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

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.

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Team members perspectives on conflicts in clinical ethics committees

Nursing Ethics ◽

10.1177/0969733019829857 ◽

2019 ◽

Vol 26 (7-8) ◽

pp. 2098-2112 ◽

Cited By ~ 2

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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POTENTIALITIES AND LIMITS OF THE CLINICAL ETHICS COMMITTEE AND NURSE PARTICIPATION: REFLECTIONS

Texto & Contexto - Enfermagem ◽

10.1590/1980-265x-tce-2018-0305 ◽

2020 ◽

Vol 29 ◽

Author(s):

Luciana Neves da Silva Bampi ◽

Lydia Feito Grande

Keyword(s):

Clinical Ethics ◽

Ethics Committees ◽

Well Being ◽

Ethics Committee ◽

Care Practice ◽

Clinical Ethics Committee ◽

School Of Medicine ◽

Ethical Conflicts ◽

History Of ◽

Key Participants

ABSTRACT Objective: to reflect on the importance of the participation of nurses in the Clinical Ethics Committee in Brazil and the knowledge required for this performance. Method: reflection based on experience of a postdoctoral internship carried out within the Department of Preventive Medicine, Public Health and History of Science of the School of Medicine of Universidad Complutense de Madrid, Madrid, Spain. Results: the Clinical Ethics Committee contributes to the improvement of health care provided by professionals and health institutions. The nurses are key participants, not only because they are professionals involved in the clinical practice, committed to the decision-making and the patient's performance, but also because they vision is necessary and irreplaceable in an environment of deliberation in which different perspectives and approximations for prudent resolution of ethical conflicts. Conclusion: if the nurses want to assume a strategic position, positively influencing the quality of care provided, protecting interests and ensuring the well-being of the users, they should assume as an urgent basis the need to develop the skills required to deal with ethical problems in the day-to-day of their care practice, accepting the responsibility to participate in the Clinical Ethics Committees, promoting their creation and inserting themselves into their activities.

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Living bioethics, clinical ethics committees and children's consent to heart surgery

Clinical Ethics ◽

10.1177/14777509211034145 ◽

2021 ◽

pp. 147775092110341

Author(s):

Priscilla Alderson ◽

Deborah Bowman ◽

Joe Brierley ◽

Martin J. Elliott ◽

Romana Kazmi ◽

...

Keyword(s):

Clinical Ethics ◽

Heart Surgery ◽

Social Research ◽

Ethics Committees ◽

Companion Paper ◽

Ethics Committee ◽

Research Report ◽

Discussion Paper ◽

Clinical Ethics Committee ◽

Clinical Ethics Committees

This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests and rights. Different approaches to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees.

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

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180109090598 ◽

2009 ◽

Vol 18 (4) ◽

pp. 397-405 ◽

Cited By ~ 3

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.

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Clinical ethics committees in nursing homes: what good can they do? Analysis of a single case consultation

Nursing Ethics ◽

10.1177/09697330211003269 ◽

2021 ◽

pp. 096973302110032

Author(s):

Morten Magelssen ◽

Heidi Karlsen

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Clinical Ethics ◽

Ethics Committees ◽

Ethics Committee ◽

Clinical Ethics Committee ◽

Clinical Ethics Committees ◽

Home Context ◽

Case Consultation ◽

Research Interviews

Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer to this question must begin with an understanding of how a clinical ethics committee might be beneficial in a nursing home context – to patients, next of kin, professionals, managers, and the institution. With the present article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to stakeholders in a nursing home context? We describe in depth a clinical ethics committee case consultation deemed successful by stakeholders, then reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics committee members and interviewed stakeholders consented to study participation, and also gave specific approval for the publication of the present article. Findings/results: Six different roles played by the clinical ethics committee in the case consultation are described: analyst, advisor, support, moderator, builder of consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research is needed to examine whether clinical ethics committees might be suitable as ethics support structures in nursing homes and community care.

