title: Clinical ethics protocols in the clinical ethics committees of Madrid.
abstract: BACKGROUND
  Currently, The nature and scope of Clinical Ethics Protocols (CEPs) in Madrid (Spain) are not well understood.
  
  
  OBJECTIVE
  The main objective is to describe the features of 'guideline/recommendation' type CEPs that have been or are being developed by existing Clinical Ethics Committees (CECs) in Madrid. Secondary objectives include characterisation of those CECs that have been the most prolific in reference to CEP creation and implementation and identification of any trends in future CEP development.
  
  
  METHODS
  We collected CEPs produced and in process by CECs accredited in the public hospitals in Madrid, Spain, from 1996 to 2008.
  
  
  RESULTS
  CECs developed 30 CEPs, with 10 more in process. The most common topic is refusal of treatment (seven CEPs developed; two in process). If CEPs addressing terminal illness, Do-Not-Resuscitate orders and advance directives are placed into a separate 'ethical problems at the end of life' category, this CEP subject emerges as the most common (eight developed; four in process). There is a relationship between the age of the CEC and the development of CEPs (the oldest CECs have developed more CEPs). CECs now seem to be more likely to engage in CEP development.
  
  
  CONCLUSIONS
  The CECs in Madrid, Spain, have developed a significant number of CEPs (30 in total and 10 in process) and there is a trend towards continued development. The most frequent topics are ethical problems at the end of life and refusal of treatment by the patient.
authors.affiliation: Department of Biomedical Sciences, European University of Madrid, , Villaviciosa de Odon, Madrid, Spain.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Herreros
authors.forename: Venktesh R
authors.initials: VR
authors.lastname: Ramnath
authors.forename: Laura
authors.initials: L
authors.lastname: Bishop
authors.forename: Emilio
authors.initials: E
authors.lastname: Pintor
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Martín
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sánchez-González
mesh_terms: D016223:Advance Directives; D002985:Clinical Protocols / Q000592:standards*; D028741:Ethics Committees, Clinical; D004992:Ethics, Medical; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D016414:Resuscitation Orders / Q000941:ethics*; D013030:Spain; D013727:Terminal Care / Q000941:ethics* / Q000592:standards; D019452:Terminally Ill; D016312:Treatment Refusal
keywords: Clinical Ethics; Ethics Committees/Consultation; Managed Care; Regulation