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HEC Forum

, Volume 28, Issue 3, pp 261–272 | Cite as

Discussing End-of-Life Decisions in a Clinical Ethics Committee: An Interview Study of Norwegian Doctors’ Experience

  • Marianne K. Bahus
  • Reidun Førde
Article

Abstract

With disagreement, doubts, or ambiguous grounds in end–of-life decisions, doctors are advised to involve a clinical ethics committee (CEC). However, little has been published on doctors’ experiences with discussing an end-of-life decision in a CEC. As part of the quality assurance of this work, we wanted to find out if clinicians have benefited from discussing end-of-life decisions in CECs and why. We will disseminate some Norwegian doctors’ experiences when discussing end-of-life decisions in CECs, based on semi-structured interviews with fifteen Norwegian physicians who had brought an end-of-life decision case to a CEC. Almost half of the cases involved conflicts with the patients’ relatives. In a majority of the cases, there was uncertainty about what would be the ethically preferable solution. Reasons for referring the case to the CEC were to get broader illumination of the case, to get perspective from people outside the team, to get advice, or to get moral backing on a decision already made. A great majority of the clinicians reported an overall positive experience with the CECs’ discussions. In cases where there was conflict, the clinicians reported less satisfaction with the CECs’ discussions. The study shows that most doctors who have used a CEC in an end-of-life decision find it useful to have ethical and/or legal aspects illuminated, and to have the dilemma scrutinized from a new perspective. A systematic discussion seems to be significant to the clinicians.

Keywords

Clinical Ethics Committee (CEC) End-of-life decisions Law Evaluation Composition Conflicts 

Notes

Acknowledgments

We thank Kristin Weaver for her contribution and efficient work with the content. We also thank Attorney-at-Law Vegard Bahus (LL.M.) for valuable contributions to the discussion. The study was supported financially by South-Eastern Norway Regional Health Authority (Health Care Trust), Eckbos Legater and Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo.

Compliance with ethical standards

Conflict of interest

None.

