EXPERIENCES OF 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

2 OVERVIEW 1)ISSUES / PROBLEMS / HISTORY 2)EXPERIENCES 3)LESSONS AND CONCLUSION

3 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

4 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).

5 2) EXPERIENCE 2.1COMPOSITION OF COMMITTEE & MEETINGS 2.2ACTIVITIES & TASKS

6 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)

7 2.1 COMPOSITION & MEETINGS 4 meetings per year Annual Activities Report for authorities (NCBE)

8 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.

9 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.

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.

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.

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.

13 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.