Ethical Support Research Articles

Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses' Experiences.

Nurses working in municipal long-term care face ethical challenges that can lead to moral distress and discomfort for the nurse and affect the quality of patient care. Tools and methods that contribute to increased ethical awareness and support for nurses dealing with moral issues are lacking. Technological innovations may be suitable for ethics work, but little research has been conducted on how such solutions could be designed or their potential benefit. Therefore, this study contributes knowledge about the development and testing of a digital tool for ethics support among nurses. To investigate how digital ethical reflection can support ethics work among nurses working in long-term care. A digital ethical reflection tool was designed and tested in nursing homes and home nursing care in collaboration with two Norwegian municipalities. The study used sequential explanatory mixed-methods design. Over a 6-week period, at the end of each shift, nurses digitally reported the ethical challenges they had experienced. Their responses and experiences were described using descriptive statistics. Additionally, focus group interviews were conducted and analyzed using reflexive thematic analysis (TA). During the study period, 17 nurses reported a total of 223 registrations, with 24.8% stating that they had been in an ethically difficult situation. The digital reporting was perceived as practically applicable and helped to increase nurses' awareness of morally charged situations. The value of the registrations was found to depend on manager participation and the application of the obtained information. The participating nurses become aware that they lacked an arena for meaningful dialogue with and recognition from their manager. Information obtained through digital reflection can form the basis for ethical reflections at the departmental level. Digital reflection has the potential to become a tool for managers in their support for employees facing ethical challenges when providing long-term care.

An empirical support of Schopenhauer's ethics: A dynamic panel data analysis on developed and developing countries

This paper covers all main theoretical features of Schopenhauer's ethics (i.e., life satisfaction arising from art, compassion based on virtue of justice or virtue of loving, and compassion leading to asceticism) in an analytical model, it translates this analytical model into a statistical model by referring to empirical variables (i.e., household expenditures in recreation and culture for art, the Gini index for compassion based on virtue of justice; percentages of people nationally defined as poor for compassion based on virtue of loving; percentages of believers in Buddhism, Christianity, Hinduism, Islam, Judaism; governmental enrolments and expenditures in primary, secondary and tertiary education; and inter-generational equal access to Earth resources for compassion leading to asceticism), and it estimates this statistical model by using panel data at a country level for 99% of the world's population (i.e., 18% in 34 OECD developed countries and 81% in 128 non-OECD developing countries) from 2000 to 2020. Statistical results about reliability show that Schopenhauer's ethics is supported by observations (i.e., all predictions are confirmed within an each individual perspective with reliable variables depicting compassion based on virtue of justice, Christianity, and primary education) and it can explain the observed decreasing life satisfaction within an average individual perspective (i.e., believers in developed countries are showed to be decreased from 86% to 73% and compassion based on virtue of justice, art, and tertiary education turn out to be reliable). Mathematical results about feasibility show that some reliable principles of Schopenhauer's ethics can compensate for the decreasing life satisfaction at a cultural individual level (i.e., compassion based on virtue of justice, Christianity) and some of its reliable principles can compensate the decreasing life satisfaction at a representative individual level (i.e., compassion based on virtue of justice, art). Therefore, the methodological contribution of this paper is twofold. First, it provides an example of interdisciplinary science (i.e., contextual rather than topical, abductive rather than inductive, observational rather than experimental). Second, it highlights (theoretical and empirical) synergies between social (behavioural) sciences and (moral) philosophy: Schopenhauer's ethics turn out to be not only a normative philosophy (i.e., it suggests individual behaviours) but also a positive philosophy (i.e., it explains individual behaviours), within its virtue approach; Schopenhauer's ethics can explain the observed dynamics of life satisfaction at global level, if an utilitarian rather than a virtue approach is adopted.

