Clinical Ethics Consultation in Germany: History, Current Status and Models of Training

Abstract

In Germany, clinical ethics consultation (CEC) has developed over the past 20 years into a well-established professional service, particularly in German hospitals, but with growing frequency and impact also in nursing homes and out-patient facilities. The most common organizational form is a “clinical ethics committee” of five to twenty members. Clinical ethics committees are engaged in individual case consultations (both prospective and retrospective), in the development of ethics guidelines and policies for the hospital, and in open sessions for training and exchange about ethical issues in the healthcare institution. From the very beginning, the development and implementation of ethics consultation services has strongly been influenced and supported by the Academy of Ethics in Medicine (AEM), the German association for medical ethics. AEM started several national training programs for ethics consultants, implemented a curriculum for ethics consultation, and is offering a process of certification for individuals to prove their qualification in the field of ethics consultation. AEM provided national standards for ethics consultation and passed recommendations and guidelines on pivotal issues: How to document individual case consultations, how to evaluate ethics consultation services and use the evaluation for quality improvement (QI), and how to develop and implement ethics guidelines and policies for the healthcare institution.