A Survey of the Ethical Problems Faced by Healthcare Professionals and the Need for Clinical Ethics Consultation Services in University Hospitals in South Korea

Clinical bioethics is big business. There are now hundreds of people who “do” bioethics in community and university hospitals, nursing homes, rehabilitation and home care settings, and some (though quite a few less) who play the role of clinical ethics consultant to transplant teams, managed care companies, and genetic testing firms. Still, there is as much speculation about what clinically active bioethicists actually do as there was ten years ago. Various commentators have pondered the need for training standards, credentials, “certification” exams, and malpractice insurance for ethicists engaged in clinical consultation. Much of the discussion seems to accept an implicit presumption that all clinical ethics consultation practices look pretty much alike. But is this accurate? What do clinical ethicists do, how and where do they do it, and what kind of clinical ethics is useful in the hospital and in other settings?

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Clinical Ethics Consultation in Neurology – a case series

BMC Neurology ◽

10.1186/s12883-021-02244-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Benjamin Ilse ◽

Bernd Alt-Epping ◽

Albrecht Günther ◽

Jan Liman ◽

Alfred Simon

Keyword(s):

Decision Making ◽

Clinical Ethics ◽

Case Series ◽

Ethics Consultation ◽

Clinical Ethics Consultation ◽

Special Importance ◽

University Hospitals ◽

Best Interest ◽

Therapeutic Consequences ◽

Continue Medical

Abstract Background The concept of clinical ethics consultation (CECs) was implemented to provide support in ethical controversies in clinical settings and are offered in at least every second hospital in Germany. Neurological disorders often require complex decision-making. The aims of this study were to determine which situations lead to CEC in neurology and to investigate the influence of the individual patient’s wishes on the recommendation. Methods Standardised CEC protocols in the years 2011 to 2017 at the University Hospitals of Goettingen and Jena were retrospectively surveyed. The contents were categorised along existing protocol templates of CEC scenarios and subsequently paraphrased and reduced to significant meanings. Results 27 CEC scenarios which were facilitated by various professional disciplines were reviewed. Stroke was the most frequent underlying condition. Nearly all patients were not able to consent. Mostly, the relatives acted as representatives or health advocates. In 67 % of cases, a sense of conflict triggered a CEC; in 33 % a sense of uncertainty was the reason for the CEC request. In 21 CEC scenarios, a recommendation was reached in consensus with all parties involved. In 59 % of cases, a decision was made to continue medical therapy. In seven cases, the patient’s wishes led to a limitation of therapy, while in just two cases this decision was made primarily relying on the patient’s best interest. In only 13 % of cases, a valid advance directive led to respective therapeutic consequences. Conclusions CEC is feasible for consensus-finding not only in conflicts, but also in situations of therapeutic uncertainty in neurology. There is a special importance of the patient’s wishes in decision-making in neurology. However, only in a few cases were advance directives precise and specific enough to have sufficient and decisive weight in therapeutic decision-making.

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Development of Bioethics and Clinical Ethics in Bulgaria

Folia Medica ◽

10.1515/folmed-2017-0015 ◽

2017 ◽

Vol 59 (1) ◽

pp. 98-105 ◽

Cited By ~ 4

Author(s):

Silviya S. Aleksandrova-Yankulovska

Keyword(s):

Medical Ethics ◽

Clinical Ethics ◽

Ethics Education ◽

Ethics Consultation ◽

Clinical Ethics Consultation ◽

Medical Professionals ◽

Clinical Settings ◽

Choice Of Treatment ◽

The Subject ◽

Consultation Services

Abstract Background: Bioethics and clinical ethics emerged from the classical medical ethics in the 1970s of the 20th century. Both fields are new for the Bulgarian academic tradition. Aim: The aims of this paper were to demarcate the subject fields of medical ethics, bioethics, and clinical ethics, to present the developments in the field of medical ethics in Bulgaria, to delineate the obstacles to effective ethics education of medical professionals, and to present the results of the application of an adapted bottom-up methodology for clinical ethics consultation in several clinical units in Bulgaria. Materials and methods: Extended literature review and application of an adapted METAP methodology for clinical ethics consultation in six clinical units in the Northern Bulgaria between May 2013 and December 2014. Results: Teaching of medical ethics in Bulgaria was introduced in the 1990s and still stands mainly as theoretical expertise without sufficient dilemma training in clinical settings. Earlier studies revealed need of clinical ethics consultation services in our country. METAP methodology was applied in 69 ethics meetings. In 31.9% of them non-medical considerations affected the choice of treatment and 34.8% resulted in reaching consensus between the team and the patient. Participants’ opinion about the meetings was highly positive with 87.7% overall satisfaction. Conclusion: Development of bioethics in Bulgaria follows recent worldwide trends. Several ideas could be applied towards increasing the effectiveness of ethics education. Results of the ethics meetings lead to the conclusion that it is a successful and well accepted approach for clinical ethics consultation with a potential for wider introduction in our medical practice.