Identifying Strategies to Overcome the Challenges of Implementing Islamic Accounting in Iran and Its Globalization

Objective: The objective of this study is to identify strategies to overcome the challenges of implementing Islamic accounting in Iran and explore its potential for globalization. Methodology: This qualitative study was conducted in Tehran, Iran, utilizing semi-structured interviews to gather data from 22 participants, including academics, accountants, financial managers, and policymakers. Participants were selected through purposive sampling to ensure a diverse range of insights. Data were analyzed using thematic analysis to identify key themes and subthemes related to the challenges and strategies for implementing Islamic accounting. The interviews were transcribed verbatim, and the data were coded and categorized to derive meaningful patterns and themes. Findings: The study identified several major challenges in the implementation of Islamic accounting in Iran, including regulatory issues, lack of standardization, deficiencies in knowledge and expertise, cultural barriers, and technological limitations. To address these challenges, the study proposes strategies such as policy reforms, enhanced training and education, development of unified standards, public awareness campaigns, technological advancements, and international collaborations. Additionally, the potential for the globalization of Islamic accounting is significant, driven by market demand for ethical finance, cultural compatibility, regulatory alignment, institutional support, technological integration, academic research, and stakeholder engagement. Conclusion: The successful implementation of Islamic accounting in Iran requires a multifaceted approach that addresses regulatory, educational, cultural, and technological challenges. By adopting the proposed strategies and leveraging the potential for globalization, Islamic accounting can be effectively integrated into Iran's financial systems and promoted internationally.

Privacidade e confidencialidade nos processos terapêuticos: presença da fundamentação bioética

Abstract This study discusses privacy and confidentiality in the areas of medicine and, particularly, mental health, arguing that the rights and duties encompassed by the two principles should be practiced in compliance to bioethics. Psychic knowledge was adopted to broaden our understanding regarding the importance of confidentiality in the therapeutic process. It emphasizes the connection between the technological and media changes of the last decades and the risk of compromising medical confidentiality, which would definitely affect the patient’s trust concerning information privacy. Finally, the text reflects on the relevancy of ethical support for health professionals, especially in cases where they must decide on whether or not to breach confidentiality.

Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act.

Clinical ethics support is a form of preventive ethics aimed at mediating ethics-related conflicts and managing ethical issues arising in the healthcare setting. However, limited evidence exists regarding the specific ethical issues in clinical practice. This study aimed to explore the diverse ethical issues of cases referred to clinical ethics support after the new legislation on hospice palliative care and end-of-life decision-making was implemented in Korea in 2018. A retrospective study of cases referred to clinical ethics support at a university hospital in Korea from February 2018 to February 2021 was conducted. The ethical issues at the time of referral were analyzed via qualitative content analysis of the ethics consultation-related documents. A total of 60 cases of 57 patients were included in the study, of whom 52.6% were men and 56.1% were older than 60 years of age. The majority of cases (80%) comprised patients from the intensive care unit. One-third of the patients were judged as being at the end-of-life stage. The most frequent ethical categories were identified as goals of care/treatment (78.3%), decision-making (75%), relationship (41.7%), and end-of-life issues (31.7%). More specifically, best interests (71.7%), benefits and burdens/harms (61.7%), refusal (53.3%), and surrogate decision-making (33.3%), followed by withholding or withdrawal (28.3%) were the most frequent ethical issues reported, which became diversified by year. In addition, the ethical issues appeared to differ by age group and judgment of the end-of-life stage. The findings of this study expand the current understanding of the diverse ethical issues including decision-making and goals of care/treatment that have been referred to clinical ethics support since the enforcement of the new legislation in Korea. This study suggests a need for further research on the longitudinal exploration of ethical issues and implementation of clinical ethics support in multiple healthcare centers.

A Concept Analysis of Moral Comfort in Nursing

Introduction: Nurses are the most trusted professional group in the United States. As such, examination and exploration of concepts or phenomena, either positively or negatively affecting nurses’ ethical decision-making and moral actions, are needed. While nursing literature is abundant on moral distress and its negative impact, literature on moral comfort (a positive phenomenon) is sparsely available. The purpose of this concept analysis is to explore MC within nursing literature and other disciplines to identify moral comfort’s defining attributes, antecedents, consequences, and empirical referents. Method: Walker and Avant’s eight-step concept analysis approach was used. Results: Six articles were included in this concept analysis. Two defining attributes emerged (the nurse’s willingness to take moral action despite personal consequences and peace of mind related to taking moral action. Antecedents included internal factors (moral commitment, moral competence and moral courage with nursing experience and expertise) and external factors (administrative support/empowerment, participation in decision-making, access to information and human/material resources, ethical climate, and role clarity/boundaries). The main consequence of moral comfort is nurses’ peace of mind. Empirical referents were: 1) nurses taking action by speaking out and questioning, 2) nurses’ verbalization of feelings of peace and/or satisfaction with their decisions and actions, 3) organizational ethical climate and support and 4) nurses’ individual moral qualities and expertise. Conclusion: Although the body of knowledge was limited, the results of this concept analysis provide a foundation for future exploration, examination, and expansion of our knowledge and understanding of moral comfort in nursing.

