A decision-making tool for building clinical ethics capacity among Irish health professionals

Abstract

Although clinical ethics support services are becoming increasingly prevalent in Europe and North America, they remain an uncommon feature of the Irish healthcare system and Irish health professionals lack formal support when faced with ethically challenging cases. We have developed a variant on existing clinical ethics decision-making tools which is designed to build capacity and confidence amongst Irish practitioners and enable them to confront challenging situations in the absence of any dedicated support structure. The tool provided below follows a transparent stepwise procedure which avoids an overcomplicated analysis while remaining sensitive to the complexity of the issues addressed. The novelty of the tool lies in the explicit association it makes between each step in the process and one or more responsibilities based on established norms of ethical decision-making in the public domain.

The Patients Changing Things Together (PATCHATT) ethics pack: A tool to support inclusive ethical decision-making in the development of a community-based palliative care intervention

“…This is not the intention behind the development of the PATCHATT Ethics Pack. Instead, although artificially divided into stages, I concur with Campbell and McCarthy 14 in promoting a highly flexible use of such models, with stages revisited and reconsidered as the ethical argument develops. In the PATCHATT model, the concentric circles, the two-headed arrows threaded through them and the dotted, permeable lines between them have been designed to suggest this flexibility.…”

Visitor restrictions during the COVID-19 pandemic: An ethical case study

“…Furthermore, clinical ethics decision-making frameworks pay particular attention to what is ethically troubling about a particular case. 22 The Campbell and McCarthy tool (Figure 1) was specifically designed to enable healthcare practitioners confront challenging situations in the absence of any formal ethics support structure such as clinical ethics committees. The latter play, at best, only a marginal role in healthcare organisations in Ireland where existing clinical ethics support is generally inadequate, fragmented and poorly resourced.…”

“…Our exploration and analysis of the case draws on an ethical decision-making tool developed by Campbell and McCarthy. 22 This tool is a variant of existing clinical ethics decision-making frameworks. 23–27 All of these frameworks emphasise adequate clinical information, inclusion of appropriate decision-makers and careful consideration of the harms and benefits associated with proposed courses of action.…”

“…Furthermore, clinical ethics decision-making frameworks pay particular attention to what is ethically troubling about a particular case. 22…”

“…The latter play, at best, only a marginal role in healthcare organisations in Ireland where existing clinical ethics support is generally inadequate, fragmented and poorly resourced. 22 The tool follows a transparent stepwise procedure which avoids an overly dense or detailed analysis, while remaining sensitive to the complexity of the issues addressed. A further strength is that it makes an explicit association between each step of the decision-making process and one or more of the ethical responsibilities based on widely agreed norms of ethical decision-making in healthcare and in the wider public context.…”