By David Mullins
There has been much talk recently of the need for both government and the National Public Health Emergency Team (NPHET) to display greater levels of accountability and transparency.
This is particularly true with respect to the deliberative processes that are being engaged in prior to conclusions and recommendations being made.
Are the decisions of NPHET unanimous? Has anyone voiced strong opposition or put forward opposing ideas around the shape of the response that is going to be required should the economic and social restrictions remain in place?
What of the harms that are clearly accruing to non-Covid patients in terms of accessing continuity of care?
These are not immaterial concerns.
In fact, they refer to centrally important procedural and ethical values, which if ignored could risk de-legitimising the national effort.
The Department of Health agrees.
Here is how it framed the matter in its recent Ethical Framework for Decision- Making in a Pandemic [1]:
“Good decision-making processes show respect for people and ensure procedural fairness, as well as confer legitimacy on the decisions made. Communicating decisions and the rationale behind them in an open and transparent way is one of the crucial factors in increasing the acceptance and cooperation of those who will be affected by these decisions, i.e. frontline healthcare professionals, patients and the general public.”
This approach is both laudable and welcome.
What we also need to know however is just who is actually behind the State’s ethical response. It is entirely inadequate just to say, ‘The Department of Health.’
For example, who specifically will offer ethical guidance to NPHET on the appropriateness or otherwise of Do Not Resuscitate Orders (DNR’s)?
Is there anyone in the State’s ethical response team who is pushing back against the permissibility of adopting criteria that de-prioritises eighty year olds [2] for clinical intervention? Who is that and why?
Given that these are clearly issues of significant concern you might have thought that it would be the members of the National Advisory Committee on Bioethics.
But as the Iona Institute has shown previously, the National Advisory Committee on Bioethics [3] last met on 24 September 2015.
There is no new available information which suggests that situation has changed.
This is despite the fact that the very reason for its existence is to “advise the Minister on the ethical and social implications of scientific developments in human medicine and healthcare. In particular, this includes: Providing advice in the form of expert reports on priority issues of national significance as requested by the Minister and providing recommendations and assistance towards the development of healthcare policy and associated legislation.”
We do know that Prof. Siobhán O’ Sullivan, who is the Chief Bioethics Officer at the Department of Health has been advising and has been present at Department of Health Covid-19 briefings [4].
Given the scale of the challenges and the ethical complexity involved in formulating a just response to this crisis, this seems like an extraordinary weight to place on one person’s shoulders.
There was a good reason to establish a bioethics advisory committee in 2012 and not just parcel the ethical deliberations out to one or even two or three people.
There are even better reasons now given the impact that ethical frameworks can have on the shaping of genuinely compassionate and person-centred care.
For the sake of ethical transparency, and the maintenance of trust, it is high time we were told where the government is getting is ethical advice from.