A typology of nurses' interaction with relatives in emergency situations.

In nursing homes, residents' relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. The present analysis aimed at elaborating a typology of nurses' experience of ethical support and challenges in their interaction with relatives in emergency situations. Thirty-three semi-structured interviews and six focus groups were conducted with nurses from different nursing homes in Germany. Data were analysed according to Mayring's method of qualitative content analysis. Participants were licensed nurses working in nursing homes. Ethical approval was granted by Ostfalia University of Applied Sciences (02.07.2020) and the Ethics Committee of Hannover Medical School (Nr. 8866_BO_K_2020; 27.01.2020). Interviewees were anonymised and focus group were pseudonymised during transcription. All participants provided written consent. In emergency situations, relatives can represent important sources of support for nurses. However, they may also give rise to different challenges, relating to four ethical conflicts: (1) the challenge of meeting the information needs of relatives while providing appropriate care to all residents; (2) the challenge of managing relatives' demands for hospitalisation when hospitalisation is not deemed necessary by nurses; (3) the challenge of managing relatives' demands for lifesaving treatment when such treatment contradicts the will of the resident; and (4) the challenge of attempting to initiate hospitalisation when relatives oppose this course of action. Several external factors make these conflicts especially challenging for nurses: fear of legal consequences, a low staffing ratio, and a lack of qualified nursing staff. Conflict between nurses and relatives typically revolves around hospitalisation and the initiation of lifesaving treatment. Whether nurses perceive interaction with relatives as supportive or conflictual essentially depends on the quality of the relationship, which may be negatively influenced by a number of external factors.

Reflecting on Ethical Processes and Dilemmas in Doctoral Research

This paper discusses ethical dilemmas from an early-career researcher perspective, drawing upon doctoral research experiences—my own. The doctoral study involved life-history interviews with five primary-school-teacher mothers. During the study, ethical dilemmas arose that were not considered by me or in the official university ethical processes. This left me feeling vulnerable in the data-collection period and overwhelmed with concerns for the well-being of participants and for myself as researcher. This paper draws on my journal entries and reflections; detailed reflections of the pre-, during and post-fieldwork stages were collected (totalling over 600 entries). The paper utilizes critical incidents analysis to explore two ethical dilemmas from the data collection phase. Findings include personal reflections on experiences of university processes and the mismatch between the metaphor of ethics as a ‘hurdle’ on a smooth track to completion, and the real-life incidents and dilemmas that followed ethical approval. Recommendations are made for a consideration of doctoral ethical dilemma support and the limitations of formal ethics processes in UK universities.

280 PERCEIVED NEED FOR A CLINICAL ETHICS SUPPORT SERVICE AT AN IRISH UNIVERSITY HOSPITAL

Abstract Background Ethics are the set of moral principles that guide a person’s behaviour. Ethical issues are a key component of healthcare and frequently arise in the management of hospitalized older patients. To improve decision-making and reduce burden on individual hospital staff, Clinical Ethics Support Services (CESS) have been widely-integrated into care pathways internationally. However, the need for CESS has received little attention in Irish hospitals. Methods A cross-sectional analysis of the ethical situation and CESS readiness at a tertiary hospital in Ireland was collected from July-October 2021 and in February 2022 via hard copies and online collection (SurveyMonkey). Both clinical (medicine, nursing other patient care role) and non-clinical (administrative, clerical, ICT, HR, general support staff and management) staff participated. Descriptive statistics were assessed taking the valid percentages, mean 5-item Likert scores and Friedman Test mean rank for ten ranked statements. Results In total, 199 people (13% response rate) completed the survey. Staff were largely (76%) clinical and the majority were qualified >10 years (57%). In all, 78% reported that ethical issues arise in the role (83% clinical staff, 59% non-clinical staff). Most (63%) were unsure who to contact about ethical concerns, instead seeking informal advice from colleagues (>90%). The majority of participants were interested in additional ethical training, especially on decision-making capacity (mean interest 4.18 out of 5), strategies for working with challenging patient/family situations (4.07 out of 5) and end-of-life care (4.06 out of 5). Out of ten options assessed, participants preferenced the development of a formal clinical ethics committee over education and training or the provision of educational materials. Conclusion Ethical issues commonly arise when caring for older hospitalized patients. This study found a perceived need and widespread interest in additional education as well as formal approaches to develop a hospital-based CESS, centred around a formal committee structure.

