Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-29T13:46:14.316Z Has data issue: false hasContentIssue false

Evaluating Clinical Ethics Consultation: A European Perspective

Published online by Cambridge University Press:  01 October 2009

Extract

This paper focuses on the topic of evaluation of clinical ethics consultation. The concept of evaluation seems to contain an internal tension: On the one hand, evaluation is seen (by some authors) as distorting the conceptual and normative content of the case(s) under scrutiny and, on the other, the evaluative act is the most important use of judgment and an inescapable part of everyday life (e.g., the decision to buy a certain car or eat certain food is based on our own evaluations). As such, we maintain that evaluation is essential.

Type
Special Section: Coming of Age in Clinical Ethics Consultation: Time for Assessment and Evaluation
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Degnin FD. Max Weber on ethics case consultation: A methodological critique of the conference on evaluation of ethics consultation. Journal of Clinical Ethics 1997;8:181–92; Goldenberg MJ. Evidence-based ethics? On evidence-based practice and the “empirical turn” from normative bioethics. BMC Medical Ethics 2005;6(11):E1–9.

2. Mertens D. Research Methods in Education and Psychology: Integrating Diversity with Quantitative and Qualitative Approaches. Thousand Oaks, CA: Sage; 1998:219.

3. Fournier V, Pousset M. [Cochin Hospital Clinical Ethics Center: The first two years] (in French). La Presse Medical 2006;35:960–6; Glasa J. Establishment and work of ethics committees in central and eastern European countries. Medical Ethics & Bioethics 2002;9:9–12; Hurst SA, Reiter-Theil S, Perrier A, Forde R, Slowther AM, Pegoraro R, Danis M. Physicians' access to ethics support services in four European countries. Health Care Analysis 2007;15:321–35; Reiter-Theil S. Ethics consultation on demand: Concepts, practical experiences and a case study. Journal of Medical Ethics 2000;26:198–203; Reiter-Theil S. Ethics consultation in Germany: The present situation. HEC Forum 2001;13:265–80; Slowther A, Bunch C, Woolnough B, Hope T. Clinical ethics support services in the UK: An investigation of the current provision of ethics support to health professionals in the UK. Journal of Medical Ethics 2001;27:i2–8; Steinkamp N, Gordijn B. Ethical case deliberation on the ward. A comparison of four methods. Medical Health Care and Philosophy 2003;6:235–46; Steinkamp N, Gordijn B, Borovecki A, Gefenas E, Glasa J, Guerrier M, et al. Regulation of healthcare ethics committees in Europe. Medical Health Care and Philosophy 2007;10:461–75.

4. Aulisio MP, Arnold RM, Youngner SJ. Health care ethics consultation: Nature, goals, and competencies. Annals of Internal Medicine 2000;133:59–69; The report of the American Society for Bioethics and Humanities. Core competencies for health care ethics consultation. In: Aulisio MP, Arnold RM, Youngner SJ, eds. Ethics Consultation. Baltimore: Johns Hopkins University Press; 2003:165–209.

5. Aleksandrova S. Survey on the experience in ethical decision-making and attitude of Pleven University Hospital physicians towards ethics consultation. Medical Health Care and Philosophy 2008;11:35–42; Borovecki A, ten Have H, Oreskovic S. Ethics committees in Croatia in the healthcare institutions: The first study about their structure and functions, and some reflections on the major issues and problems. HEC Forum 2006;18:49–60; Førde R, Pedersen R, Akre V. Clinicians' evaluation of clinical ethics consultations in Norway: A qualitative study. Medical Health Care and Philosophy 2008;11:17–25; see note 3, Hurst et al. 2007; Hurst SA, Reiter-Theil S, Slowther AM, Pegoraro R, Forde R, Danis M. Should ethics consultants help clinicians face scarcity in their practice? Journal of Medical Ethics 2008;34:241–6; Neitzke G. Confidentiality, secrecy and privacy in ethics consultation. HEC Forum 2007;19:293–302; Reiter-Theil S. The Freiburg approach to ethics consultation: Process, outcome and competencies. Journal of Medical Ethics 2001;27:i21–3; Reiter-Theil S. Balancing the perspectives. The patient's role in clinical ethics consultation. Medical Health Care and Philosophy 2003;6:247–54; Reiter-Theil S, Agich GJ. Research on clinical ethics and consultation. Introduction to the theme. Medical Health Care and Philosophy 2008 11:3–5; Robles PH. Evaluation of healthcare ethics committees: The experience of an HEC in Spain. HEC Forum 1999;11:263–76; Williamson L, McLean S, Connell J. Clinical ethics committees in the United Kingdom: Towards evaluation. Medical Law International 2007;8:221–38.

