Abstract
Internationally, the prevalence of clinical ethics support (CES) in health care has increased over the years. Previous research on CES focused primarily on ethics committees and ethics consultation, mostly within the context of hospital care. The purpose of this article is to investigate the prevalence of different kinds of CES in various Dutch health care domains, including hospital care, mental health care, elderly care and care for people with an intellectual disability. A mixed methods design was used including two survey questionnaires, sent to all health care institutions, two focus groups and 17 interviews with managing directors or ethics support staff. The findings demonstrate that the presence of ethics committees is relatively high, especially in hospitals. Moral case deliberation (MCD) is available in about half of all Dutch health care institutions, and in two-thirds of the mental health care institutions. Ethics consultants are not very prominent. A distinction is made between explicit CES forms, in which the ethical dimension of care is structurally and professionally addressed and implicit CES forms, in which ethical issues are handled indirectly and in an organic way. Explicit CES forms often go together with implicit forms of CES. MCD might function as a bridge between the two. We conclude that explicit and implicit CES are both relevant for clinical ethics in health care. We recommend research regarding how to combine them in an appropriate way.
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Aroskar, M. A. (1987). The prevalence and design of ethics committees in nursing homes. Journal of the American Geriatrics Society, 35(11), 1028–1033.
Bolmsjo, I. A., Edberg, A. K., & Sandman, L. (2006). Everyday ethical problems in dementia care: A teleological model. Nursing Ethics, 13(4), 340–359.
Brown, B. A., Miles, S. H., & Aroskar, M. A. (1987). The prevalence and design of ethics committees in nursing homes. Journal of the American Geriatrics Society, 35(11), 1028–1033.
Browning, D. M. (2011). Study for common things: Cultivating moral sense making on the front lines of practice. Journal of Medical Ethics,. doi:10.1136/medethics-2011-100084.
Chapin, M. K. (2010). The language of change: Finding words to define culture change in long-term care. Journal of Aging, Humanities and the Arts, 4, 185–199.
Chun-Chen, H., Ching-Sing, Y., & Ming-Tien, T. (2012). A multidimensional analysis of ethical climate, job satisfaction, organizational commitment, and organizational citizenship behaviors. Nursing Ethics, 19, 513.
Cox, B., & Roy, M. M. (1985). Nursing ethics can improve quality long term care: Forming an ethics committee. Journal American Health Care Association, 11(6), 48–51.
Dorries, A. (2007). Die Implementierung Klinischer Ethikberatung in Deutschland: Ergebnisse einer bundesweiten Umfrage bei Krankenhäusern. Ethik in der Medizin, 19, 148–156.
Flynn, A., & Anderson, C. (2012). Meaningful collaboration. Nursing Management, 43(12), 2–4.
Forde, R., & Pedersen, R. (2011). Clinical ethics committees in Norway: What do they do, and does it make a difference? Special section—Bioethics beyond borders. Cambridge Quarterly Health Care Ethics, 20, 389–395.
Fox, E., Myers, S., & Pearlman, R. (2007). Ethics consultation in United States hospitals: A national survey. American Journal of Bioethics, 7, 13–25.
Goldman, A., & Tabak, N. (2010). Perception of ethical climate and its relationship to nurses’demographic characteristics and job satisfaction. Nursing Ethics, 17, 233.
Greenfield, J. (2010). Understanding the lived experiences of patients: Application of a phenomenological approach to ethics. Physical Therapy, 90(8), 1185–1197.
Horner, R., & Kelly, T. B. (2007). Ethical decision-making in the helping profession: A contextual and caring approach. Journal of Religion and Spirituality Social Work, 26(1), 71–88.
Martin, M. (2000). Meaningful work: Rethinking professional ethics. New York: Oxford University Press.
Mertens, D. M. (2010). Research and evaluation in education and psychology: Integrating diversity with quantitative, qualitative and mixed methods. Thousand Oaks, California: Sage Publications.
Molewijk, B., Abma, T., Stolper, M., & Widdershoven, G. A. (2008). Teaching ethics in the clinic. The theory and practice of moral case deliberation. Journal of Medical Ethics, 34, 120–124.
Olson, L. L. (1995). Ethical climate in health care organizations. International Nursing Review, 42, 85–90.
