Abstract

This paper provides a series of reflections on making the case to senior leaders for the introduction of clinical ethics support services within a UK hospital Trust at a time when clinical ethics committees are dwindling in the UK. The paper provides key considerations for those building a (business) case for clinical ethics support within hospitals by drawing upon published academic literature, and key reports from governmental and professional bodies. We also include extracts from documents relating to, and annual reports of, existing clinical ethics support within UK hospitals, as well as extracts from our own proposal submitted to the Trust Board. We aim for this paper to support other ethicists and/or health care staff contemplating introducing clinical ethics support into hospitals, to facilitate the process of making the case for clinical ethics support, and to contribute to the key debates in the literature around clinical ethics support. We conclude that there is a real need for investment in clinical ethics in the UK in order to build the evidence base required to support the wider introduction of clinical ethics support into UK hospitals. Furthermore, our perceptions of the purpose of, and perceived needs met through, clinical ethics support needs to shift to one of hospitals investing in their staff. Finally, we raise concerns over the optional nature of clinical ethics support available to practitioners within UK hospitals.

Highlights

  • This paper provides a series of reflections of an academic socio-ethicist’s (LM) and a senior clinician’s (MW) experiences of making the case for the introduction of Clinical Ethics Support Services (CESS) within a National Health Service (NHS) Trust

  • CESS in the United Kingdom (UK) has tended to be organised around clinical ethics committees, seminars, and conferences, whereas Scandinavian countries and the Netherlands have witnessed the rise of moral case deliberation and ethics reflection groups, and American hospitals usually have a clinical ethicist on hand for rapid reviews

  • The significance of research when making the case for CESS emerged when faced with the business case application

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Summary

Introduction

This paper provides a series of reflections of an academic socio-ethicist’s (LM) and a senior clinician’s (MW) experiences of making the case for the introduction of Clinical Ethics Support Services (CESS) within a National Health Service (NHS) Trust. We aim for this paper to support other ethicists and/or health care staff contemplating introducing CESS into NHS Trusts, to facilitate the process of making the case for CESS, and to contribute to the key debates in the literature around CESS. CESS in the UK has tended to be organised around clinical ethics committees, seminars, and conferences, whereas Scandinavian countries and the Netherlands have witnessed the rise of moral case deliberation and ethics reflection groups, and American hospitals usually have a clinical ethicist on hand for rapid reviews. A worrying finding for healthcare professionals facing ethical and moral challenges within a NHS that is under immense financial strain (Morley et al 2019) and delivering care at a time of great political uncertainty nationally and internationally

A Need for Clinical Ethics Support in the UK
Concluding Thoughts
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