6. See note 3, Reiter-Theil 2000; Agich GJ. Joining the team: Ethics consultation at the Cleveland Clinic. HEC Forum 2003;15:310–22.

7. See note 3, Slowther et al. 2001; Slowther A, Johnston C, Goodall J, Hope T. Development of clinical ethics committees. British Medical Journal 2004;328:950–2; see note 5, Williamson et al. 2007.

8. See note 3, Steinkamp et al. 2007.

9. See note 5, Robles 1999.

10. See note 5, Neitzke 2007; see note 3, Reiter-Theil 2001; see note 5, Reiter-Theil 2001.

11. See note 3, Fournier, Pousset 2006.

12. Guerrier M. Hospital based ethics, current situation in France: Between “Espaces” and committees. Journal of Medical Ethics 2006;32:503–6.

13. See note 3, Hurst et al. 2007; see note 5, Hurst et al. 2008; see note 5, Reiter-Theil, Agich 2008.

14. See note 5, Aleksandrova 2008; see note 5, Borovecki et al. 2006; see note 3, Glasa 2002; see note 3, Steinkamp et al. 2007.

15. Fletcher JC, Siegler M. What are the goals of ethics consultation? A consensus statement. The Journal of Clinical Ethics 1996;7:122–6 at p. 124.

16. Boesch-Willi A, Hoesli-Krais I, Fahnenstich H, Hetzel P, Reiter-Theil S. Informal ad hoc case discussion versus systematic ethics case consultation in a neonatal intensive care unit (NICU)—Comparing practicability, transparency and practical impact. Abstract for the 4th International Conference Clinical Ethics Consultation (ICCEC), Poster Session on Education and Qualification in Clinical Ethics Consultation, Rijeka, Croatia, 2008.

17. White JC, Dunn PM, Homer L. A practical instrument to evaluate ethics consultations. HEC Forum 1997;9(3):228–46 at p. 230.

18. See note 5, Førde et al. 2008.

19. See note 4, Aulisio et al. 2000.

20. Agich GJ. The question of method in ethics consultation. American Journal of Bioethics 2001;1:31–41.

21. See note 3, Steinkamp, Gordijn 2003.

22. Reiter-Theil S. Klinische Ethikkonsultation—Eine methodische Orientierung zur ethischen Beratung am Krankenbett. Schweizerische Ärztezeitung 2005;86:346–51.

23. Schotsmans P. Personalism in medical ethics. Ethical Perspectives 1999;6:10–19.

24. Tulsky JA, Fox E. Evaluating ethics consultation: Framing the questions. Journal of Clinical Ethics 1996;7:109–15.

25. Fox E. Concepts in evaluation applied to ethics consultation research. Journal of Clinical Ethics 1996;7:116–21; Fox E, Arnold RM. Evaluating outcomes in ethics consultation research. Journal of Clinical Ethics 1996;7:127–38; Fox E, Tulsky JA. Evaluation research and the future of ethics consultation. Journal of Clinical Ethics 1996;7:146–9; Tulsky JA, Stocking CB. Obstacles and opportunities in the design of ethics consultation evaluation. Journal of Clinical Ethics 1996;7:139–45.

26. See note 25, Fox 1996.

27. See note 25, Fox 1996; see note 25, Fox, Arnold 1996.

28. See note 25, Fox, Arnold 1996:128.

29. See note 25, Fox, Arnold 1996:128.

30. See note 25, Fox, Arnold 1996:131.

31. See note 25, Fox, Arnold 1996:133.

32. See note 5, Neitzke 2007; see note 5, Reiter-Theil 2003; Sass HM. Ethical decision making in committee. A view from Germany. Notizie di Politeia 2002;18:65–81.

33. See note 5, Williamson et al. 2007.

34. Boesch-Willi A. Schwierige ethische Entscheidungen in der Neonatologie. Basel: Systematische Fallanalysen von Ethikkonsilen; 2007; see note 5, Robles 1999.

35. See note 5, Reiter-Theil, Agich 2008.

36. See note 4, Aulisio et al. 2000; see note 5, Reiter-Theil, Agich 2008.

37. See note 5, Williamson et al. 2007.

38. See note 16, Boesch-Willi et al. 2008; see note 5, Førde et al. 2008.

39. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002;288:1987–93; Begat I, Ellefsen B, Severinsson E. Nurses' satisfaction with their work environment and the outcomes of clinical nursing supervision on nurses' experiences of well-being—A Norwegian study. Journal of Nursing Management 2005;13:221–30; Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nursing Ethics 2005;12:381–90; Kälvemark S, Höglund AT, Hansson MG, Westerholm P, Arnetz B. Living with conflicts—Ethical dilemmas and moral distress in the health care system. Social Science and Medicine 2004;58:1075–84.