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Evaluating the effectiveness of clinical ethics committees: a systematic review

Medicine Health Care and Philosophy ◽

10.1007/s11019-020-09986-9 ◽

2020 ◽

Author(s):

Chiara Crico ◽

Virginia Sanchini ◽

Paolo Giovanni Casali ◽

Gabriella Pravettoni

Keyword(s):

Systematic Review ◽

User Satisfaction ◽

Clinical Ethics ◽

Ethical Issues ◽

Ethics Consultation ◽

Ethics Committees ◽

Policy Formation ◽

Patient Treatment ◽

Main Function ◽

Clinical Ethics Committees

AbstractClinical Ethics Committees (CECs), as distinct from Research Ethics Committees, were originally established with the aim of supporting healthcare professionals in managing controversial clinical ethical issues. However, it is still unclear whether they manage to accomplish this task and what is their impact on clinical practice. This systematic review aims to collect available assessments of CECs’ performance as reported in literature, in order to evaluate CECs’ effectiveness. We retrieved all literature published up to November 2019 in six databases (PubMed, Ovid MEDLINE, Scopus, Philosopher’s Index, Embase and Web of Science), following PRISMA guidelines. We included only articles specifically addressing CECs and providing any form of CECs performance assessment. Twenty-nine articles were included. Ethics consultation was the most evaluated of CECs’ functions. We did not find standardized tools for measuring CECs’ efficacy, but 33% of studies considered “user satisfaction” as an indicator, with 94% of them reporting an average positive perception of CECs’ impact. Changes in patient treatment and a decrease of moral distress in health personnel were reported as additional outcomes of ethics consultation. The highly diverse ways by which CECs carry out their activities make CECs’ evaluation difficult. The adoption of shared criteria would be desirable to provide a reliable answer to the question about their effectiveness. Nonetheless, in general both users and providers consider CECs as helpful, relevant to their work, able to improve the quality of care. Their main function is ethics consultation, while less attention seems to be devoted to bioethics education and policy formation.

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An introduction to clinical ethics in psychiatry

BJPsych Advances ◽

10.1192/bja.2020.46 ◽

2020 ◽

Vol 27 (1) ◽

pp. 20-25

Author(s):

Gwen Adshead ◽

Jeremy Cave

Keyword(s):

Professional Development ◽

Royal College ◽

Clinical Ethics ◽

Ethical Dilemmas ◽

Continuing Professional Development ◽

Ethics Committees ◽

Ethics Committee ◽

Psychiatric Practice ◽

Clinical Ethics Committee ◽

Ethics In Psychiatry

SUMMARYThe Royal College of Psychiatrists’ continuing professional development (CPD) module on clinical ethics in psychiatry by Pearce & Tan describes some common ethical dilemmas in psychiatric practice and the work of clinical ethics committees in analysing these dilemmas. In this article we build upon their work and offer additional exploration of the nature of ethical dilemmas in psychiatry. We also build upon the models of reasoning that are described in the module and suggest ways for psychiatrists to think about ethical dilemmas when a clinical ethics committee is not available.

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Invoking the Law in Ethics Consultation

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100004497 ◽

1993 ◽

Vol 2 (4) ◽

pp. 457-467 ◽

Cited By ~ 6

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.

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Guest Editorial: Encouraging the Dialogue

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180109090537 ◽

2009 ◽

Vol 18 (4) ◽

pp. 333-337 ◽

Cited By ~ 3

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.

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Nurses performance in clinical ethics committees and commissions: An integrative review

Nursing Ethics ◽

10.1177/0969733017724611 ◽

2017 ◽

Vol 26 (3) ◽

pp. 688-699 ◽

Cited By ~ 4

Author(s):

Gabriela Menezes Gonçalves de Brito ◽

Darci de Oliveira Santa Rosa

Keyword(s):

Clinical Ethics ◽

Ethical Issues ◽

Ethics Committees ◽

Ethics Committee ◽

Integrative Review ◽

Clinical Ethics Committees ◽

The World ◽

Nursing Professionals ◽

Ethics Commissions ◽

Different Parts

Background: The research on nursing professionals in Clinical Ethics Committees and Nursing Ethics Commissions occurs in different parts of the world; however, little information on this subject is found in the literature. Objective: This study analyzed national and international publications in relation to the participation of nursing professionals in Clinical Ethics Committees. Research design: This was an integrative review of articles published in national and international journals between 1994 and 2016 which described the participation of nursing professionals in ethics commissions. Participants and research context: A total of 35 articles were selected. Discussion and conclusion for this article: The thematic categories were the need for time to discuss ethical issues; ethics committee to reduce the moral suffering of professionals; competencies required for participation; and barriers/difficulties and facilitators for implementation/ performance. It was concluded that professionals recognize the need for ethics committees to foster discussions. However, barriers hamper operation and fundamental competencies for participation. Communication of committee activities to professionals and educational activities may be major allies to improve the functioning of these committees.

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