Institutional Challenges for Clinical Ethics Committees
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.
KeywordsClinical ethics committees Organizational ethics Clinical ethics consultation Quality management Evaluation
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.
- Argyris, C. H., & Schön, D. A. (1996). Organizational learning II: Theory, method, and practice. Reading, MA: Addison-Wesley (reprinted with correction).Google Scholar
- Beyleveld, D., Brownsword, R., & Wallace, S. (2002). Clinical ethics committees: Clinician support or crisis management? HEC Forum, 14, 13–25.Google Scholar
- 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
- 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.
- 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
- 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
- Fox, E., & Tulsky, J. A. (1996). Evaluation research and the future of ethics consultation. Journal of Clinical Ethics, 7, 146–149.Google Scholar
- 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
- Kooperation für Transparenz und Qualität im Gesundheitswesen (KTQ). Retrieved August 17, 2010, from http://www.ktq.de.
- 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