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At the centre of things: Rebekah Ley

Updated Tuesday 4th August 2009

The Open University's Derek Matravers talks to Rebekah Ley, Convenor of the clinical ethics committee for Addenbrookes Hospital

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Derek Matravers:
Hello, I’m Derek Matravers and I’m in the Philosophy Department at the Open University, and I’m here in Adenbrookes Hospital talking to Rebekah Ley about the Adenbrookes Clinical Ethics Forum.

Rebekah Ley:
Hello, I’m Rebekah Ley, I’m an Assistant Director here at Adenbrookes Hospital and I’m also Convener for the Trust’s Clinical Ethics Forum, and I’ve been in that role for about five years now.

Derek Matravers:
Could you just say a little about what the role of the Clinical Ethics Forum is?

Rebekah Ley:
The forum is there to provide advice to clinicians, we also take referrals from patients and relatives as well, around difficult ethical dilemmas that clinicians might be facing in terms of treating patients, or patients or families who might want advice from us as well.

All sorts of cases. We talk about difficult paediatric cases, withdrawal of care, also cases involving some of our older patients where we perhaps have differences of opinion between what clinicians would like and what families like. So a whole, broad range of things.

Derek Matravers:
And you yourself have a background in law but also in medical ethics?

Rebekah Ley:
That's right I do, yes.

Derek Matravers:
And do you find that kind of training has helped you in discussions in the forum?

Rebekah Ley:
Yes. The forum developed three years ago a structured way of looking at cases, so we actually have a formal process that we go through so that if we are providing advice or input and support we’re giving it in a very structured way.

Derek Matravers:
What sort of people serve on the forum?

Rebekah Ley:
We have a multidisciplinary mixture, so clinicians, both from Adenbrookes but also from other trusts, we also have input from the primary care trust, we also have lay members as well.

Derek Matravers:
Are there any sorts of cases that come up again and again? Are there cases which you sort of think of as standard cases to be considered by the Clinical Ethics Forum?

Rebekah Ley:
No, I don’t think there are, and I think that's the beauty of its strength really in that we discuss a whole range of different issues.

So we might be talking about somebody developing a policy or developing information to give to patients around liver transplants, we might be looking at withdrawing care, we might be retrospectively going back and reviewing a case that a clinician’s brought to us to say could I have done something differently. So that's, the beauty lies in the diversity of the things that we discuss.

Derek Matravers:
What's the relation between the kind of issues that are discussed in the Clinical Ethics Forum and legal issues? So one might have thought that there were laws to cover all these things.

Rebekah Ley:
I think that's probably why I became the convener for the forum because most people pick up the telephone to me and ask me what the legal answer is, and often the law will give you certain parameters within which you can make decisions but it won’t necessarily give you the answers, and it won’t necessarily sort out those disputes, if you have them, between patients and relatives and clinicians.

Derek Matravers:
And the medical profession seems to be the kind of place in which lots of ethical dilemmas arise, do you think that, do you think they’re sorted out satisfactorily or do you think that often people will leave unhappy?

Rebekah Ley:
I would like to think that the role of the ethics forum is there to provide a touchstone to provide advice to enable things to be resolved satisfactorily for all parties. I’d be very disappointed if people went away and were unhappy about it.

Occasionally, though, opinion will be so polarised that you won’t be able to bridge the gaps between them, but I think if you do have an active ethics forum that is a way of bridging the gap and hopefully enabling both parties, all parties, to go away happy and satisfied.

Derek Matravers:
Well thank you very much for you time.

Rebekah Ley:
Pleasure.

 

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