Quality Characteristics for Clinical Ethics Support in the Netherlands

Hartman, Laura; Baarle, Eva van; Diepeveen, Mariëlle; Widdershoven, Guy; Molewijk, Bert

doi:10.1080/23294515.2021.1925776

Cited by 5 publications

(1 citation statement)

References 21 publications

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“…(8, 9) Additionally, the characteristics, functionalities and effectiveness of these mechanisms have been documented. (10)(11)(12) However, African settings are faced with ethical dilemmas, with scanty evidence of approaches for their resolution. Limitations to formation and access to CESS may range from inadequate knowledge of these mechanisms and processes, misconceptions about ethical consultations by patients and HCPs, power imbalances between HCPs and patients or their families, lack of time, inadequate quali ed ethicists as well as limited resources to establish formal ethics consultations.…”

Section: Introductionmentioning

confidence: 99%

Exploration of Clinical Ethics Consultation in Uganda: A case study of Uganda Cancer Institute

Nanyonga,

Kutyabami,

Kituuka

et al. 2024

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Introduction Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESS) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence of mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda.Methodology This qualitative study utilized in-depth-interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers, who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook.Results There was no formal committee nor mechanism utilized to resolve ethical dilemmas at the UCI. The study uncovered six fora where ethical dilemmas were addressed: individual consultations, tumor board meetings, morbidity and mortality meetings, core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas.Conclusion The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.

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Section: Introductionmentioning

confidence: 99%

Exploration of Clinical Ethics Consultation in Uganda: A case study of Uganda Cancer Institute

Nanyonga,

Kutyabami,

Kituuka

et al. 2024

Preprint

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Conceptualizing and Fostering the Quality of CES Through a Dutch National Network on CES (NEON)

et al. 2021

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The prevalence of Clinical ethics support (CES) services is increasing. Yet, questions about what quality of CES entails and how to foster the quality of CES remain. This paper describes the development of a national network (NEON), which aimed to conceptualize and foster the quality of CES in the Netherlands simultaneously. Our methodology was inspired by a responsive evaluation approach which shares some of our key theoretical presuppositions of CES. A responsive evaluation methodology engages stakeholders in developing quality standards of a certain practice, instead of evaluating a practice by predefined standards. In this paper, we describe the relationship between our theoretical viewpoint on CES and a responsive evaluation methodology. Then we describe the development of the network (NEON) and focus on three activities that exemplify our approach. In the discussion, we reflect on the similarities and differences between our approach and other international initiatives focusing on the quality of CES.

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Conceptualizing the impact of moral case deliberation: a multiple-case study in a health care institution for people with intellectual disabilities

2022

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Background As moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research. Methods A multiple-case study was conducted in a care organization for people with intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level. Results According to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up. Conclusions Concretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences.

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Quality Characteristics for Clinical Ethics Support in the Netherlands

Cited by 5 publications

References 21 publications

Exploration of Clinical Ethics Consultation in Uganda: A case study of Uganda Cancer Institute

Exploration of Clinical Ethics Consultation in Uganda: A case study of Uganda Cancer Institute

Conceptualizing and Fostering the Quality of CES Through a Dutch National Network on CES (NEON)

Conceptualizing the impact of moral case deliberation: a multiple-case study in a health care institution for people with intellectual disabilities

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