Medicine, Health Care and Philosophy

, Volume 11, Issue 1, pp 17–25 | Cite as

Clinicians’ evaluation of clinical ethics consultations in Norway: a qualitative study

  • Reidun FørdeEmail author
  • Reidar Pedersen
  • Victoria Akre
Scientific Contribution


Clinical ethics committees have existed in Norway since 1996. By now all hospital trusts have one. An evaluation of these committees’ work was started in 2004. This paper presents results from an interview study of eight clinicians who evaluated six committees’ deliberations on 10 clinical cases. The study indicates that the clinicians found the clinical ethics consultations useful and worth while doing. However, a systematic approach to case consultations is vital. Procedures and mandate of the committees should be known to clinicians in advance to ensure that they know what to expect. Equally important is bringing all relevant facts, medical as well as psychosocial, into the discussion. A written report from the deliberation is also important for the committees to be taken seriously by the clinicians. This study indicates that the clinicians want to be included in the deliberation, and not only in the preparation or follow-up. Obstacles for referring a case to the committee are the medical culture’s conflict aversion and its anxiety of being judged by outsiders. The committees were described as a court by some of the clinicians. This is a challenge for the committees in their attempt to balance support and critique in their consultation services.


clinical ethics committee clinical ethics consultation conflicts evaluation procedures 


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  1. Aasland O.G., Førde R.: 2005, Impact of Feeling Responsible for Adverse Events on Doctors’ Personal and Professional Lives: The Importance of Being Open to Criticism from Colleagues. Quality & Safety in Health Care 14(1):13–17CrossRefGoogle Scholar
  2. Akre V., Falkum E., Hoftvedt B.O., Aasland O.G.: 1997, The Communication Atmosphere Between Physician Colleagues: Competitive Perfectionism or Supportive Dialogue? A Norwegian Study. Social Science and Medicine 44(4):519–526PubMedCrossRefGoogle Scholar
  3. Denzin N.K., Lincoln Y.S. (eds.) (2005). The Sage Handbook of Qualitative Research. Thousand Oaks, CA: SAGEGoogle Scholar
  4. DuVal G., Sartorius L., Clarridge B., Gensler G., Danis M.: 2001, What Triggers Requests for Ethics Consultations? Journal of Medical Ethics 27 (suppl 1) i24–i29PubMedCrossRefGoogle Scholar
  5. Førde R., Vandvik I.H.: 2005, Clinical Ethics, Information, and Communication: Review of 31 Cases from a Clinical Ethics Committee. Journal of Medical Ethics 31:73–77PubMedCrossRefGoogle Scholar
  6. Gacki-Smith J., Gordon E.J.: 2005, Residents’ Access to Ethics Consultations: Knowledge, Use, and Perceptions. Academic Medicine 80(2):168–175PubMedCrossRefGoogle Scholar
  7. Goldie J., Schwartz L., McCionnachie A., Morrison J.: 2003, Students’ Attitudes and Potential Behaviour with Regard to Whistle Blowing as they Pass Through a Modern Medical Curriculum. Medical Education 37(4):368–375PubMedCrossRefGoogle Scholar
  8. Hurst S.A., Hull S.C., DuVal G., Danis M.: 2005, How Physicians Face Ethical Difficulties: A Qualitative Analysis. Journal of Medical Ethics 31(1):7–14PubMedCrossRefGoogle Scholar
  9. Kalvemark S., Hoglund A.T., Hansson M.G., Westerholm P., Arnetz B.: 2004, Living with Conflicts-Ethical Dilemmas and Moral Distress in the Health Care System. Social Science and Medicine 58(6):1075–1084PubMedCrossRefGoogle Scholar
  10. Kvale S.: 1996, Interviews. An Introduction to Qualitative Research Interviewing. London: SAGE publicationsGoogle Scholar
  11. Light D.W.: 1988, Towards a New Sociology of Medical Education. Journal of Health and Social Behaviour 29:307–322CrossRefGoogle Scholar
  12. Malterud K.: 1996, ‹Kvalitative metoder i medisinsk forskning. En innføring.’ (Qualitative Methods in Medical Research. An Introduction.) Oslo: Tano AschehougGoogle Scholar
  13. Miles M., Huberman A.M.: 1994, Qualitative Data Analysis. An Expanded Sourcebook. London: SAGE publicationsGoogle Scholar
  14. National Center for Ethics in Health Care: 2005, Ethics Consultations. Responding to Ethics Concerns in Health Care. Veteran Health AdministrationGoogle Scholar
  15. Orlowski J.P., Hein S., Christensen J.A., Meinke R., Sincich T.: 2006, Why Doctors Use or Do Not Use Ethics Consultation. Journal of Medical Ethics 32(9):499–503PubMedCrossRefGoogle Scholar
  16. Pedersen R., Førde R.: 2005, What are the Norwegian Clinical Ethics Committees Doing? The Journal of the Norwegian Medical Association 125(22):3127–3129Google Scholar
  17. Pinnock R., Crosthwaite J.: 2004, The Auckland Hospital Ethics Committee: The First 7 Years. New Zealand Medical Journal 117(1205):U1152PubMedGoogle Scholar
  18. Reiter-Theil S.: 2003, Balancing the Perspectives. The Patient’s Role in Clinical Ethics Consultation. Medicine, Health Care and Philosophy 6:247–254CrossRefGoogle Scholar
  19. Smith R.: 2001, One Bristol, but There Could Have Been Many. British Medical Journal 232(7306):179–180CrossRefGoogle Scholar
  20. Wafer A.: 1999, Lonesome Whistle. BMA News Review 11(December):18–21Google Scholar
  21. Waring J.J.: 2005, Beyond Blame: Cultural Barriers to Medical Incident Reporting. Social Science and Medicine 60(9):1927–1935PubMedCrossRefGoogle Scholar
  22. Wu A.W.: 2000, Medical Error: The Second Victim. The Doctor Who Makes the Mistake Needs Help Too. British Medical Journal 320(7237):726–727PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Reidun Førde
    • 1
    • 2
    Email author
  • Reidar Pedersen
    • 1
  • Victoria Akre
    • 1
  1. 1.Section for Medical EthicsUniversity of OsloOsloNorway
  2. 2.The Research Institute of the Norwegian Medical AssociationOsloNorway

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