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HEC Forum

, 23:193 | Cite as

Institutional Challenges for Clinical Ethics Committees

  • Andrea Dörries
  • Pierre Boitte
  • Ana Borovecki
  • Jean-Philippe Cobbaut
  • Stella Reiter-Theil
  • Anne-Marie Slowther
Article

Abstract

Clinical ethics committees (CECs) have been developing in many countries since the 1980s, more recently in the transitional countries in Eastern Europe. With their increasing profile they are now faced with a range of questions and challenges regarding their position within the health care organizations in which they are situated: Should CECs be independent bodies with a critical role towards institutional management, or should they be an integral part of the hospital organization? In this paper, we discuss the organizational context in which CECs function in Europe focusing on five aspects. We conclude that in Europe clinical ethics committees need to maintain a critical independence while generating acceptance of the CEC and its potential benefit to both individuals and the organization. CECs, perhaps particularly in transitional countries, must counter the charge of “alibi ethics”. CECs must define their contribution to in-house quality management in their respective health care organization, clarifying how ethical reflection on various levels serves the hospital and patient care in general. This last challenge is made more difficult by lack of consensus about appropriate quality outcomes for CECs internationally. These are daunting challenges, but the fact that CECs continue to develop suggests that we should make the effort to overcome them. We believe there is a need for further research that specifically addresses some of the institutional challenges facing CECs.

Keywords

Clinical ethics committees Organizational ethics Clinical ethics consultation Quality management Evaluation 

Notes

Acknowledgments

The authors are all members of the ECEN (European Clinical Ethics Network) where this topic was discussed during one of the regular meetings. The ECEN is a network with experts in clinical ethics from various European countries. We thank the members of ECEN for their helpful comments concerning the drafting of this paper.

