Entwicklungsstand von klinischer Ethikberatung in der Psychiatrie

Gather, Jakov; Kaufmann, Sarah; Otte, Ina; Juckel, Georg; Schildmann, Jan; Vollmann, Jochen

doi:10.1055/a-0579-6469

Cited by 10 publications

(13 citation statements)

References 18 publications

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“…Although two thirds of the participating general and forensicpsychiatric hospitals declared that they had access to CES, one of our main findings was a noticeable difference in the availability of CES between forensic and general psychiatry, i.e., forensic psychiatric hospitals reported having less access to CES than general psychiatric hospitals. However, the rate of 43% found in this survey for the whole of Germany is slightly higher than the rate of 29% found by Gather et al (15) for the district of North Rhine-Westphalia, which might indicate that clinical ethics is developing but still not well established in forensic psychiatry. Moreover, we found a substantial difference in the availability of CES between forensic psychiatric hospitals that offer treatment according to Section 63 (83%) and those treating patients according to Section 64 (25%).…”

Section: Discussioncontrasting

confidence: 88%

“…Even though in its 2017 consensus statement on standards in forensic mental health care in Germany an interdisciplinary expert group emphasized that the four normative principles autonomy, non-maleficence, beneficence, and justice must be the basis of any therapeutic decision (14), little is known about clinical ethics and the role of CES in forensic mental health care in Germany. Gather et al (15) found that in the federal state of North Rhine-Westphalia, only 29% of all forensic psychiatric hospitals had some kind of CES, whereas 90% of general psychiatric hospitals offered such services.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Ethics Support Services Are Not as Well-Established in Forensic Psychiatry as in General Psychiatry

et al. 2020

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Section: Discussioncontrasting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Clinical Ethics Support Services Are Not as Well-Established in Forensic Psychiatry as in General Psychiatry

et al. 2020

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“…Durch die Loyalität zur eigenen Klinik könnten die Ergebnisse geschönt worden sein. Die Ergebnisse widersprechen der von Gather und Kollegen [1] gefundenen fast vollständigen Durchdringung (90 %) der ethischen Fallberatungen in nordrhein-westfälischen psychiatrischen Akutkrankenhäusern. Diese Diskrepanz von 27 % kann bisher nicht abschließend erklärt werden.…”

Section: Stärken Und Limitationenunclassified

Zum Stand der Anwendung klinischer Ethikberatung in deutschen Kliniken für Psychiatrie und Psychotherapie

Wollenburg

Claus²,

Kieser

et al. 2020

Psychiatr Prax

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ZusammenfassungDie vorliegende Studie gibt erstmals einen umfassenden Überblick über die Verbreitung und den Entwicklungsstand der Klinischen Ethikberatung in deutschen Kliniken für Psychiatrie und Psychotherapie. Insgesamt waren nur bei etwas mehr als der Hälfte der Kliniken Strukturen der Ethikberatung vorhanden. Umgekehrt wurden bei etwa einem Drittel der teilnehmenden Kliniken Strukturen der Ethikberatung noch nicht thematisiert, oder gar bewusst abgelehnt. Die verbleibenden Kliniken befinden sich derzeit noch im Aufbau ethischer Strukturen. Hinsichtlich der Teammerkmale und der konkreten praktischen Durchführung konnten qualitative Unterschiede zwischen den Kliniken gefunden werden. Zusammenfassend zeigte sich, dass ethische Strukturen zwar bereits in der knappen Mehrheit der deutschen psychiatrischen Kliniken etabliert sind, es aber noch erheblichen Bedarf sowohl hinsichtlich der Verbreitung als auch der Qualität der praktischen Umsetzung gibt.

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“…Different medical cultures (e.g., lower hierarchies) and needs in consulting and competencies, such as the more communication-oriented attitude of mental health professionals, were assumed to be the reason ( 15 – 17 ). However, recent surveys revealed that more than half of the psychiatric hospitals in Germany, in fact, offer some kind of CESS which often includes ethical case consultation ( 18 – 20 ). Notwithstanding this fact, data indicate a mismatch in supply and demand since many of the hospitals reported ethical consultations in only a very few or even no cases per year.…”

Section: Introductionmentioning

confidence: 99%

Types of Ethical Problems and Expertise in Clinical Ethics Consultation in Psychiatry – Insights From a Qualitative Empirical Ethics Study

et al. 2021

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Background: Ethics consultation has been advocated as a valuable tool in ethically challenging clinical situations in healthcare. It is paramount for the development and implementation of clinical ethics support services (CESS) in psychiatry that interventions can address the moral needs of mental health professionals adequately and communicate the nature of the services clearly. This study explores types of ethical problems and concepts of ethical expertise as core elements of CESS in mental healthcare with the aim of contributing to the further development of ethical support in psychiatry.Methods: We conducted 13 semi-structured interviews with mental health professionals and CESS members and triangulated them with four non-participant observations of ethical case consultations in psychiatry. Data were analyzed according to principles of grounded theory and are discussed from a normative perspective.Results: The analysis of the empirical data reveals a typology of three different ethical problems professionals want to refer to CESS: (1) Dyadic problems based on the relationship between patients and professionals, (2) triangular problems, where a third party is involved and affected as a side effect, and (3) problems on a systemic level. However, CESS members focus largely on types (1) and (2), while the third remains unrecognized or members do not feel responsible for these problems. Furthermore, they reflect a strong inner tension connected to their role as ethical experts which can be depicted as a dilemma. On the one hand, as ethically trained people, they reject the idea that their judgments have expert status. On the other hand, they feel that mental health professionals reach out for them to obtain guidance and that it is their responsibility to offer it.Conclusion: CESS members and professionals in mental healthcare have different ideas of the scope of responsibility of CESS. This contains the risk of misunderstandings and misconceptions and may affect the quality of consultations. It is necessary to adapt concepts of problem solving to practitioners' needs to overcome these problems. Secondly, CESS members struggle with their role as ethical experts. CESS members in psychiatry need to develop a stable professional identity. Theoretical clarification and practical training are needed.

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Entwicklungsstand von klinischer Ethikberatung in der Psychiatrie

Abstract: Clinical ethics consultation is more widespread in psychiatric institutions than was hitherto assumed. Future medical ethics research should therefore give greater attention to the methodology and the quality of clinical ethics consultation in psychiatric practice.

Cited by 10 publications

References 18 publications

Clinical Ethics Support Services Are Not as Well-Established in Forensic Psychiatry as in General Psychiatry

Clinical Ethics Support Services Are Not as Well-Established in Forensic Psychiatry as in General Psychiatry

Zum Stand der Anwendung klinischer Ethikberatung in deutschen Kliniken für Psychiatrie und Psychotherapie

Types of Ethical Problems and Expertise in Clinical Ethics Consultation in Psychiatry – Insights From a Qualitative Empirical Ethics Study

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