Clinical ethics support and education
The Centre's research in clinical ethics support and education is varied, and tracks current research interests of individual staff members. Topics range from how to understand and respond to moral distress, through to the ethics of medical education itself, and there is significant crossover with other research areas, including end-of-life, reproduction and methodology.
Staff use their research in this area to inform the development of teaching and training materials, as well as various public engagement activities.
BABEL (BAlancing Best interests in Healthcare Ethics And Law)
The interdisciplinary BABEL project explores healthcare decisions for individuals who are deemed to be unable to make decisions for themselves. When someone is considered to lack what the law calls ‘mental capacity’ or ‘competence’, then decisions must be made in their 'best interests'. Best interest decisions may be made concerning children – as poignantly illustrated in the widely-publicised legal case of Charlie Gard – and adults, including those with learning disabilities, dementia or prolonged disorders of consciousness.
BABEL asks how the 'best interests' of such patients should be understood – which factors and values should be considered, who should be involved, and indeed whether ‘best interests' is even the best approach.
The current BABEL study built on a Wellcome Trust seed project undertaken by Huxtable and Birchley. That work focused particularly on legal judgments about the provision or withdrawal of life-supporting treatment from patients in a minimally conscious state, alongside analysis of decisions about cryonics and vaccination.
Conscience and Professional Integrity
Deans has a strong interest in questions of conscience and conscientious objection, having explored these issues particularly in relation to pharmacy practice. Huxtable has also explored conscience and the idea of professional integrity, particularly in connection with assisted dying.
Ethics, Law and Clinical Decision-making
Much of the Centre’s research addresses ethical and legal issues arising in clinical practice. Huxtable co-authored the second edition of The Cambridge Medical Ethics Workbook and has proposed a model describing the legal dimensions of treatment and non-treatment decisions. Morley, supported by a Wellcome Trust Clinical Fellowship and supervised by Ives and Huxtable, explored moral distress in UK nursing. This research drew on feminist empirical bioethics to explore the way that nurses experience moral distress, and used this to inform a conceptual analysis of moral distress that aimed to provide insights into how we might respond to it. Austin, supervised in the Centre by Huxtable and supported by the ESRC, is exploring ethical, legal and regulatory conceptions of autonomy and standards of informed consent, and the application of those within legal judgments and fitness to practice decisions. Smith, supervised by Ives in the Centre, is exploring the ethical and legal/regulatory implications of developing artificial intelligence to play a role in clinical decision-making.
Clinical Ethics Support
Many members of the Centre team – including Huxtable, Deans, Birchley and Ives – provide clinical ethics support, for example as members of clinical ethics advisory groups. Huxtable is chair of the UK Clinical Ethics Network and Ives is a member of the Royal College of General Practitioners Medical Ethics Committee. Huxtable has written about clinical ethics support services in a recent book, and has elsewhere published (including with Birchley) and presented on the topic, including at the Medicine Unboxed conference.
ALCMAEON is a large EU project with partners in Spain, Greece, Romania, Italy and the UK. It is exploring ways of enhancing learning in medicine through the medical humanities, with an emphasis on using medical history and digital museums. Our focus in Bristol is using medical history as a window into learning about medical ethics.
E Valenti, D Giacco (2022)
Persuasion or coercion? An empirical ethics analysis about the use of influence strategies in mental health community care
BMC Health Services Research 22, Article number: 1273
J Parsons (2021)
Deemed consent for organ donation: a comparison of the English and Scottish approaches
Journal of Law and the Biosciences, 8(1)
D Dickenson, R Huxtable, M Parker (2010)
The Cambridge Medical Ethics Workbook
Cambridge University Press
Z Deans (2013)
Conscientious objections in pharmacy practice in Great Britain
Organ Donation and Transplantation
Parsons conducts research on various issues in organ donation and transplantation, with a particular focus on ‘opt out’ systems and their development in UK law. Most recently, he has been exploring the ethical questions pertaining to directed and conditional uterus donation.