Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review

Abstract

This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a “bottom-up” perspective might give healthcare personnel opportunities to think and reflect more than a “top-down” perspective. A “bottom-up” approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a “top-down” approach risks removing such moral responsibility.

Importance of systematic deliberation and stakeholder presence: a national study of clinical ethics committees

“…Clinical ethics case consultation is a demanding and often complex task which may influence decisions with serious consequences 1. In order to raise the quality of this service, critical evaluations are mandatory.…”

Ethical decision-making in biopharmaceutical research and development: applying values using the TRIP & TIPP model

“…This process allows for the so-called top-down (by bioethics board) and bottom-up (by research team) assessments to be complemented, 25 whereby both teams and board apply the same values-based decision-making model. Employees are thus engaged as moral agents at the center of decisions, which has the potential to increase their autonomy and competence, as has been reported in healthcare settings.…”

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

“…The best ways to deal with moral issues in patient care is implementing systematic ethics work raising awareness and fostering a climate of openness and dialogue (30,31). Collective systematic ethics work may foster greater awareness of ethical aspects, personal and professional development, understanding and respect for colleagues and patients, along with cooperation and new ways to approach di cult situations (13,(32)(33)(34). This can be done by ethics re ection groups, as in the Norwegian project in municipal healthcare services which resulted in improvements in these areas; handling ethical challenges, employee cooperation, service quality and relations to patients and relatives (35,36).…”