Impact of clinical ethics support on daily practice—First‐line managers’ experiences in the Euro‐MCD project

AbstractThis study investigates the role of worldview in moral case deliberation (MCD). MCD is a form of clinical ethics support which aims to assist caregivers in reflection on moral dilemmas, experienced in daily practice. Bioethicists acknowledge that existential and religious aspects must be taken into account in the analysis of ethical questions, but it remains unclear how these elements are addressed in clinical ethics support. We investigated how facilitators of MCD address worldview in MCD. MCD facilitation is often done by spiritual caregivers, but not in their role as spiritual caregiver. Discussing worldview is no standard part of the procedure in MCD. This study was qualitative, focusing on the views and experiences of the facilitators of MCD. Semi-structured interviews (N = 12) were conducted with facilitators of MCD. Grounded theory was used for analysis. The results show that worldview plays both an explicit and an implicit role in the MCD process. The explicit role concerns the religious beliefs of patients and professionals. This calls for avoiding stereotyping and devoting attention to different visions. The implicit role comes to the fore in addressing core values and spiritual fulfillment. In order to clarify the fundamental nature of values, more explicit attention for worldview might be useful during MCD. However, this should be done with caution as the term ‘worldview’ might be interpreted by participants in terms of religious and personal beliefs, rather than as an invitation to reflect on one’s view of the good life as a whole.

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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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‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

Clinical Ethics ◽

10.1177/14777509211036649 ◽

2021 ◽

pp. 147775092110366

Author(s):

Harika Avula ◽

Mariana Dittborn ◽

Joe Brierley

Keyword(s):

Intensive Care ◽

Clinical Ethics ◽

Ethical Issues ◽

General Setting ◽

Daily Practice ◽

Paediatric Intensive Care ◽

Ethical Challenges ◽

Legal Cases ◽

Ethics Support ◽

The Uk

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.

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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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