References

  1. Aleksandrova, S. (2008). Survey on the experience in ethical decision-making and attitude of Pleven University Hospital physicians towards ethics consultation. Medicine, Health Care and Philosophy, 11, 35–42.CrossRefGoogle Scholar
  2. Argyris, C. H., & Schön, D. A. (1996). Organizational learning II: Theory, method, and practice. Reading, MA: Addison-Wesley (reprinted with correction).Google Scholar
  3. Beck, S., van de Loo, A., & Reiter-Theil, S. (2008). A “little bit illegal”: Withholding and withdrawing of mechanical ventilation in the eyes of German intensive care physicians. Medicine Health Care and Philosophy, 11(1), 7–16.CrossRefGoogle Scholar
  4. Beyleveld, D., Brownsword, R., & Wallace, S. (2002). Clinical ethics committees: Clinician support or crisis management? HEC Forum, 14, 13–25.Google Scholar
  5. Boitte, P. (2005). For an ethical function in hospitals. In C. Viafora (Ed.), Clinical bioethics. A search for the foundations (pp. 169–180). Dordrecht: Springer.CrossRefGoogle Scholar
  6. Borovecki, A., Oreskovic, S., & ten Have, H. (2005). Ethics and the structures of health care in the European countries in transition: hospital ethics committees in Croatia. British Medical Journal, 331, 227–229.CrossRefGoogle Scholar
  7. Borovecki, A., ten Have, H., & Oreskovic, S. (2006). Ethics and the European countries in transition—the past and the future. Bulletin of Medical Ethics, 214, 15–20.Google Scholar
  8. Care Quality Commission. Our strategy: 2010–2015. (2009). London CQC 2009. Retrieved December 1, 2009, from http://www.cqc.org.uk/_db/_documents/full_strategic_plan_consultation_document_200910011532.pdf.
  9. Cobbaut, J. (2009). Communauté de pratiques, action collective et réflexivité. In M. Maesschalck (Ed.), Ethique et gouvernance, Les enjeux actuels d’une philosophie de normes (pp. 251–267). Hildesheim: OLMS.Google Scholar
  10. Dörries, A. (2003). Mixed feelings: Physicians’ concerns about clinical ethics committees in Germany. HEC Forum, 3, 245–257.CrossRefGoogle Scholar
  11. Dörries, A., & Hespe-Jungesblut, K. (2007). Die Implementierung klinischer Ethikberatung in Deutschland. Ergebnisse einer bundesweiten Umfrage in Krankenhäusern. Ethik in der Medizin, 19, 148–156.CrossRefGoogle Scholar
  12. Ells, C. (2006). Healthcare ethics committee’s contribution to review of institutional policy. HEC Forum, 18, 265–275.CrossRefGoogle Scholar
  13. Foerde, R., Pedersen, R., & Akre, V. (2008). Clinicians’ evaluation of clinical ethics consultations in Norway: A tool for quality improvement. Medicine, Health Care and Philosophy, 11, 1.CrossRefGoogle Scholar
  14. Foglia, M. B., Pearlman, R., Bottrell, M., Altemose, J. K., & Fox, E. (2009). Ethical challenges within veterans administration healthcare facilities: Perspectives of managers, clinicians, patients, and ethics committee chairpersons. American Journal of Bioethics, 9, 28–36.Google Scholar
  15. Fox, E., & Tulsky, J. A. (1996). Evaluation research and the future of ethics consultation. Journal of Clinical Ethics, 7, 146–149.Google Scholar
  16. Fox, E., Myers, S., & Pearlman, R. A. (2007). Ethics consultation in United States hospitals: A national survey. American Journal of Bioethics, 7, 13–25.Google Scholar
  17. Gefenas, R. (2001). Is “failure to thrive” syndrome relevant to Lithuanian healthcare ethics committees? HEC Forum, 4, 381–392.CrossRefGoogle Scholar
  18. Hurst, S. A., Hull, S. C., DuVal, G., & Danis, M. (2005). How physicians face ethical difficulties: A qualitative analysis. Journal of Medical Ethics, 31, 7–14.CrossRefGoogle Scholar
  19. Hurst, S., Reiter-Theil, S., Slowther, A., Pegoraro, R., Foerde, R., & Danis, M. (2007). Physicians’ access to ethics support services in four European countries. Health Care Analysis, 15, 321–335.CrossRefGoogle Scholar
  20. Hurst, S. A., Reiter-Theil, S., Slowther, A., Pegoraro, R., Foerde, R., & Danis, M. (2008). Should ethics consultants help clinicians face scarcity in their practice? Journal of Medical Ethics, 34, 241–246.CrossRefGoogle Scholar
  21. Kooperation für Transparenz und Qualität im Gesundheitswesen (KTQ). Retrieved August 17, 2010, from http://www.ktq.de.
  22. Kuczewski, M. G. (1999). When your healthcare ethics committee “fails to thrive”. HEC Forum, 3, 197–207.CrossRefGoogle Scholar
  23. MacRae, S. K., Fox, E., & Slowther, A. (2008). Clinical ethics and system thinking. In P. A. Singer & A. M. Viens (Eds.), The Cambridge textbook of bioethics (pp. 313–321). New York: Cambridge University Press.CrossRefGoogle Scholar
  24. Molewijk, A., Abma, T., Stolper, M., et al. (2008). Teaching ethics in the clinic. The theory and practice of moral case deliberation. Journal of Medical Ethics, 34, 120–124.CrossRefGoogle Scholar
  25. Nelson, W. A., Neily, J., Mills, P., & Weeks, W. B. (2008). Collaboration of ethics and patient safety programs: Opportunities to promote quality care. HEC Forum, 20(1), 15–27.CrossRefGoogle Scholar
  26. Newson, A. J., Neitzke, G., & Reiter-Theil, S. (2009). Editorial: The role of patients in European clinical ethics consultation. Clinical Ethics, 4, 109–110.CrossRefGoogle Scholar
  27. Nilson, E. G., & Fins, J. J. (2006). Reinvigorating ethics consultations: An impetus from the “quality” debate. HEC Forum, 18, 298–304.CrossRefGoogle Scholar
  28. Opel, D. J., Wilfond, B. S., Brownstein, D., Diekema, D. S., & Pearlman, R. A. (2009). Characterisation of organisational issues in paediatric clinical ethics consultation: A qualitative study. Journal of Medical Ethics, 35, 477–482.CrossRefGoogle Scholar
  29. Pearson, S. D., Sabin, J. E., & Emanuel, E. J. (2003). No mission, no margin. Health-care organizations and the quest for ethical excellence (pp. 27–28). New York: Oxford University Press.Google Scholar
  30. Reiter-Theil, S. (2000). Ethics consultation on demand: Concepts, practical experiences and a case study. Journal of Medical Ethics, 26, 198–203.CrossRefGoogle Scholar
  31. Reiter-Theil, S. (2009). Dealing with the normative dimension in clinical ethics consultation. Cambridge Quarterly Healthcare Ethics, 18(4), 347–348.CrossRefGoogle Scholar
  32. Siegler, M. (1986). Ethics committees: Decisions by bureaucracy. Hastings Cent Report, 16, 22–24.CrossRefGoogle Scholar
  33. Singer, P. A., Pellegrino, E. D., & Siegler, M. (2001). Clinical ethics revisited. BMC Medical Ethics, 2, 1.CrossRefGoogle Scholar
  34. Slowther, A., Bunch, C., Woolnough, B., & Hope, T. (2001). Clinical ethics support services in the UK: An investigation of the current provision of ethics support to health professionals in the UK. Journal of Medical Ethics, 27(suppII), i2–i8.CrossRefGoogle Scholar
  35. Steinkamp, N., & Gordijn, N. (2003). Ethical case deliberation on the ward. A comparison of four methods. Medicine Health Care and Philosophy, 6(3), 235–246.CrossRefGoogle Scholar
  36. Steinkamp, N., Gordjin, V., Borevecki, A., et al. (2007). Regulation of health care ethics committees in Europe. Medicine Health Care and Philosophy, 10(4), 461–475.CrossRefGoogle Scholar
  37. Vorstand der Akademie für Ethik in der Medizin e.V. (2010). Standards für Ethikberatung in Einrichtungen des Gesundheitswesens. Ethik in der Medizin, 22, 149–153.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Andrea Dörries
    • 1
  • Pierre Boitte
    • 2
  • Ana Borovecki
    • 3
  • Jean-Philippe Cobbaut
    • 4
  • Stella Reiter-Theil
    • 5
  • Anne-Marie Slowther
    • 6
  1. 1.Zentrum für Gesundheitsethik (ZfG)HannoverGermany
  2. 2.Centre d’Éthique MédicaleUniversité Catholique de LilleLilleFrance
  3. 3.School of Medicine, Andrija Stampar School of Public HealthUniversity of ZagrebZagrebCroatia
  4. 4.Centre d’Éthique MédicaleUniversité Catholique de LilleLilleFrance
  5. 5.Clinical Ethics Support & Accompanying Research, Institute for Bio- and Medical EthicsUniversity of BaselBaselSwitzerland
  6. 6.Clinical Ethics, Warwick Medical SchoolUniversity of WarwickCoventryUK

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