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

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.

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

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.

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.

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 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.

An introduction to clinical ethics in psychiatry

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.

Will medically-assisted suicide mean the rebirth of (clinical) ethics committees in Italy?

2020 ◽  
Vol 88 (1_suppl) ◽  
pp. 26-30
Author(s):  
Carlo Petrini
Keyword(s):  
Clinical Ethics ◽  
Assisted Suicide ◽  
Ethics Committees ◽  
Criminal Code ◽  
Ethics Committee ◽  
Constitutional Court ◽  
Clinical Ethics Committees ◽  
Informed Decisions

The Italian Constitutional Court has held that, in certain specific circumstances, prosecution for assisted suicide, regulated by Article 580 of the Criminal Code, is not compatible with the Constitution. The circumstances in question relate to individuals who are being kept alive by life-sustaining treatments, who are fully capable of taking free, informed decisions and are suffering from irreversible conditions that are a source of intolerable physical or mental suffering. The Court has held that the Ethics Committees must assess a request for assisted suicide made by an individual meeting these conditions. The decision requires the identification of the Ethics Committee authorised to issue authorisation in such cases and a guarantee that these Ethics Committees are able to deal with this type of issue. The Court’s decision is an important opportunity to establish and promote clinical Ethics Committees, which are not nationally regulated in Italy and exist in very small numbers in only a few parts of the country.

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

2017 ◽  
Vol 26 (3) ◽  
pp. 688-699 ◽  
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.

Barriers and facilitators to consulting hospital clinical ethics committees

2011 ◽  
Vol 18 (6) ◽  
pp. 767-780 ◽  
Author(s):  
Alice Gaudine ◽  
Marianne Lamb ◽  
Sandra M LeFort ◽  
Linda Thorne
Keyword(s):  
Clinical Ethics ◽  
Nurse Managers ◽  
Ethics Committees ◽  
Structured Interview ◽  
Ethics Committee ◽  
Barriers And Facilitators ◽  
Clinical Ethics Committees ◽  
Interview Guide ◽  
Nurses And Physicians ◽  
Hospital Ethics

Hospitals in many countries have had clinical ethics committees for over 20 years. Despite this, there has been little research to evaluate these committees and growing evidence that they are underutilized. To address this gap, we investigated the question ‘What are the barriers and facilitators nurses and physicians perceive in consulting their hospital ethics committee?’ Thirty-four nurses, 10 nurse managers and 31 physicians working at four Canadian hospitals were interviewed using a semi-structured interview guide as part of a larger investigation. We used content analysis of the interview data related to barriers and facilitators to use of hospital ethics committees to identify nine categories of barriers and nine categories of facilitators. These categories as well as their subcategories are discussed and those specific to nurses or physicians are identified. The need to increase health professionals' use of clinical ethics committees through reducing barriers and maximizing facilitators is discussed.

scholarly journals Importance of systematic deliberation and stakeholder presence: a national study of clinical ethics committees

2019 ◽  
Vol 46 (2) ◽  
pp. 66-70 ◽  
Author(s):  
Morten Magelssen ◽  
Reidar Pedersen ◽  
Ingrid Miljeteig ◽  
Håvard Ervik ◽  
Reidun Førde
Keyword(s):  
Clinical Ethics ◽  
Large Scale ◽  
Evaluation Studies ◽  
Ethics Committees ◽  
National Study ◽  
Next Of Kin ◽  
Complex Activity ◽  
Stakeholder Satisfaction ◽  
Clinical Ethics Committees ◽  
Case Consultation

BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule.

scholarly journals Challenging misconceptions about clinical ethics support during COVID-19 and beyond: a legal update and future considerations

2021 ◽  
pp. medethics-2020-107092
Author(s):  
Joe Brierley ◽  
David Archard ◽  
Emma Cave
Keyword(s):  
Clinical Ethics ◽  
Ethics Committees ◽  
Treatment Decisions ◽  
Street Hospital ◽  
Clinical Ethics Support ◽  
Great Ormond Street Hospital ◽  
Clinical Ethics Committee ◽  
Ethics Support ◽  
Clinical Ethics Committees

The pace of change and, indeed, the sheer number of clinical ethics committees (not to be confused with research ethics committees) has accelerated during the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. The recent case of Great Ormond Street Hospital for Children NHS Foundation Trust v MX, FX and X ([2020] EWHC 1958 (Fam), [21]–[23] and [58]) has highlighted the importance of patient/family representation at clinical ethics committee meetings. The court viewed these meetings as making decisions about such treatment. We argue that this misunderstands the role of ethics support, with treatment decisions remaining with the clinical team and those providing their consent. The considered review by clinical ethics committees of the moral issues surrounding complex treatment decisions is not a matter of determining a single ethical course of action. In this article, we consider current legal understandings of clinical ethics committees, explore current concepts of ethics support and suggest how they may evolve, considering the various mechanisms of the inclusion of patients and their representatives in ethics meetings which is not standard in the UK.

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