Ethics consultation or psychological supervision? Case-based and methodological reflections on an unresolved relationship

Mitzscherlich, Beate; Reiter-Theil, Stella

doi:10.1007/s00481-017-0455-7

Cited by 10 publications

(3 citation statements)

References 17 publications

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“…In general, requestor feedback on EC, where available, is more than appreciative. Specifically, the outcome that the consensus built in EC was new compared with the situation prior to the EC meeting, which was a crucial one: It corroborates the idea that EC is not about holding an understanding conversation, albeit being of an educational or psycho-hygienic value; it does not function like psychological supervision either (31). Rather, it offers specific components and concrete steps to methodically analyze and solve ethical problems in a clinical context (20, 22, 23).…”

Section: Discussionmentioning

confidence: 72%

Reflecting on the Reasons Pros and Cons Coercive Measures for Patients in Psychiatric and Somatic Care: The Role of Clinical Ethics Consultation. A Pilot Study

et al. 2019

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Background and aim: Coercive measures in patient care have come under criticism leading to implement guidelines dedicated to the reduction of coercion. This development of bringing to light clinical ethics support is hoped to serve as a means of building up awareness and potentially reducing the use of coercion. This study explores the specific features of ethics consultation (EC) while dealing with coercion. Material and method: Basel EC documentation presents insight to all persons involved with a case. The EC database of two Basel university hospitals was developed on the grounds of systematic screening and categorization by two reviewers. One hundred fully documented EC cases databased from 2013 to 2016 were screened for the discussion of coercive measures (somatic hospital and psychiatry: 50% cases). Results: Twenty-four out of 100 EC cases addressed coercion in relation to a clinically relevant question, such as compulsory treatment (70.8%), involuntary committal (50%), or restricting liberty (16.6%). Only 58.3% of EC requests mentioned coercion as an ethical issue prior to the meeting. In no case was patient decisional capacity given, capacity was impaired (43.5%), not given (33.3%), or unclear (21.7%; one not available). Discussion: As clinical staff appears sensitive to perceiving ethical uncertainty or conflict, but less prepared to articulate ethical concern, EC meetings serve to “diagnose” and “solve” the ethical focus of the problem(s) presented in EC. Patient decisional incapacity proved to be an important part of reasoning, when discussing the principle of harm prevention. While professional judgment of capacity remains unsystematic, rationality or even ethicality of decision making will be hampered. The documented EC cases show a variety of decisions about whether or not coercion was actually applied. Ethical reasoning on the competing options seemed to be instrumental for an unprejudiced decision complying with the normative framework and for building a robust consensus. Conclusions: The recommendation is whether EC should be used as a standard practice whenever coercion is an issue—ideally before coercion is applied, or otherwise. Moreover, more efforts should be made toward early and professional assessment of patient capacity and advance care counseling including the offer of advance directives.

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Section: Discussionmentioning

confidence: 72%

Reflecting on the Reasons Pros and Cons Coercive Measures for Patients in Psychiatric and Somatic Care: The Role of Clinical Ethics Consultation. A Pilot Study

et al. 2019

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“…Communication with patients in such a vulnerable state requires a certain level of proficiency and reflection. Case conferences with different professionals or Ethics Consultations [ 4 , 5 , 6 ] have been in place and prove to be important for exploring situations as described in all vignettes and for determining an appropriate care plan. Providing formal and emotional support for health care professionals to enable them to provide good care is an institutional responsibility [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a broader perspective, ethics policies are considered as options of clinical ethics support including also ethics consultation, staff-related educational activities, etc. [ 4 , 5 , 6 ]; e.g., national medical ethical guidelines, which also count as ethics support.…”

Section: Introductionmentioning

confidence: 99%

Taking One’s Own Life in Hospital? Patients and Health Care Professionals Vis-à-Vis the Tension between Assisted Suicide and Suicide Prevention in Switzerland

Reiter-Theil

Wetterauer

Frei

2018

IJERPH

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In Switzerland, the practice of lay right-to-die societies (RTDS) organizing assisted suicide (AS) is tolerated by the state. Patient counseling and accompaniment into the dying process is overtaken by RTDS lay members, while the role of physicians may be restricted to prescribing the mortal dose after a more or less rigorous exploration of the patient’s decisional capacity. However, Swiss health care facilities and professionals are committed to providing suicide prevention. Despite the liberal attitude in society, the legitimacy of organized AS is ethically questioned. How can health professionals be supported in their moral uncertainty when confronted with patient wishes for suicide? As an approach towards reaching this objective, two ethics policies were developed at the Basel University Hospital to offer orientation in addressing twofold and divergent duties: handling requests for AS and caring for patients with suicidal thoughts or after a suicide attempt. According to the Swiss tradition of “consultation” (“Vernehmlassung”), controversial views were acknowledged in the interdisciplinary policy development processes. Both institutional policies mirror the clash of values and suggest consistent ways to meet the challenges: respect and tolerance regarding a patient’s wish for AS on the one hand, and the determination to offer help and prevent harm by practicing suicide prevention on the other. Given the legal framework lacking specific norms for the practice of RTDS, orientation is sought in ethical guidelines. The comparison between the previous and newly revised guideline of the Swiss Academy of Medical Sciences reveals, in regard to AS, a shift from the medical criterion, end of life is near, to a patient rights focus, i.e., decisional capacity, consistent with the law. Future experience will show whether and how this change will be integrated into clinical practice. In this process, institutional ethics policies may—in addition to the law, national guidelines, or medical standards—be helpful in addressing conflicting duties at the bedside. The article offers an interdisciplinary theoretical reflection with practical illustration.

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Ethisches Spannungsfeld – Freiheit und Schutz im Kontext der psychiatrischen Versorgung

Wetterauer¹,

Reiter-Theil²

2022

Springer Reference Pflege – Therapie – Gesundheit

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Ethics consultation or psychological supervision? Case-based and methodological reflections on an unresolved relationship

Cited by 10 publications

References 17 publications

Reflecting on the Reasons Pros and Cons Coercive Measures for Patients in Psychiatric and Somatic Care: The Role of Clinical Ethics Consultation. A Pilot Study

Reflecting on the Reasons Pros and Cons Coercive Measures for Patients in Psychiatric and Somatic Care: The Role of Clinical Ethics Consultation. A Pilot Study

Taking One’s Own Life in Hospital? Patients and Health Care Professionals Vis-à-Vis the Tension between Assisted Suicide and Suicide Prevention in Switzerland

Ethisches Spannungsfeld – Freiheit und Schutz im Kontext der psychiatrischen Versorgung

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