but should be presented more clearly in terms of the implications for increasing or reducing health inequalities, which would help to bring out the ethical issues that were raised. The chapter should include a Box on examples of highly coercive interventions, such as seat belts or drink-driving regulations. Revisions would be re-circulated to the Working Party.
11 The Chair asked all members to set aside a day over the following weeks to work on the draft Report, to ensure that a robust version could be sent to the peer reviewers. In view of the work required it was proposed to delay peer review to February 2007, so that the Working Party could sign of a sufficiently developed version at their January meeting. Members approved this alteration and the Secretariat would liaise with the reviewers who had already accepted, to ensure that they would still be able to carry out the task.
ANY OTHER BUSINESS
12 There was none.
Last Updated Thu, 8 November 2007