Invoking the Law in Ethics Consultation

1993 ◽  
Vol 2 (4) ◽  
pp. 457-467 ◽  
Author(s):  
Bethany Spielman
Keyword(s):  
Ethical Issues ◽  
Ethics Consultation ◽  
Ethics Committee ◽  
Legal Issues ◽  
University Hospital ◽  
Recent Book ◽  
Consultation Process ◽  
Legal Information ◽  
Case Consultation ◽  
Hospital Ethics

A request that an ethics committee or consultant analyze the ethical issues in a case, delineate ethical options, or make a recommendation need not automatically but often does elicit legal information. In a recent book in which ethics consultants described cases on which they had worked, almost all cited a legal case or statute that had shaped the consultation process. During a period of just a few months, case consultation done under the auspices of one university hospital ethics committee involved interpretation of statutes on living wills, durable powers of attorney, competency, confidentiality, guardianship, AIDS testing, and disability (personal observation). At another hospital, 30% of ethics consultations were thought to involve legal issues. Attorneys at a third hospital estimated that virtually every case involves legal issues. The notion that ethics consultation is an “amalgam” of medicine, ethics, interpersonal skills, and law is gaining currency. Ethics consultation has become a channel through which law enters the clinical setting.

scholarly journals Physicians’ and nurses’ expectations and objections toward a clinical ethics committee

2013 ◽  
Vol 20 (7) ◽  
pp. 771-783 ◽  
Author(s):  
Maximiliane Jansky ◽  
Gabriella Marx ◽  
Friedemann Nauck ◽  
Bernd Alt-Epping
Keyword(s):  
Clinical Ethics ◽  
Ethical Issues ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
Ethics Committee ◽  
University Hospital ◽  
Sufficient Information ◽  
Interprofessional Communication ◽  
Clinical Ethics Committee ◽  
Ethical Conflicts

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account.

Development of a Hospital Ethics Committee: Lessons from Five Years of Case Consultations

1992 ◽  
Vol 1 (1) ◽  
pp. 41-50 ◽  
Author(s):  
William S. Andereck
Keyword(s):  
Community Hospital ◽  
Evaluation Model ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Consultation Process ◽  
Substituted Judgment ◽  
Competing Demands ◽  
Case Consultation ◽  
Hospital Ethics ◽  
Attending Physician

The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care. Most patients evaluated have been unable to clearly express their wishes concerning further treatments, highlighting the need for promoting advance directives. When resorting to substituted judgment, our committee has supported continued care in a majority of cases. Limitation of the consultation process to the attending physician has, in our experience, actually served to increase the credibility of the committee and has promoted acceptance of its recommendations. The committee's most useful function seems to be in assisting physicians and their patients in defining realistic goals and limitations of treatment. Within this context, the coming decade may find ethics committees concerned less with promoting the autonomous wishes of individual patients than with defining the limits of that autonomy against the competing demands of the larger society. Such a shift be approached with caution.

Ethics Case Consultation in Primary Care: Contextual Challenges for Clinical Ethicists

2009 ◽  
Vol 18 (4) ◽  
pp. 397-405 ◽  
Author(s):  
ANNE SLOWTHER
Keyword(s):  
Primary Care ◽  
Clinical Ethics ◽  
Western Europe ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Ethics Committee ◽  
Health Maintenance ◽  
Case Consultation

The development of ethics case consultation over the past 30 years, initially in North America and recently in Western Europe, has primarily taken place in the secondary or tertiary healthcare settings. The predominant model for ethics consultation, in some countries overwhelmingly so, is a hospital-based clinical ethics committee. In the United States, accreditation boards suggest the ethics committee model as a way of meeting the ethics component of the accreditation requirement for payment by Health Maintenance Organizations (HMOs), and in some European countries, there are legislatory requirements or government recommendations for hospitals to have clinical ethics committees. There is no corresponding pressure for primary care services to have ethics committees or ethics consultants to advise clinicians, patients, and families on the difficult ethical decisions that arise in clinical practice.

scholarly journals Guest Editorial: Encouraging the Dialogue

2009 ◽  
Vol 18 (4) ◽  
pp. 333-337 ◽  
Author(s):  
GEORGE J. AGICH ◽  
STELLA REITER-THEIL
Keyword(s):  
Patient Care ◽  
Clinical Ethics ◽  
Guest Editorial ◽  
Ethical Issues ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
Organizational Structures ◽  
Healthcare Services ◽  
Delivery Of Healthcare ◽  
Hospital Ethics

Ethics consultation is the most engaged aspect of clinical ethics, a field focused on ethical issues, questions, and conflicts arising in the course of patient care and delivery of healthcare services. Despite the skepticism of some academic bioethicists and criticism expressed by social commentators, clinical ethics, which began in North America, has expanded to Europe and many other parts of the world with the proliferation of healthcare institution ethics and ethics consultation support services. Along with the development and implementation of ethics policies and guidelines for patient care through work on hospital ethics committees, clinical ethicists are increasingly involved in the ethics of healthcare organizational structures and processes and the day to day provision of ethics consultative services to health professionals, patients, and families.

Is Consent Necessary for Ethics Consultation?