Powers, B. A. (2005). Everyday ethics in assisted living facilitites: A framework for assessing resident-focused issues. Journal of Gerontological Nursing, 31(1), 31–37.
Reiter-Theil, S., Mertz, M., Schurmann, J., Stingelin Giles, N., & Meyer-Zehnder, B. (2011). Evidence-competence-discourse: The theoretical framework of the multi-centreclinical ethics support project METAP. Bioethics, 25, 403–412.
Roberts, M. (2004). Psychiatric ethics: A critical introduction for mental health nurses. Journal of Psychiatric and Mental Health Nursing, 11(5), 38–583.
Schluter, J., Winch, S., Holzhauser, K., & Henderson, A. (2008). Nurses’ moral sensitivity and hospital ethical climate: A literature review. Nursing Ethics, 15, 304–321.
Silen, M., Svantesson, M., Kjellstrom, S., Sidenvall, B., & Christensson, L. (2011). Moral distress and ethical climate in a Swedish nursing context: Perceptions and instrument usability. Journal of Clinical Nursing, 20, 3483–3493.
Slowther, A. (2007). Ethics consultation and ethics committees. In R. E. Ashcroft, A. Dawson, H. Draper, & J. R. McMillan (Eds.), Principles of health care ethics (pp. 527–534). Chichester, England: Wiley.
Slowther, A., Bunch, C., & Woolnough, B. (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, 2–8.
Slowther, A., Johnston, C., Goodall, J., & Hope, T. (2004). Development of clinical ethics committees: Support for dealing with ethical issues in clinical practice should be an integral part of patient care. British Medical Journal, 328, 950.
Slowther, A. M., McClimans, L., & Price, C. (2012). Development of clinical ethics services in the UK: A national survey. Journal of Medical Ethics, 38, 210–214.
Svantesson, M., Lofmark, R., & Thorsen, H. (2008). Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds. Journal of Medical Ethics, 34, 399–406.
van Dartel, J. N., Jacobs, M., & Jeurissen, R. J. M. (2002). Ethiek bedrijven in de zorg: Een zaak van het management. Assen: Van Gorcum.
van der Dam, S. (2012). Ethics support in institutional elderly care: A review of the literature. In S. S. Van der Dam (Ed.), Ethics support in elderly care: Developments and specific needs for ethics support, and an evaluation of moral case deliberation in two Dutch elderly care organizations. Maastricht: University press.
van der Dam, S., Abma, T. A., Kardol, M. J. M., & Widdershoven, G. A. M. (2012). ‘Here’s my dilemma’. Moral case deliberation as a platform for discussing everyday ethics in elderly care. Health Care Analysis, 20(3), 250–267.
van der Dam, S. S., Abma, T. A., Molewijk, A. C., Kardol, M. J., Schols, J. M., & Widdershoven, G. A. (2011). Organizing moral case deliberation in mixed groups: Experiences in two Dutch nursing homes. Nursing Ethics, 18(3), 327–340.
van Willigenburg, T., Verweij, M., Kleemans, C. H. M., & van der Kloot-Meijburg, H. H. (1991). Ethiek, levensbeschouwing en het management in instellingen voor intramurale gezondheidszorg. Utrecht: Nationaal Ziekenhuisinstituut.
Victor, B., & Cullen, J. B. (1987). A theory and measurement of ethical climate in organizations. Research in Corporate Social Performance and Policy, 9, 51–71.
Weidema, F. C., Molewijk, A. C., Kamsteeg, F., & Widdershoven, G. A. M. (2013). Aims and harvest in moral case deliberation. Nursing Ethics, 20(5), 617–631.
Youngner, S. J., Jackson, D. L., Coulton, C., Juknialis, B. W., & Smith, E. M. (1983). A national survey of hospital ethics committees. Critical Care Medicine, 11, 902–905.
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This article is a part of a research project financially supported by the Department of Ethics from the Dutch Ministry of Health, Welfare and Sports. We thank all respondents for their effort and their valuable contribution to this research.
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Dauwerse, L., Weidema, F., Abma, T. et al. Implicit and Explicit Clinical Ethics Support in The Netherlands: A Mixed Methods Overview Study. HEC Forum 26, 95–109 (2014). https://doi.org/10.1007/s10730-013-9224-2
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DOI: https://doi.org/10.1007/s10730-013-9224-2