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Clinical and Organisation Ethics: Implications for Healthcare Practice

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Key Concepts and Issues in Nursing Ethics

Abstract

Clinical and organisation ethics are relatively new forms of ethical governance in healthcare. Clinical ethics identifies and addresses ethical challenges arising in the clinical setting, while organisation ethics addresses ethical issues relating to the management and financial operation of healthcare institutions. The following discussion will examine each in turn.

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Notes

  1. 1.

    For reasons of space, a discussion of managed care and its implications will not be included here.

  2. 2.

    These committees are known in the US and Canada as Health Care Ethics Committees (HCECs) and in the UK and Europe as Clinical Ethics Committees (CECs). The terms ‘Clinical Ethics Service’ (CES) or ‘Clinical Ethics Support Service’ (CESS) are increasingly used in the literature, and will be used in this chapter, to denote both.

  3. 3.

    Please see Appendix 15.1 at the end of this chapter.

  4. 4.

    This case-study takes as its point of departure a case described by (Finder 2008). The facts of the case have been reproduced, but the outcome has been changed substantially, with the author’s permission.

  5. 5.

    In 1995, the Joint Commission: Accreditation, Health Care, Certification (JCAHO) introduced an accreditation standard which required organisations to have a mechanism for addressing organisation ethics issues.

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Authors and Affiliations

  1. School of Medicine, National University of Ireland, Galway, Ireland

    Louise Campbell

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  1. Louise Campbell
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Correspondence to Louise Campbell .

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Editors and Affiliations

  1. Vice President for Equality & Diversity, National University of Ireland, Galway, Ireland

    P. Anne Scott

Appendix 15.1

Appendix 15.1

Jonsen Sieler and winslade’s ‘Fur-Box’ method for analysing ethically- challenging situations (2006).

Medical indications (beneficence and non-maleficence)

Patient preferences (autonomy)

What is the patient’s medical problem? History? Diagnosis? Prognosis?

Is the problem acute? Chronic? Critical? Emergent? Reversible?

What are the goals of treatment?

What are the probabilities of success?

What are the plans in case of therapeutic failure?

In sum, how can this patient benefit from medical/nursing/psychiatric care, and how can harms be avoided?

Is the patient mentally capable and legally competent? Is there evidence of incapacity?

If competent, what treatment preferences is the patient stating?

Has the patient been informed of benefits, risks, understood this information, and given consent?

If incapacitated, who is the appropriate surrogate? Is the surrogate using appropriate standards for decision-making?

Has the patient expressed prior preferences (e.g., an advance directive?)

Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

In sum, is the patient’s ethical and legal right to autonomous choice being respected to the fullest possible extent?

Quality of life (principle of beneficence, non-maleficence, respect for autonomy)

Contextual features (principles of loyalty and fairness)

What are the prospects, with or without treatment, for a return to a normal life?

What physical, mental and social deficits are likely to result if treatment succeeds?

Are there biases which might prejudice the provider’s evaluation of the patient’s quality of life?

Is the patient’s present or future condition such that his continued life could be considered undesirable?

Is there any plan or rationale to forego treatment?

Are there any plans for palliative or comfort care?

Are there family issues which might influence the patient’s treatment decisions?

Are there provider issues – physicians and nurses – which might influence treatment decisions?

Are there financial and economic factors involved?

Are there religious or cultural factors involved?

Are there limits on confidentiality?

Are there problems of resource allocation?

How does the law influence treatment decisions?

Is clinical research or teaching involved?

Is there any conflict of interest on the part of providers or the institution?

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Campbell, L. (2017). Clinical and Organisation Ethics: Implications for Healthcare Practice. In: Scott, P. (eds) Key Concepts and Issues in Nursing Ethics. Springer, Cham. https://doi.org/10.1007/978-3-319-49250-6_15

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  • DOI: https://doi.org/10.1007/978-3-319-49250-6_15

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