263 Benefits of Structured Multi Disciplinary Medical Ethical Decision Making

Abstract

Background/aim: Until 2008, medical ethical decision making (MEDM) in the NICU lacked structure. Moral deliberation and effecting ethical decisions were not up to standard. A guideline to improve MEDM was developed, and evaluated one year after implementation. Method: The guideline consisted of multidisciplinary meetings presided by an independent chair, and uniform preparation and report. Meetings were structured following a five phase model: 1) exploration, 2) agreement on the ethical question, 3) analysis, 4) evaluating possible solutions, decision-making, 5) planning actions. Initially, health care workers (HCW) of the NICU were trained in ethical/legal aspects and practiced the method with a historical patient case. Before the training, HCW completed a 15-item questionnaire on ‘structure’, ‘role participants’, ‘parental representation’, ‘problems, solutions and deliberation’, and ‘decisions and documentation’. One year and 22 structured meetings after introduction, the same questionnaire was completed again. Results: Response before and after introduction of the guideline was 91/114 (80%) and 85/123 (69%) respectively. Nurses and physicians were equally represented in the two samples (N=63/63, and N=19/14; χ2=.601; p=.438). Evaluation of the guideline showed improvement in ‘structure of MEDM’ (p<.000 for all 5 items), ‘role participants’ (p<.000 for all 3 items), ‘parental representation’ (p<.000, for 1 item), and ‘problems, solutions and deliberation’ (p<.000, for 2 items; the 3rd item treatment options did not improve, p=.932). ‘Decisions and documentation’ showed no improvement (3 items, p=.215, p=.412 and p=.066 respectively). Conclusions: Ethical deliberation significantly improved after implementation of structured MEDM. Ongoing attention will be paid to ‘documentation of the decisions’.