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

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.

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Notes

  1. 1.

    Dörries et al. (2011), Pfäfflin et al. (2009) and Hurst et al. (2007a, b) with further references.

  2. 2.

    Report IS-2091. https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/67/IS-2091-Beslutningsprosesser-ved-begrensning-av-livsforlengende-behandling.pdf (only in Norwegian).

  3. 3.

    TBERG-2006-665 (court of first instance) and LG-2007-100482 (court of appeal).

  4. 4.

    Manual for working in a Clinical Ethics Committee in secondary health services: http://www.med.uio.no/helsam/tjenester/kunnskap/etikk-helsetjenesten/manualer/manual_rev2015.pdf.

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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.

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Correspondence to Marianne K. Bahus.

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Bahus, M.K., Førde, R. Discussing End-of-Life Decisions in a Clinical Ethics Committee: An Interview Study of Norwegian Doctors’ Experience. HEC Forum 28, 261–272 (2016). https://doi.org/10.1007/s10730-015-9296-2

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Keywords

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