References

  1. Agich, G. J. (2013). Education and the improvement of clinical ethics services. BMC Medical Education, 13, 41.CrossRefGoogle Scholar
  2. Bahus, M. K. (2013). Legers rettsanvendelse ved liv/død-beslutninger. Retfærd, 140, 46–68.Google Scholar
  3. Bahus, M. K. (2014). Beslutningsprosessen ved liv/død-avgjørelser En empirisk studie av et utvalg av norske legers handlingsvalg ved beslutninger om livsforlengende behandling skal gis eller ikke gis til alvorlig syke og døende pasienter (Akademika Forlag).Google Scholar
  4. Brierley, J., Linthicum, J. F., & Petros, A. (2013). Should religious beliefs be allowed to stonewall a secular approach to withdrawing and withholding treatment in children? Journal of Medical Ethics, 39(9), 573–577.CrossRefGoogle Scholar
  5. Dörries, A., Boitte, P., Borovecki, A., Cobbaut, J. P., Reiter-Theil, S., & Slowther, A. M. (2011). Institutional challenges for clinical ethics committees. Paris: HEC Forum.Google Scholar
  6. DuVal, G., Sartorius, L. F., Clarridge, B. F., Gensler, G. F., & Danis, M. (2001). What triggers requests for ethics consultations? Journal of Medical Ethics, 27, i24–i29.CrossRefGoogle Scholar
  7. Førde, R. (2008). Doctors and clinical ethics committees: Friends or foes? Bioethica Forum, 1, 45–50.Google Scholar
  8. Førde, R., & Hansen, T. W. R. (2009). Involving patients and relatives in a Norwegian clinical ethics committee: What have we learned? Clinical Ethics, 4(3), 125–130.CrossRefGoogle Scholar
  9. Førde, R., & Linja, T. (2015). “It scares me to know that we might not have been there!”: A qualitative study into the experiences of parents of seriously ill children participating in ethical case discussions. BMC Medical Ethics, 16, 40.CrossRefGoogle Scholar
  10. Førde, R., & Vandvik, I. H. (2005). Clinical ethics, information, and communication: Review of 31 cases from a clinical ethics committee. Journal of Medical Ethics, 31, 73–77.CrossRefGoogle Scholar
  11. Gacki-Smith, J., & Gordon, E. J. (2005). Residents’ access to ethics consultations: Knowledge, use, and perceptions. Academic Medicine, 80, 168.CrossRefGoogle Scholar
  12. Hamric, A. B., & Blackhall, L. J. (2007). Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Critical Care Medicine, 35, 422–429.CrossRefGoogle Scholar
  13. Hurst, S. A., Perrier, A. F., Pegoraro, R. F., Reiter-Theil, S., Førde, R., Slowther, A. M., et al. (2007a). Ethical difficulties in clinical practice: Experiences of European doctors. Journal of Medical Ethics, 33, 51–57.CrossRefGoogle Scholar
  14. Hurst, S. A., Reiter-Theil, S., Perrier, A., Perrier, A. F., Førde, R., Slowther, A. M., et al. (2007b). Physicians’ access to ethics support services in four European countries. Health Care Analysis, 15, 321.CrossRefGoogle Scholar
  15. Jansky, M., Marx, G., Nauck, F., & Alt-Epping, B. (2013). Physicians’ and nurses’ expectations and objections toward a clinical ethics committee. Nursing Ethics, 20, 771–783.CrossRefGoogle Scholar
  16. Kalager, G., Førde, R., & Pedersen, R. (2011). Is the discussion of patient cases in clinical ethics-committees useful? Tidsskrift for den Norske Laegeforening, 131(2), 118–121.CrossRefGoogle Scholar
  17. Kvale, S., & Brinkmann, S. (2009). InterView Introduktion til et håndværk (2nd ed.). København: Hans Reitzels Forlag.Google Scholar
  18. Marcus, B. S., Shank, G. F., Carlson, J. N., & Venkat, A. (2015). Qualitative analysis of healthcare professionals’ viewpoints on the role of ethics committees and hospitals in the resolution of clinical ethical dilemmas. HEC Forum, 27, 11–34.CrossRefGoogle Scholar
  19. Mickelsen, R. A., Bernstein, D. S., Marshall, M. F., & Miles, S. H. (2013). The Barnes case: Taking difficult futility cases public. Journal of Law, Medicine & Ethics, 41, 374–378.CrossRefGoogle Scholar
  20. Pfäfflin, M. F., Kobert, K. F., & Reiter-Theil, S. (2009). Evaluating clinical ethics consultation: A European perspective. Cambridge Quarterly Healthcare Ethics, 18, 406–419.CrossRefGoogle Scholar
  21. Reiter-Theil, S. (2003). Balancing the perspectives. The patient's role in clinical ethics consultation. Medicine, Health Care and Philosophy, 6(3), 247–254.CrossRefGoogle Scholar
  22. Swetz, K. M., Crowley, M. E., Hook, C. C., & Mueller, P. S. (2007). Report of 255 clinical ethics consultations and review of the literature. Mayo Clinic Proceedings, 82(6), 686–691.CrossRefGoogle Scholar
  23. Trotochaud, K., Coleman, J. R., Krawiecki, N., & McCracken, C. (2015). Moral distress in pediatric healthcare providers. Journal of Pediatric Nursing,. doi: 10.1016/j.pedn.2015.03.001.Google Scholar
  24. Whitehead, P. B., Herbertson, R. K., Hamric, A. B., Epstein, E. G., & Fisher, J. M. (2015). Moral distress among healthcare professionals: Report of an institute-wide survey. Journal of Nursing Scholarship, 47(2), 117–125.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.School of Business and Law, Department of LawUniversity of AgderKristiansandNorway
  2. 2.Faculty of Medicine, Centre for Medical Ethics, Institute of General Practice and Community MedicineUniversity of OsloOsloNorway

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