Evaluating Clinical Ethics Support: On What Grounds Do We Make Judgments About Reports of Ethics Consultation?

Clinical ethics committees (CECs) in the United Kingdom (UK) have developed significantly over the past 15 years. The issue of access to and participation in clinical ethics consultation by patients and family members has, however, gone largely unrecognized. There are various dimensions to this kind of contact, including patient notification, consent and participation. This study reports the first specific investigation of patient contact with UK CECs. A questionnaire study was carried out with representatives from UK CECs. Results suggest that patient participation in clinical ethics consultation is low and unlikely to change significantly in the near future. Attitudes towards patients having a role in clinical ethics consultation are mixed, with a variety of reasons put forward both for and against patient participation. These results are discussed in the light of common themes in the literature and the practical and political context of clinical ethics support in the UK.

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Provide Access to Information on Assisted Suicide for a Patient with a Diagnosis of Depression?

GeroPsych ◽

10.1024/1662-9647/a000259 ◽

2021 ◽

pp. 1-6

Author(s):

Laura Winkler ◽

Charlotte Wetterauer

Keyword(s):

Clinical Ethics ◽

Assisted Suicide ◽

Healthcare Professionals ◽

Psychiatric Patients ◽

Ethics Consultation ◽

Daily Practice ◽

Clinical Ethics Support ◽

Moral Uncertainty ◽

Ethics Support ◽

Clinical Ethics Consultants

Abstract. Assisted suicide (AS) is one of the most controversially discussed topics, both in bioethical academia and in clinical practice. This is especially true for psychiatric patients. In Switzerland, the organization of AS and patient accompaniment in the dying process is practiced by lay right-to-die societies (RTDS). Despite this demedicalization, healthcare professionals are increasingly encountering AS requests in their institutions and experiencing moral uncertainty. This led to a physician’s request for clinical ethics support when confronted with an elderly patient with depression asking for information on AS: When does “assistance” start and what am I supposed and willing to do? The following clinical case report discusses these ethical questions from the perspective of the clinical ethics consultants involved. By recounting and discussing this clinical ethics case, this article aims to illustrate the difficulties that arise in daily practice, the importance of guidance and support in view of controversy, the possibilities of finding pragmatic, acceptable solutions for all parties involved, and what clinical ethics consultation can contribute.

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48. Clinical ethics support services in veterinary practice

Professionals in food chains ◽

10.3920/978-90-8686-869-8_48 ◽

2018 ◽

Author(s):

S. Springer ◽

U. Auer ◽

F. Jenner ◽

H. Grimm

Keyword(s):

Support Services ◽

Clinical Ethics ◽

Clinical Ethics Support ◽

Veterinary Practice ◽

Ethics Support

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Managing ethical issues in patient care and the need for clinical ethics support

Australian Health Review ◽

10.1071/ah14034 ◽

2015 ◽

Vol 39 (1) ◽

pp. 44 ◽

Cited By ~ 3

Author(s):

Evan Doran ◽

Jennifer Fleming ◽

Christopher Jordens ◽

Cameron L Stewart ◽

Julie Letts ◽

...

Keyword(s):

Patient Care ◽

Clinical Ethics ◽

Ethical Issues ◽

Public Hospitals ◽

Cross Sectional Survey ◽

Convenience Sample ◽

Clinical Ethics Support ◽

Ethical Environment ◽

Ethics Support ◽

A Priority

Objective To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. Methods A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Results Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. Conclusion Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia. What is known about the topic? Clinicians working in hospitals in the US, Canada and UK have access to ethics expertise to help them manage ethical issues that arise in patient care. How Australian clinicians currently manage the ethical issues they face has not been investigated. What does this paper add? This paper describes the types of ethical issues faced by Australian clinicians, how they manage these issues and whether they think ethics support would be helpful. What are the implications for practitioners? Clinicians frequently encounter ethically and legally difficult decisions and want additional ethics support. Helping clinicians to provide ethically sound patient care should be a priority of public hospitals in NSW and elsewhere in Australia.

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Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?

Journal of Medical Ethics ◽

10.1136/medethics-2016-104042 ◽

2017 ◽

Vol 44 (1) ◽

pp. 27-31 ◽

Cited By ~ 14

Author(s):

Rosalind J McDougall ◽

Lynn Gillam ◽

Clare Delany ◽

Yasmin Jayasinghe

Keyword(s):

Fertility Preservation ◽

Clinical Ethics ◽

Reproductive Potential ◽

Clinical Ethics Support ◽

Prepubertal Children ◽

Ethics Support ◽

Future Fertility ◽

Difference Of Opinion ◽

Proven Efficacy ◽

Pathway Of Care

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia.

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