Clinical Ethics Consultation in the Transition Countries of Central and Eastern Europe

Orzechowski, Marcin; Schochow, Maximilian; Steger, Florian

doi:10.1007/s11948-019-00141-z

Cited by 11 publications

(12 citation statements)

References 49 publications

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“…Significant impact on the functioning of hospital ethics committees in Poland has a longstanding practice of paternalism in medical care (Orzechowski et al 2020;Czarkowski 2010b) and the lack of legal regulations and action standards as well as HECs financing rules (Czarkowski 2010b). Also, the availability of properly educated people who could competently handle cases addressed to HECs (Czarkowski 2010a) may be important.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital Ethics Committees (HECs) have been operating in health care systems for several decades (Tapper 2013). In most Central and Eastern European countries, the teams set up to carry out ethical consultations in clinical conditions were not established until 1989 (Orzechowski et al 2020). In Poland in 2009 the Polish Bioethics Society initiated a discussion on the need to establish hospital ethics committees, initiated by the PTB statement on hospital ethics committees (Polish Bioethics Society 2009).…”

Section: Introductionmentioning

confidence: 99%

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Hospital Ethics Committees in accredited hospitals in Poland—availability of information

Zurzycka

Puto

Czyżowicz

et al. 2021

International Journal of Ethics Education

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The role of Hospital Ethics Committees (HECs) is to support patients and their relatives as well as medical staff in solving ethical issues that arise in relation to the implementation of medical care. In Poland there are no clearly formulated legal regulations concerning the establishment and functioning of hospital ethics committees. Hospitals applying for accreditation are obliged to present solutions defining the way of solving ethical issues in a given institution, some of them appoint HECs for this purpose. The aim of this study was to analyze information concerning the functioning of hospital ethics committees in Poland on the basis of publicly available data published on the websites of accredited hospitals. Very few accredited hospitals (56) make public information about functioning in their ethics consulting facilities through hospital ethics committees. In most cases, the information provided on the functioning of HECs is general, both in terms of the committees’ functioning, type of cases under consideration and the composition of personnel.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital Ethics Committees in accredited hospitals in Poland—availability of information

Zurzycka

Puto

Czyżowicz

et al. 2021

International Journal of Ethics Education

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“…We would require finances for having the members trained on clinical ethics so that they offer good services while in the clinical ethics consultation [Country 7] I will need further training in clinical ethics and perhaps a benchmarking exercise to see exactly how these operate and guidance in developing policies, guidelines and tools that govern their operations [17]…”

Section: Description Of Clinical Ethics Committeesmentioning

confidence: 99%

“…Members of CECs are trained to conduct a structured analysis of what is at stake in any given clinical-ethical dilemma, with an emphasis on moral values, moral principles, and relevant law involved in the case [16]. CECs have been widely established in developed countries since the 1970s [17][18][19]. However, there are limited studies that have assessed CECs in resource poor countries, especially in Africa.…”

mentioning

confidence: 99%

Clinical Ethics Committees in Africa: lost in the shadow of RECs/IRBs?

et al. 2020

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Background Clinical Ethics Committees (CECs) are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services (CESs) on the continent. Methods A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data were subjected to descriptive analysis and Fischer's exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics (p = 0.005). All participants were familiar with Research Ethics Committees (RECs), and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants (81.7%) were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed.

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“…CECs play several roles in order to fulfill their functions, which include the roles of analyst, moderator, disseminator, facilitator, stakeholder advocate, advisor, and guardian of values and laws [ 5 ]. The role is well defined in high-income countries (HICs) such as in Europe, the United States, and Canada [ 6 , 7 ], where CECs are regularly presented with various ethical dilemmas (end-of-life decisions, consent, confidentiality, and respecting family or surrogate wishes) [ 8 – 10 ]. However, according to the literature, there are no formal established CECs in Africa, other than two CECs in South Africa [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 underscores the important role of Clinical Ethics Committees in Africa

et al. 2021

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Background The COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa. Methods Twenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses. Results Kenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking. Conclusions This study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.

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Clinical Ethics Consultation in the Transition Countries of Central and Eastern Europe

Cited by 11 publications

References 49 publications

Hospital Ethics Committees in accredited hospitals in Poland—availability of information

Hospital Ethics Committees in accredited hospitals in Poland—availability of information

Clinical Ethics Committees in Africa: lost in the shadow of RECs/IRBs?

COVID-19 underscores the important role of Clinical Ethics Committees in Africa

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