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Clinical ethics support services during the COVID-19 pandemic in the UK: a cross-sectional survey
  1. Mariana Dittborn1,2,
  2. Emma Cave3,
  3. David Archard1
  1. 1 School of History, Anthropology, Philosophy and Politics, QUB, Belfast, UK
  2. 2 Paediatric Bioethics Centre, Great Ormond Street Hospital, London, UK
  3. 3 Durham Law School, Durham University, Durham, UK
  1. Correspondence to Dr Mariana Dittborn, Paediatric Bioethics Centre, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; mariana.dittborn{at}


Background The COVID-19 pandemic highlighted the need for clinical ethics support provision to ensure as far as possible fair decision making and to address healthcare workers’ moral distress.

Purpose To describe the availability, characteristics and role of clinical ethics support services (CESSs) in the UK during the COVID-19 pandemic.

Method A descriptive cross-sectional online survey was developed by the research team. The survey included questions on CESSs characteristics (model, types of support, guidance development, membership, parent and patient involvement) and changes in response to the pandemic. Invitations to participate were widely circulated via National Health Service institutional emails and relevant clinical ethics groups known to the research team.

Results Between October 2020 and June 2021, a total of 53 responses were received. In response to the pandemic, new CESSs were established, and existing provision changed. Most took the form of clinical ethics committees, groups and advisory boards, which varied in size and membership and the body of clinicians and patient populations they served. Some services provided moral distress support and educational provision for clinical staff. During the pandemic, services became more responsive to clinicians’ requests for ethics support and advice. More than half of respondents developed local guidance and around three quarters formed links with regional or other local services. Patient and/or family members’ involvement in ethics discussions is infrequent.

Conclusions The pandemic has resulted in an expansion in the number of CESSs. Though some may disband as the pandemic eases, the reliance on CESSs during the pandemic demonstrates the need for additional research to better understand the effectiveness of their various forms, connections, guidance, services and modes of working and for better support to enhance consistency, transparency, communication with patients and availability to clinical staff.

  • COVID-19
  • ethics committees
  • ethics- medical
  • ethics

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Data availability statement

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  • Contributors MD designed the survey in conjunction with DA and EC. MD drafted the results, and DA and EC drafted the discussion. All authors finalised and approved the submission. MD is responsible for the overall content as guarantor.

  • Funding The authors acknowledge the support of the British Academy, grant number COV19\200446 for their project ‘Ethical advice and ethics committees in the pandemic’ June 2020-July 2021.

  • Competing interests DA and MD are members of the GOSH Paediatric Bioethics Centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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