Advertisement

HEC Forum

, Volume 26, Issue 2, pp 147–158 | Cite as

Do Organizational and Clinical Ethics in a Hospital Setting Need Different Venues?

  • Reidun Førde
  • Thor Willy Ruud Hansen
Article

Abstract

The structure of ethics work in a hospital is complex. Professional ethics, research ethics and clinical ethics committees (CECs) are important parts of this structure, in addition to laws and national and institutional codes of ethics. In Norway all hospital trusts have a CEC, most of these discuss cases by means of a method which seeks to include relevant guidelines and laws into the discussion. In recent years many committees have received more cases which have concerned questions of principle. According to Ellen Fox and co-authors the traditional CEC model suffers from a number of weaknesses. Therefore, in their organization a separate body deals with organizational matters. In this paper, we discuss what is gained and what is lost by creating two separate bodies doing ethics consultation. We do this through an analysis of detailed minutes of CEC discussions in one CEC during a 6-year period. 30 % of all referrals concerned matters of principle. Some of these discussions originated in a dilemma related to a particular patient. Most of the discussions had some consequences within the hospital organization, for clinical practice, for adjustment of guidelines, or may have influenced national policy. We conclude that a multiprofessional CEC with law and ethics competency and patient representation may be well suited also for discussion of general ethical principles. A CEC is a forum which can help bridge the gap between clinicians and management by increasing understanding for each others’ perspectives.

Keywords

Ethics committee Clinical ethics Organizational ethics Independency 

References

  1. Agich, G. J., (2013). Education and the improvement of clinical ethics services. Medical Education, 13:41 http://www.biomedcentral.com/1472-6920/13/41.
  2. Davis, L., & Hudson, L. D. (1999). Why don’t physicians use ethics consultations? Journal of Clinical Ethics, 10(2), 116–125.Google Scholar
  3. Dörries, A. (2003). Mixed feelings: Physicians concerns about clinical ethics committees in Germany. HEC Forum, 15, 245–257.CrossRefGoogle Scholar
  4. Førde, R., & Hansen, T. W. R. (2009). Involving patients and relatives in a Norwegian clinical ethics committee: what have we learned? Clinical Ethics, 4, 121–130.CrossRefGoogle Scholar
  5. Førde, R., & Pedersen, R. (2011). Clinical ethics committees in Norway: What do they do, and does it make a difference? Cambridige Quaterly of Healthcare Ethics, 20, 389–395.CrossRefGoogle Scholar
  6. Førde, R., Pedersen, R., & Akre, V. (2008). Clinicians’ evaluation of clinical ethics consultations in Norway: A qualitative study. Medicine, Health Care and Philosophy, 11, 17–25.CrossRefGoogle Scholar
  7. 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
  8. Fox, E., Bottrell, M. M., Berkowitz, K. A., Chanko, B. L., Foglia, M. B., & Pearlman, R. A., (2012). Integrated ethics: An innovative program to improve ethics quality in health care. The Innovation Journal: The public Sector Innovation Journal, 15(2), article 8:1–29.Google Scholar
  9. Koch, T. (2012). Thieves of virtue. Cambridge, MA: MIT Press.Google Scholar
  10. Magelssen, M., Pedersen, R., Førde, R. (2013). Sources of bias in clinical ethics case deliberation. Journal of Medical Ethics. doi: 10.1136/medethics-2013-101604.
  11. Mørland, B., Ringard, A., & Røttingen, J. A. (2010). Supporting tough decisions in Norway: A healthcare system approach. International Journal of Technology Assessment in Health Care, 26, 398–404.CrossRefGoogle Scholar
  12. 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
  13. Singer P. A., Pellegrino E. D., & Siegler M., (2001). Clinical ethics revisited. BMC Medical Ethics, 2:1. http://www.biomedcentral.com/1472-6939/2/1.

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Center for Medical EthicsUniversity of OsloOsloNorway
  2. 2.Department of Neonatology, Women’s and Children’s Division and Clinical Ethics Committee, Oslo University Hospital and Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOlsoNorway

Personalised recommendations