Improving outcomes for patients with lymphoma: design and development of the Australian and New Zealand Lymphoma and Related Diseases Registry

BackgroundLymphoma is a malignancy of lymphocytes and lymphoid tissues comprising a heterogeneous group of diseases, with up to 80 entities now described. Lymphoma is the 6th most common cancer in Australia, affecting patients of all ages, with rising incidence rates. With the proliferation of efficacious novel agents, therapeutic strategies are increasingly diverse and survival is improving. There is a clear need for contemporary robust and detailed data on diagnostic, investigational and management strategies for this disease in Australia, New Zealand and worldwide, to inform and benchmark local and international standards of care. Clinical quality registries can provide these data, and support development of strategies to address variations in management, including serving as platforms for clinical trials and other research activities. The Lymphoma and Related Diseases Registry (LaRDR) was developed to capture details of patient demographics, disease characteristics, and management throughout their disease course and therapy and to develop outcome benchmarks nationally and internationally for lymphoma. This report describes the aims, development and implementation of the LaRDR, as well as challenges addressed in the process.MethodsThe LaRDR was established in 2016 as a multicentre, collaborative project at sites across Australia with a secure online database which collects prospective data on patients with a new diagnosis of lymphoma or chronic lymphocytic leukaemia (CLL). LaRDR development required multidisciplinary participation including specialist haematology, information technology, and biostatistical support, as well as secure funding. Here we describe the database development, data entry, ethics approval process, registry governance and support for participating sites and the coordinating centre.ResultsTo date more than 5,300 patients have been enrolled from 28 sites in Australia and New Zealand. Multiple challenges arose during the development, which we describe, along with approaches used to overcome them. Several confirmed international collaborations are now in place, and the registry is providing valuable data for clinicians, researchers, industry and government, including through presentations of results at major national and international conferences.ConclusionChallenges in establishing the LaRDR have been successfully overcome and the registry is now a valuable resource for lymphoma clinicians, researchers, health economists and others in Australia, New Zealand and globally.

Defining the role of facilitated mediation in medical treatment decision-making for critically ill children in the Australian clinical context

In this article, we explore alternative conflict resolution strategies to assist families and clinicians in cases of intractable dissent in paediatric health care decision-making. We focus on the ethical and legal landscape using cases from the Australian jurisdiction in New South Wales, while referencing some global sentinel cases. We highlight a range of alternative means of addressing conflict, including clinical ethics support, and contrast and contextualise facilitative or interest-based mediation, concluding that legal intervention via the courts can be protracted and distressing and should be a ‘last resort’. We acknowledge many might view this as the current status quo, but we go further to recommend strategies optimal for all parties to recognise early signs of conflict and prevent its harmful escalation. While more empirical research is needed, we contend that interest-based mediation may be a valuable adjunctive method of conflict resolution. If judiciously distinguished from and utilised with clinical ethical support, it can be an effective tool to address dissent and its negative sequelae in paediatric healthcare decision-making.

How to deal with moral challenges around the decision-making competence in transgender adolescent care? Development of an ethics support tool

BackgroundDecision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics support tool to assist care providers when dealing with moral challenges around decision-making competence in transgender adolescent care.MethodsThe study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the structure and content of the tool was constructed and discussed in two focus group meetings, after which four care providers tested the tool and additional feedback was collected from the team and an advisory board. The final tool was presented to all Dutch care providers in transgender adolescent care.ResultsCare providers expressed a need for guidance in defining and assessing decision-making competence. Main moral challenges concerned discussing fertility options with young clients, dealing with co-occurring mental health difficulties and the decision-making role of parents. The final tool, named the Competence Consultant, is an interactive pdf containing four parts: (1) Clarify information; (2) Identify doubts and moral questions; (3) Guidance for conversations and (4) Overview and Conclusions.DiscussionDeveloping an ethics support tool in a controversial care setting is highly relevant as it aims to help individual care providers in defining, discussing and dealing with their moral challenges in actual practice. The ‘Competence Consultant’ for transgender care providers contributes to their moral sensitivity and moral competence. It is an example of the development of innovative and integrative forms of thematic ethics support.

