Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care

Abstract

Would primary care services benefit from the aid of a clinical ethics committee (CEC)? The implementation of CECs in primary care in four Norwegian municipalities was supported and their activities followed for 2.5 years. In this study, the CECs’ structure and activities are described, with special emphasis on what characterizes the cases they have discussed. In total, the four CECs discussed 54 cases from primary care services, with the four most common topics being patient autonomy, competence and coercion; professionalism; cooperation and disagreement with next of kin; and priority setting, resource use and quality. Nursing homes and home care were the primary care services most often involved. Next of kin were present in 10 case deliberations, whereas patients were never present. The investigation indicates that it might be feasible for new CECs to attain a high level of activity including case deliberations within the time frame. It also confirms that significant, characteristic and complex moral problems arise in primary care services.

Clinical Ethics Committee in an Oncological Research Hospital: two-years Report

“…35 However, involving next of kin in deliberation can also contribute to conflict resolution and signal that they are taken seriously. 36 Ethics education and CEC's access. Considering education and training targeting HPs, the second CEC's function, our findings provide several insights into its content, format, and other characteristics.…”

“… 35 However, involving next of kin in deliberation can also contribute to conflict resolution and signal that they are taken seriously. 36 …”

“…As noted by Magelssen, CECs are indeed more and more required to overcome the standard threefold set mentioned, attempting different working methods—tailored seminars for particular departments, wards, or professional groups; leading ethics reflection groups in clinical wards; inviting wards to submit a case to CEC and participate in deliberation; dealing with organizational and ethics; and bringing ethical perspectives to other stakeholders in the organization or health services. 36 …”

Etikkdrøftinger i kommunale etikkomiteer – hva bidrar det til?

“…Komité D ble forankret under kommunedirektør (rådmann), og kom i gang med sitt komitéarbeid først et år etter de øvrige. (78). Vi fant også at pårørende deltok i 10 av 54 etikkdrøftinger, mens pasientene aldri deltok.…”

“…Mange pasienter som mottar helsehjelp i kommunehelsetjenesten, er eldre mennesker, ofte med varierende grad av kognitiv svikt. Det melder seg dermed ofte spørsmål om samtykkekompetanse, og i slike situasjoner kan det oppstå moralske utfordringer (78). Slike situasjoner kan også vaere bakgrunnen for at det gjennomføres etikkdrøftinger (39).…”