Ethics Support Services Research Articles

Perception of ethical aspects in psychiatric patient care: a pilot study

Research on staff perception of ethical aspects of psychiatric patient care are scarce; little is known about systematic supplies of ethics support in psychiatric institutions. The goal of this pilot study is to inform the implementation of Clinical Ethics Support Services in psychiatric institutions by assessing which topics of psychiatric practice are considered ethically challenging by the staff. Explorative survey as pilot study by questionnaire with clinical staff, quantitative (descriptive) and qualitative (coding) data-analysis. Involuntary treatment, the relationship between healthcare professionals and patients, staff shortage and the collaboration between the professions as well as dealing with patient relatives came up as ethical challenges. Clinical Ethics Support in psychiatric patient care should not only cover aspects that are specific for psychiatry, but also structural topics such as short resources, interprofessional collaboration and communication with relatives.

Clinical ethics support services: An evolving model

Ethical issues arising in clinical practice are complex and clinicians must be able to manage the needs of ethically vulnerable patients and families. This paper describes a model for providing Clinical Ethics Support Services as a broad spectrum of care for management of conflict and ethically difficult situations in health care and describes how an ethics consultation process was transformed to a Holistic Care Continuum for managing the needs of ethically vulnerable patients. During a 4-year journey at a regional medical center, a Family Support Team played a central role in identification of ethically vulnerable patients/family, interdisciplinary connectivity, and iterative engagement in the clinical milieu. Concepts of professional advocacy and interdisciplinary perspectives resulted in a model for ethically sound patient care promoting communication among patients/family, staff, and professionals; clarification of interdisciplinary roles and responsibilities; establishment of mutually derived goals and shared solutions; and implementation of interventions maximizing institutional resources.

THE PRACTICAL IMPORTANCE OF THEORY IN CLINICAL ETHICS SUPPORT SERVICES

BioethicsVolume 25, Issue 7 p. ii-iii THE PRACTICAL IMPORTANCE OF THEORY IN CLINICAL ETHICS SUPPORT SERVICES BERT MOLEWIJK, Corresponding Author BERT MOLEWIJK Department of Medical Humanities, EMGO+ Institute, VU University Medical Centre, Amsterdam, and institute for Mental Health Care in ZutphenBert Molewijk, Rm. D324, Dep. Medical Humanities (Division VI), Van der Boechorst straat 7, 1081 BT, Amsterdam, NL. E-mail: [email protected]Search for more papers by this authorANNE SLOWTHER, ANNE SLOWTHER Warwick Medical SchoolSearch for more papers by this authorMARK AULISIO, MARK AULISIO Department of Bioethics at Case, and the Centre for Biomedical Ethics at MetroHealth Medical Centre (Cleveland, Ohio)Search for more papers by this author BERT MOLEWIJK, Corresponding Author BERT MOLEWIJK Department of Medical Humanities, EMGO+ Institute, VU University Medical Centre, Amsterdam, and institute for Mental Health Care in ZutphenBert Molewijk, Rm. D324, Dep. Medical Humanities (Division VI), Van der Boechorst straat 7, 1081 BT, Amsterdam, NL. E-mail: [email protected]Search for more papers by this authorANNE SLOWTHER, ANNE SLOWTHER Warwick Medical SchoolSearch for more papers by this authorMARK AULISIO, MARK AULISIO Department of Bioethics at Case, and the Centre for Biomedical Ethics at MetroHealth Medical Centre (Cleveland, Ohio)Search for more papers by this author First published: 26 July 2011 https://doi.org/10.1111/j.1467-8519.2011.01917.xCitations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume25, Issue7Special Issue: Clinical ethics support services: theory, method, and practiceSeptember 2011Pages ii-iii RelatedInformation

EVIDENCE – COMPETENCE – DISCOURSE: THE THEORETICAL FRAMEWORK OF THE MULTI‐CENTRE CLINICAL ETHICS SUPPORT PROJECT METAP

In this paper we assume that 'theory' is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES. A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including 'how-to' questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics). In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three 'pillars' as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP. We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES.

Physicians’ Access to Ethics Support Services in Four European Countries

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P=0.001), or who had had ethics courses in medical school (P=0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensitivity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available.