Relevance of the Clinical Ethics Committee (CEC) for Clinical Staff of a Specialized Neurological Clinic

Abstract

Clinical ethics committees (CECs) have been implemented in German clinics since the 1990s. Besides problems with the integration into clinical routines, CECs result in an enrichment and relief for employees and relatives. Investigating the current status of CECs in specialized neurological clinics is crucial because changes in therapy goals towards palliative care are often requested and the treatment team is sometimes overwhelmed with clarifying the presumed patient's wishes. So far, however, there have been no studies that have examined the work of the CEC and its importance for clinical staff in specialized neurological clinics. In a single-center, prospective observational study, 161 clinic employees with contact to the patients and 10 members of the CEC were asked about their previous experiences and impressions with and in the CEC. At the same time, 31 patients were retrospectively identified for whom an ethical case consultation was carried out by the CEC in 2019. A qualitative evaluation was carried out for the protocols of the ethical case counseling. 56% of the clinic employees and 90% of the CEC members considered the CEC as enrichment for the clinic. Although more than a third of the clinic employees evaluated the CEC as a relief during difficult ethical decisions, the presence of the CEC in particular for relatives and employees is described as insufficient. In the majority, a reduction in the hierarchy by the CEC was confirmed by the members of the CEC (70%), whereas the majority of the clinic employees increasingly denied this (55%). The CEC recommendation was implemented in 94% of the cases. A central problem in working with and within a CEC is maybe the lack of presence and information for employees. Due to this lack of presence, the CEC is not sufficiently visible in everyday clinical practice.