The Implementation of Assisted Dying in Quebec and Interdisciplinary Support Groups: What Role for Ethics?

The purpose of this text is to tell the story of the implementation of the Act Respecting End-of-Life Care, referred to hereafter as Law 2 (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's Ministère de la santé et des services sociaux (MSSS). As established, ISGs provide "clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)" (Gouvernement du Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations.

Convergence and Divergence in Canadian Ethics Support Services

This article discusses clinical ethics consultation (CEC), and thereby ethics support services in the Canadian context. Commonalities and differences between the three models of ethics support and CEC shared in this article are identified, set within the broader context of the Canadian healthcare system, accreditation, and professionalization of practicing healthcare ethicists.

Moral Dilemmas of Dutch Prison Staff; a Thematic Overview from All Professional Disciplines

ABSTRACT Prison staff face situations with conflicting interests and values. To strengthen craftsmanship Dutch prison staff reflected upon personal moral dilemmas during Moral Case Deliberation (MCD) sessions. This research aims to gain systematic insight into themes and moral dilemmas Dutch prison staff encounter. Evaluation-forms of 171 MCD-sessions were collected (N = 1065 MCD-participants, N = 171 MCD-facilitators) from 22 teams of different professional disciplines at 3 locations. Our qualitative thematic content analysis included 154 moral dilemmas. We noted the organizational level and professional disciplines the moral dilemmas related to, and how dilemmas were formulated. All professional disciplines within prison work show to encounter a wide range of moral dilemmas, which emerge in and between all organizational levels. “Security” and “cooperation” were frequently mentioned themes, while dilemmas relating to the rehabilitation of prisoners were underrepresented. Some formulations of moral dilemmas were based on frustrations toward colleagues or the organization, expressed “powerlessness” to change practice, or contained normative arguments instead of an open formulation. These insights call for structural facilitation of methods for prison staff to deal with moral dilemmas. Ethics Support Services (ESS), such as MCD-sessions, can be used to further strengthen the moral craftsmanship of prison staff.

The Investigator’s Dilemma - A Review of Social Media Analytics Research Ethics in Information Systems

Social media have become not only integral parts of our private and professional lives, but also an indispensable source of data for empirical research across a variety of academic disciplines. Applying a Social Media Analytics (SMA) methodology, however, imposes heavy ethical challenges on researchers. Scholars in the Information Systems (IS) discipline must deal with a patchwork of ethical frameworks, regulations, and (missing) institutional support. To initiate a debate on how to develop a common understanding of SMA research ethics, this paper compiles a scoping review of extant literature and suggests a research agenda for IS scholarship on this matter. The review yields a total of eight fundamental principles of ethical SMA research, which provide a starting point to guiding individual researchers towards more ethical conduct. At the same time, this work unearths a multitude of intricate dilemmas that are currently unresolved. The findings of this review will encourage IS scholarship to find its own voice in the debate about social media research ethics.

In old people's homes, carers face Covid-19

Many ethical issues were raised by the pandemic crisis. Caregivers were under great pressure and stress in their work in residential care facilities for the dependent elderly (Ehpad), both with residents and their families. The implementation of ethical support tools was only gradual, particularly for the management of residents' deaths. Anxiety has set in among all the people working or living in the Ehpad, blurring interpersonal relations and increasing tensions and professional exhaustion.