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A RETROSPECTIVE REVIEW OF CLINICAL ETHICS CONSULTATIONS REQUESTED BY NURSES FOR ONCOLOGY PATIENTS

Journal of Nursing ◽

10.18686/jn.v7i1.137 ◽

2018 ◽

Vol 7 (1) ◽

Author(s):

Colleen Mary Gallagher ◽

Megan Ball Neel ◽

Claudia R. Sotomayor

Keyword(s):

Clinical Ethics ◽

Ethics Education ◽

Ethics Consultation ◽

Clinical Ethics Consultation ◽

Code Status ◽

Appropriate Care ◽

Curative Care ◽

Appropriate Treatment ◽

Cancer Setting ◽

Consultation Services

<div>Background: With growing importance of clinical ethics in daily nursing practice, and the increasing occurrence and utilization of ethics consultation nationwide, awareness about the motives behind consults is vital to enhancing patient care.</div><div>Aim: to determine the predominant requests for ethics consultation from nurses in a cancer setting. </div><div>Design: This is a retrospective data review of the ethics consultations recorded in the clinical ethics consultation database. The data reviewed consist of the ethics consults requested by nurses from records in the database of consultations conducted from January 1, 2008 through July 31, 2013. </div><div>Findings: The predominant reason for requesting an ethics consult was the level of appropriate care with a total of 27 consults (28%). Within this topic, there were ten consults about the shift from curative care to palliative care, 13 about code status, 2 about general appropriate level of care and 2 regarding hospice.</div><div>Discussion: The data show that the nurses at this hospital had similar concerns as other nurses in the literature in that there were several requests for concerns regarding code status, informed consent, and appropriate treatment, including the decision to withhold or withdraw life-sustaining therapies.</div><div>Conclusion: Improving access to ethics consultation services access and the ethics education for nursing staff are necessary steps to improve confidence among them to engage more often with clinical ethics consultation. </div><div> </div>

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Clinical Ethics Consultation Services Questionnaire

PsycTESTS Dataset ◽

10.1037/t76232-000 ◽

2018 ◽

Author(s):

Virginia L. Bartlett ◽

Stuart G. Finder

Keyword(s):

Clinical Ethics ◽

Ethics Consultation ◽

Clinical Ethics Consultation ◽

Consultation Services

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Clinical ethics consultation in Europe: a comparative and ethical review of the role of patients

Clinical Ethics ◽

10.1258/ce.2009.009020 ◽

2009 ◽

Vol 4 (3) ◽

pp. 131-138 ◽

Cited By ~ 25

Author(s):

Véronique Fournier ◽

Eirini Rari ◽

Reidun Førde ◽

Gerald Neitzke ◽

Renzo Pegoraro ◽

...

Keyword(s):

Clinical Ethics ◽

Best Practice ◽

Patient Involvement ◽

Ethical Issues ◽

Ethics Consultation ◽

Clinical Ethics Consultation ◽

Ethical Review ◽

The Past ◽

Consultation Services

Clinical ethics has developed significantly in Europe over the past 15 years and remains an evolving process. While sharing our experiences in different European settings, we were surprised to discover marked differences in our practice, especially regarding the position and role of patients. In this paper, we describe these differences, such as patient access to and participation or representation in ethics consults. We propose reasons to explain these differences, hypothesizing that they relate to the historic and sociocultural context of implementation of clinical ethics consultation services (Cecs), as well as the initial aims for which each structure was established. Then, we analyse those differences with common ethical arguments arising in patient involvement. We conclude that there is no unique model of best practice for patient involvement in clinical ethics, as far as Cecs reflect on how to deal with the challenging ethical issues raised by patient role and position.

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Lessons learned from nurses’ requests for ethics consultation: Why did they call and what did they value?

Nursing Ethics ◽

10.1177/0969733016660879 ◽

2016 ◽

Vol 25 (5) ◽

pp. 601-617 ◽

Cited By ~ 3

Author(s):

Virginia L Bartlett ◽

Stuart G Finder

Keyword(s):

Quality Improvement ◽

Service Quality ◽

Quality Assessment ◽

Clinical Ethics ◽

Ethics Consultation ◽

Lessons Learned ◽

Clinical Ethics Consultation ◽

Consultation Service ◽

Consultation Services

Background: An ongoing challenge for clinical ethics consultation is learning how colleagues in other healthcare professions understand, make use of, and evaluate clinical ethics consultation services. Aim: In pursuing such knowledge as part of clinical ethics consultation service quality assessment, clinical ethics consultation services can learn important information about the issues and concerns that prompt colleagues to request ethics consultation. Such knowledge allows for greater outreach, education, and responsiveness by clinical ethics consultation services to the concerns of clinician colleagues. Design: This quality assessment project explores consultation requests and follow-up questionnaire responses voluntarily submitted from nurses who requested clinical ethics consultation. We present qualitative data analyzed using content analysis and constant comparison methods to identify key concerns that prompted requests as well as common themes among nurse requestors’ evaluations of what was most important in clinical ethics consultations. Participants and context: A total of 41 nurses requesting clinical ethics consultation and 15 who returned the follow-up questionnaire. Ethical considerations: Our Office of Research Compliance and Quality Improvement determined that our project was not considered human subjects research and so did not require institutional review board approval or exemption. However, efforts were made to avoid any sense of coercion and all data were de-identified prior to analysis. Findings: Our analysis revealed six main categories of issues that prompted nurses’ requests for ethics consultation, as well as unifying themes around nurses’ experiences, advocacy, and family support while caring for patients in the intersections of patients, families, and physicians. Discussion: The insights gained from analyzing nurses’ requests for and responses to clinical ethics consultation may serve as a resource for clinical ethics consultation services seeking to identify, respond to, and educate regarding issues of importance to nurse colleagues and may be a resource for nursing administrators and leadership seeking to identify and address common ethical issues nurses face. Conclusion: Ongoing work on clinical ethics consultation service quality improvement and engagement with our nursing colleagues about their concerns prompting—and their evaluations of—clinical ethics consultation are necessary.

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