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EXPERIENCESOF AN EXTERNAL PREVENTION SERVICE

IN OCCUPATIONAL HEALTH WITH A MEDICAL ETHICS COMMITTEE

G. MOENS, S. BULTERYS

IDEWE, External Service for Prevention and Protection at Work,Leuven, Belgium

Dept. Occupational Medicine, Catholic University Leuven, Belgium

ICOH-Workshop on HRM in OHS, Ghent, 6-8 Nov 2003

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OVERVIEW

1) ISSUES / PROBLEMS / HISTORY

2) EXPERIENCES

3) LESSONS AND CONCLUSION

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1) ISSUES / PROBLEMS / HISTORY

• Occupational health practitioners are frequently confronted with ethical issues, e.g. :– Alcohol / drug testing at the workplace– Data collection and protection– Privacy and multidisciplinary work– Conflicting ethical and legal aspects

• Committees for Medical Ethics (CMEs) were established by Belgian Law only for hospitals

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1) ISSUES / PROBLEMS / HISTORY

• Criteria and supervision by Belgian College of Physicians (BCP) and by the National Committee for Bio-ethics.

• In 1994, IDEWE, the largest Belgian External Prevention Service established the first CME in preventive health care. IDEWE employs 150 occupational physicians among a total of 450 employees. It is providing OH-care for more than 500,000 workers employed by 35,000 employers.

• Official certification of the CME by the BCP (n° 117).

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2) EXPERIENCE

2.1 COMPOSITION OF COMMITTEE & MEETINGS

2.2 ACTIVITIES & TASKS

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2.1 COMPOSITION & MEETINGS

• According to the Law and the criteria set out by BCP: – Min. 8 to max. 15 members– Majority of medical personnel– General Director : only observer/advisory role– Actual composition = 11 members :

• 1 expert in medical ethics (= president of CME)• 1 lawyer expert in medical law• 1 general practitioner (outside OH)• 3 occupational physicians

(2 field workers + 1 retired medical director)• 1 occupational nurse• 1 safety prevention advisor• 1 director R&D (occupational physician-epidemiologist)• 1 general director (advisory role)• 1 secretary (administrative role)

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2.1 COMPOSITION & MEETINGS

• 4 meetings per year

• Annual Activities Report for authorities (NCBE)

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2.2 ACTIVITIES AND TASKS

A CME can have three distinct functions :

1) Act as an ASSESSMENT COMMITTEE for experimental studies with human beings.

2) Act as an ADVISORY COMMITTEE in non-experimental studies and in more general ethical and legal matters.

3) Act as an AD HOC COMMITTEE for individual cases / questions about ethics.

Most of the activities until now were in fields 2 and 3.

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2.2 ACTIVITIES AND TASKS

EXAMPLES :

– Giving ethical and legal advice on all study protocols (e.g. 9 in 2002), assessing scientifical, qualitative, ethical and privacy aspects : e.g. questionnaire studies on the prevalence and determinants of work stress (among > 15,000 workers until now).

– Supervising ethical and legal aspects of the routine computerized registration system of medical data, yearly collected at the medical examination of > 300,000 workers.

– Assessing the consequences of the new Privacy Act (RD 13/02/2001) for study-design and data collection, treatment and conservation :e.g. application of informed consent,

adaptation of study protocols.

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2.2 ACTIVITIES AND TASKS

EXAMPLES (continuation) :

– Advising adequate procedures for storage, conservation and destruction of data.

– Assessing procedures of data protection, access to medical information for non-medical personnel.

– Assessing procedures on transfer of medical files to other Prevention Services, to other medical personnel, to GP etc…

– Issuing guidelines for the ethical and legal use of alcohol and drug testing at work.

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2.2 ACTIVITIES AND TASKS

EXAMPLES (continuation) :

– Assessing the ethical and legal implications of the implementation of new legislation : e.g. RD 28/05/2003 on Health surveillance of workers,

Law 11/06/2003 and RD 11/07/2002 on protection of workers against mobbing.

– Implications of multidisciplinary team work for confidentiality and sharing of information.

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2.2 ACTIVITIES AND TASKS

EXAMPLES (continuation) :

– Ad hoc committee : individual questions / problems forwarded by members of CME or field workers : e.g. * Case of employer asking for HIV-testing

* Medical acts by non-medical personnel * Transfer of medical data to the Court.

IMPORTANT : advices of CME in function 2 or 3 are not mandatory,

but the advices are overall well implemented.

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3) LESSONS AND CONCLUSIONS

Very valuable experience :

• Support and coaching of individual OH field workers in ethical and legal issues/problems.

• Benefit for the whole organization, issuing advices and best practice procedures in :– Sensitive policies e.g. on harassment, drug testing etc.– Implementation of (sometimes conflicting) new legislation.– Data collection and protection, privacy and professional

secret aspects.

• Essential tool in quality assurance of : – Implementation of research.– Delivery of good OH practice in general.