scholarly journals Applying ethical dimensions in clinical dilemmas

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S159-S159
Author(s):  
Rachel Swain ◽  
Kazeem Owudunni ◽  
Graham Behr ◽  
Jo Emmanuel ◽  
Matt Malherbe
Keyword(s):  
Decision Making ◽  
Clinical Ethics ◽  
Case Reports ◽  
Ethics Committee ◽  
Careful Consideration ◽  
Diverse Range ◽  
North West ◽  
Clinical Ethics Committee ◽  
Wide Range ◽  
Inform Decision Making

AimsCentral and North West London's Clinical Ethics Committee (CEC) offers a non-judgmental space to discuss ethical concerns and challenges and provide ethical guidance. This project aims to publicise these ethical dilemmas and guidance to inform decision making trust-wide.BackgroundA Clinical Ethics Committee (CEC) encompasses a diverse range of figures, from psychiatrists and general practitioners to members of the clergy and experts by experience. The CEC in Central and North West London have been meeting regularly since 2003 to provide ethical assistance to a wide range of medical, surgical and psychiatric teams. Complex ethical cases are presented by the treating team, allowing a subsequent discussion of the ethical theories and frameworks within the case with the committee members. This synthesis of information can then assist the treating team in the shaping of ethical based solutions to their dilemmas.The committee wished to encourage ethical based clinical thinking within the trust and enable others to learn from the valuable insights already provided by the CEC over the years.MethodCase notes, recorded from the last 17 years of meetings of the Clinical Ethics Committee were reviewed. 98 cases were identified between 2003-2019. The contemporaneous case reports were then anonymised and indexed into one easy to use file. This file was published on the local intranet and publicised to staff.ResultThe cases were compiled into a PDF document which is available for all staff members within the trust on the intranet. This resource is open to all clinical staff, and serves the dual purpose of encouraging ethical-based thinking and also promoting the ethics committee to those who might be in need of assistance.ConclusionClinical decisions can be complex and nuanced, often complicated by multiple viewpoints and ways of thinking. The database demonstrates the use of ethical dimensions by the ethics committee to inform decision making in a series of varied clinical and management dilemmas. The project required careful consideration around preservation of confidentiality as well as overcoming the logistical barriers of trust-wide dissemination. The result is a document that will allow ethical based decision-making to be embedded into everyday practice.

scholarly journals Living bioethics, clinical ethics committees and children's consent to heart surgery

2021 ◽  
pp. 147775092110341
Author(s):  
Priscilla Alderson ◽  
Deborah Bowman ◽  
Joe Brierley ◽  
Martin J. Elliott ◽  
Romana Kazmi ◽  
...  
Keyword(s):  
Clinical Ethics ◽  
Heart Surgery ◽  
Social Research ◽  
Ethics Committees ◽  
Companion Paper ◽  
Ethics Committee ◽  
Research Report ◽  
Discussion Paper ◽  
Clinical Ethics Committee ◽  
Clinical Ethics Committees

This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests and rights. Different approaches to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees.

scholarly journals Clinical ethics committees in nursing homes: what good can they do? Analysis of a single case consultation

2021 ◽  
pp. 096973302110032
Author(s):  
Morten Magelssen ◽  
Heidi Karlsen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Clinical Ethics ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Clinical Ethics Committee ◽  
Clinical Ethics Committees ◽  
Home Context ◽  
Case Consultation ◽  
Research Interviews

Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer to this question must begin with an understanding of how a clinical ethics committee might be beneficial in a nursing home context – to patients, next of kin, professionals, managers, and the institution. With the present article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to stakeholders in a nursing home context? We describe in depth a clinical ethics committee case consultation deemed successful by stakeholders, then reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics committee members and interviewed stakeholders consented to study participation, and also gave specific approval for the publication of the present article. Findings/results: Six different roles played by the clinical ethics committee in the case consultation are described: analyst, advisor, support, moderator, builder of consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research is needed to examine whether clinical ethics committees might be suitable as ethics support structures in nursing homes and community care.

Setting up a student clinical ethics committee

2012 ◽  
Vol 7 (2) ◽  
pp. 51-53 ◽  
Author(s):  
Carolyn Johnston ◽  
Christopher Williams ◽  
Charlotte Dias ◽  
Amelia Lapraik ◽  
Leila Marvdashti ◽  
...  
Keyword(s):  
Clinical Ethics ◽  
Ethics Committee ◽  
Clinical Ethics Committee

scholarly journals Physicians’ and nurses’ expectations and objections toward a clinical ethics committee

2013 ◽  
Vol 20 (7) ◽  
pp. 771-783 ◽  
Author(s):  
Maximiliane Jansky ◽  
Gabriella Marx ◽  
Friedemann Nauck ◽  
Bernd Alt-Epping
Keyword(s):  
Clinical Ethics ◽  
Ethical Issues ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
Ethics Committee ◽  
University Hospital ◽  
Sufficient Information ◽  
Interprofessional Communication ◽  
Clinical Ethics Committee ◽  
Ethical Conflicts

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account.

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