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Health care ethics and clinical risk management: What does regulation have to do with morality?

Dr Richard Ashcroft
Imperial College School of Medicine
Email: r.ashcroft@imperial.ac.uk|

Date: June 2001


Many hospitals and health care organisations in the US, and a growing number in the UK, have developed two kinds of mechanism for managing and averting "trouble" - medical ethics committees, and clinical risk management. Both of these mechanisms involve a growing number of personnel, a coalescing sub profession, and a diversity of institutional forms and roles. Clinical risk management is reasonably well studied by analysts of law, regulation and management. Meanwhile ethics has not been widely studied from these perspectives. In part this is because ethics is seen as a personal matter, relating to individual values, beliefs and behaviour, where risk management is about social structures and processes. Ethics is a province of the intellect, where risk is a matter for organisations. Ethics concerns thought and reflection, where risk is a topic for calculation and trade-off. Brutally put, clinical risk management is thought to be about avoiding losses of cash and goodwill to the organisation, while ethics is about doing the morally right thing.

In this paper, Dr Ashcroft deconstructs this series of contrasts, through an examination of the history of medical ethics and ethics committees in the institutional setting and by exploring why institutions became interested in medical ethics. He argues that tools of regulatory analysis illuminate much about medical ethics in the healthcare sector today; in particular they provide us with methods for evaluating medical ethics methods and institutions. He described one particular regulatory device, the "research ethics committee", in detail, and set out a programme of work which permits understanding the scope and effect of this device in the healthcare, political and life sciences sectors.