2009 ◽  
Vol 18 (4) ◽  
pp. 384-396
Author(s):  
STUART G. FINDER
Keyword(s):  
Clinical Practice ◽  
Clinical Ethics ◽  
Life Support ◽  
Ethics Consultation ◽  
Ethics Committee ◽  
Clinical Ethics Consultation ◽  
Life Support System ◽  
Reasonable Possibility ◽  
Hospital Ethics ◽  
Consultative Body

Is consent necessary prior to the initiation of a specific clinical ethics consultation? This is not a question that has received much attention despite the fact that the issue of consent is one of the earliest considerations associated with bioethics. Perhaps this is because of how clinical ethics consultation, as a formidable clinical practice, came into being. Specifically, although the place and time of its conception is not readily identifiable, it is not unreasonable to say it was born on March 31, 1976, when the New Jersey Supreme Court stated, in its Quinlan decision, that consultation would be necessary with “the hospital ‘Ethics Committee’ or like body of the institution in which Karen is then hospitalized. [And i]f that consultative body agrees that there is no reasonable possibility of Karen's ever emerging from her present comatose condition [then her] life-support system may be withdrawn.”

scholarly journals The Roles of Hospital Ethics Committee and Clinical Ethics Consultation Teams

2017 ◽  
Vol 20 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Dae Seog Heo ◽  
김범석 ◽  
이진우 ◽  
박혜윤 ◽  
홍진의
Keyword(s):  
Clinical Ethics ◽  
Ethics Consultation ◽  
Ethics Committee ◽  
Clinical Ethics Consultation ◽  
Hospital Ethics

Research Ethics Consultation in Nursing Studies

2021 ◽  
pp. 155626462110365
Author(s):  
Chikako Kane ◽  
Satoshi Sakaguchi ◽  
Masayuki Chuma ◽  
Kenta Yagi ◽  
Kenshi Takechi ◽  
...  
Keyword(s):  
Clinical Research ◽  
Research Ethics ◽  
Ethics Consultation ◽  
Ethics Committee ◽  
University Hospital ◽  
Future Studies ◽  
Japanese University ◽  
Research Areas ◽  
Clinical Research Center ◽  
Research Ethics Consultation

Despite the importance and acceptance of research ethics consultation as an entity in many medical research areas, little is known about its status in nursing research. Focusing on inquiries from nurse researchers, we retrospectively analyzed records of integrated clinical research consultation, provided by members of the Clinical Research Center independently of the research ethics committee, at a Japanese university hospital during 2018–2019. Among various consultations in nursing studies ( n = 101), 43 were related to research ethics. The main issues in research ethics consultation were compatibility with guidelines ( n = 28; 65%) and application of ethics review ( n = 12; 28%). Future studies should investigate international settings and address the relevance of research ethics consultation to promote proper nursing studies.

Quality Control for Hospitals' Clinical Ethics Services: Proposed Standards

1997 ◽  
Vol 6 (3) ◽  
pp. 257-268 ◽  
Author(s):  
Cavin P. Leeman ◽  
John C. Fletcher ◽  
Edward M. Spencer ◽  
Sigrid Fry-Revere
Keyword(s):  
Health Care ◽  
Quality Control ◽  
Patient Care ◽  
Clinical Ethics ◽  
Health Care Organizations ◽  
Ethical Issues ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Hospital Ethics Committees ◽  
Hospital Ethics

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a President's Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states stipulate that certain types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee.

Community hospital ethics consultation: Evaluation and comparison with a University Hospital Service

1992 ◽  
Vol 92 (4) ◽  
pp. 346-351 ◽  
Author(s):  
John La Puma ◽  
Carol B. Stocking ◽  
Cheryl M. Darling ◽  
Mark Siegler
Keyword(s):  
Community Hospital ◽  
Ethics Consultation ◽  
University Hospital ◽  
Hospital Service ◽  
Hospital Ethics

scholarly journals Team members perspectives on conflicts in clinical ethics committees

2019 ◽  
Vol 26 (7-8) ◽  
pp. 2098-2112 ◽  
Author(s):  
Anika Scherer ◽  
Bernd Alt-Epping ◽  
Friedemann Nauck ◽  
Gabriella Marx
Keyword(s):  
Clinical Ethics ◽  
Ethical Issues ◽  
Research Question ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
Ethics Committee ◽  
University Hospitals ◽  
Clinical Ethics Committee ◽  
Clinical Ethics Committees ◽  
Ethical Conflicts

Background: Clinical ethics committees have been broadly implemented in university hospitals, general hospitals and nursing homes. To ensure the quality of ethics consultations, evaluation should be mandatory. Research question/aim: The aim of this article is to evaluate the perspectives of all people involved and the process of implementation on the wards. Research design and participants: The data were collected in two steps: by means of non-participating observation of four ethics case consultations and by open-guided interviews with 28 participants. Data analysis was performed according to grounded theory. Ethical considerations: The study received approval from the local Ethics Commission (registration no.: 32/11/10). Findings: ‘Communication problems’ and ‘hierarchical team conflicts’ proved to be the main aspects that led to ethics consultation, involving two factors: unresolvable differences arise in the context of team conflicts on the ward and unresolvable differences prevent a solution being found. Hierarchical asymmetries, which are common in the medical field, support this vicious circle. Based on this, minor or major disagreements regarding clinical decisions might be seen as ethical conflicts. The expectation on the clinical ethics committee is to solve this (communication) problem, but the participants experienced that hierarchy is maintained by the clinical ethics committee members. Discussion: The asymmetrical structures of the clinical ethics committee reflect the institutional hierarchical nature. They endure, despite the fact that the clinical ethics committee should be able to detect and overcome them. Disagreements among care givers are described as one of the most difficult ethically relevant situations and should be recognised by the clinical ethics committee. On the contrary, discussion of team conflicts and clinical ethical issues should not be combined, since the first is a mandate for team supervision. Conclusion: To avoid dominance by physicians and an excessively factual character of the presentation, the case or conflict could be presented by both physicians and nurses, a strategy that strengthens the interpersonal and emotional aspects and also integrates both professional perspectives.

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