40. DuVal G, Clarridge B, Gensler G, Danis M. A national survey of U.S. internists' experiences with ethical dilemmas and ethics consultation. Journal of General Internal Medicine 2004;19:251–8.

41. Schneiderman LJ. Effect of ethics consultations in the intensive care unit. Critical Care Medicine 2006;34:S359–63; Schneiderman LJ, Gilmer T, Teetzel HD. Impact of ethics consultations in the intensive care setting: A randomized, controlled trial. Critical Care Medicine 2000;28:3920–4; Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Blustein J, Cranford R, et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: A randomized controlled trial. JAMA 2003;290:1166–72.

42. Molewijk B, Verkerk M, Milius H, Widdershoven G. Implementing moral case deliberation in a psychiatric hospital: Process and outcome. Medical Health Care and Philosophy 2008;11:43–56.

43. See note 22, Reiter-Theil 2005.

44. Craig JM, May T. Evaluating the outcomes of ethics consultation. Journal of Clinical Ethics 2006;17:168–80 at p. 170.

45. Godkin MD, Faith K, Upshur RE, Macrae SK, Tracy CS. Project examining effectiveness in clinical ethics (PEECE): Phase 1—Descriptive analysis of nine clinical ethics services. Journal of Medical Ethics 2005;31:505–12.

46. La Puma J, Stocking CB, Silverstein MD, DiMartini A, Siegler M. An ethics consultation service in a teaching hospital. Utilization and evaluation. JAMA 1988;260:808–11; Perkins HS, Tolle SW. Evaluation of ethics consultations. American Journal of Medicine 1993;94:116.

47. See note 46, Perkins, Tolle 1993.

48. Heyland DK, Tranmer JE. Measuring family satisfaction with care in the intensive care unit: The development of a questionnaire and preliminary results. Journal of Critical Care 2001;16:142–9; Orr RD, Moon E. Effectiveness of an ethics consultation service. Journal of Family Practice 1993;36:49–53; Orr RD, Morton KR, deLeon DM, Fals JC. Evaluation of an ethics consultation service: Patient and family perspective. American Journal of Medicine 1996;101:135–41; Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Goodman-Crews P, Cohn F. Dissatisfaction with ethics consultations: The Anna Karenina principle. Cambridge Quarterly of Healthcare Ethics 2006;15:101–6; see note 17, White et al. 1999. Yen BM, Schneiderman LJ. Impact of pediatric ethics consultations on patients, families, social workers, and physicians. Journal of Perinatology 1999;19:373–8.

49. See note 48, Orr et al. 1996.

50. Cohn F, Goodman-Crews P, Rudman W, Schneiderman LJ, Waldman E. Proactive ethics consultation in the ICU: A comparison of value perceived by healthcare professionals and recipients. Journal of Clinical Ethics 2007;18:140–7.

51. See note 48, Orr et al. 1996.

52. See note 48, Schneiderman et al. 2006.

53. See note 48, Yen BM, Schneiderman LJ 1999.

54. See note 41, Schneiderman 2006; see note 41, Schneiderman et al. 2003.

55. See note 41, Schneiderman 2006:362.

56. Rawls J. A Theory of Justice. Cambridge, MA: Harvard University Press; 1971.

57. Cohn F, Goodman-Crews P, Rudman W, Schneiderman LJ, Waldman E. Proactive ethics consultation in the ICU: A comparison of value perceived by healthcare professionals and recipients. Journal of Clinical Ethics 2007;18:140–7.

58. See note 3, Hurst et al. 2007.

59. See note 5, Hurst et al. 2008.

60. Paul NW. Klinische Ethikberatung: Therapieziele, Patientenwille und Entscheidungsprobleme in der modernen Medizin. In: Junginger T, Perneczky A, Vahl CF, Werner C, eds. Grenzsituationen in der Intensivmedizin: Entscheidungsgrundlagen. Heidelberg: Springer; 2008:207–17.

61. Fox E, Tulsky JA. Recommendations for the ethical conduct of quality improvement. Journal of Clinical Ethics 2005;16:61–71.

62. See note 17, White et al. 1997.

63. Phillips DF. Ethics consultation quality: Is evaluation feasible? JAMA 1996;275:1866–7.

64. See note 45, Godkin et al. 2005:511.

65. See note 5, all references on Europe.