MAXIMIZING WORKPLACE EFFICIENCY AND COLLABORATION: THE IMPACT OF COFFEE BREAKS ON PRODUCTIVITY AND TEAM DYNAMICS

This study investigates the impact of specialty coffee on workplace coffee breaks, with a focus on worldwide trends and its unique influence in Saudi Arabia. Specialty coffee has grown in popularity around the world due to its outstanding quality, precise sourcing, and distinct flavor profiles. With the emergence of specialty coffee, coffee breaks have been transformed into chances for increasing work productivity and establishing great team environments. Specialty coffee boosts employee happiness, contentment, and engagement by giving a more sensory experience. Its precise sourcing and roasting techniques can also improve cognitive function and focus, resulting in increased productivity at work. Furthermore, the emphasis in specialty coffee on sustainability and social responsibility connects with employees, instilling a feeling of purpose and pride. Practical strategies for implementing specialty coffee into office coffee breaks are reviewed, including ethical sourcing, variety, employee education, and community support. The findings emphasize the significance of embracing specialty coffee as a global trend and capitalizing on its potential to generate significant and delightful coffee break experiences in a variety of workplace cultures, including Saudi Arabia.

Digital Dialogue in Learning: Cognitive, Social, Existential Features and Risks

Digitalization of socio-cultural phenomena, including the education system, generates transformations of their qualitative characteristics and parameters, which requires research from the standpoint of methodological analysis and assessment of their possible consequences on humans and society. A significant element of the digital environment, in general, and educational, in particular, is the dialogue, the role of which has both cognitive and ideological, existential, social aspects. The purpose of the research is a philosophical analysis of the digital transformation of dialogue in the context of the educational process, an assessment of its potential and impact on the individual. The research methodology has a complex, interdisciplinary character and is associated with the application of an existential approach to understanding the essence of dialogue (M. Bakhtin, M. Buber, G. Marcel, E. Levinas), the theory of the development of individual thinking by L.S. Vygotsky, developed by the author of the theories of electronic (digital) culture and based on modern developments in the field of the introduction of digital tools in education. The study shows that dialogue in the digital learning environment becomes not so much a form of rapprochement, integration of subjects, as a form of autonomy, isolation, individuals, which changes the nature of learning and has social and existential consequences. This creates the need to transform the digital learning environment when using it from the position of supplementing it with ethical, socio-psychological and emotional components and support tools for the student. Based on the existential-axiological analysis, the positive and risky features of digital dialogue as one of the phenomena of electronic culture and online learning tools are revealed. The concept of digital dialogue in learning, the characteristics of its features, functions, role and influence on the learner in the digital environment are presented. The difficulties of dialogic learning characteristic of the digital environment are revealed, recommendations of a methodological and methodical nature for application in the education system are presented.

Ethical issues in oncology practice: a qualitative study of stakeholders’ experiences and expectations

BackgroundClinical Ethics Support Services (CESS) have been established to support healthcare professionals in addressing ethically sensitive issues in clinical practice and, in many countries, they are under development. In the context of growing CESS, exploring how healthcare professionals experience and address clinical ethics issues in their daily practice represents a fundamental step to understand their potential needs. This is even more relevant in the context of extremely sensitive diseases, such as cancer. On this basis, we carried out a qualitative study conducting in-depth semi-structured interviews with stakeholders of a major comprehensive cancer centre in Italy, with the twofold aim of investigating what ethical issues arise in the context of clinical oncology and how they are addressed, as well as stakeholders’ expectations about a potential CESS to be implemented within the Institution.MethodsThe study was conducted within the theoretical framework of Grounded Theory. Participants were healthcare professionals and other key stakeholders working within the cancer centre. The semi-structured interview aimed at exploring common ethical aspects of oncology, investigating stakeholders’ professional experience in dealing with clinical ethics issues, their expectations and requests regarding ethics support services. Transcripts of the interviews were coded and analysed according to the principles of Grounded Theory.ResultsTwenty-one stakeholders were interviewed. Our analysis showed a wide consensus on the identification of ethically relevant issues, above all those concerning communication, end-of-life, and resource allocation. The absence of institutional tools or strategies to address and manage ethical issues at the patient bedside emerged, and this is reflected in the widespread request for their development in the future. The ideal support service should be fast and flexible in order to adapt to different needs and clinical cases.ConclusionsThe interviewees showed a limited degree of ‘ethical awareness’: despite having reported many issues in clinical practice, they could hardly identify and describe the ethical aspects, while complaining about a lack of ethical resources in their management. To build a truly effective support service, it therefore seems appropriate to take such context into consideration and address the emerged needs. Ethical sensitivity seems to be key and it becomes even more relevant in critical clinical areas, such as the therapeutic pathways of terminally ill patients.