Clinical Ethics Support Services: An Evolving Concept

ABSTRACT Clinical ethics is a sub-domain of bioethics. Clinical ethics focuses on the ethical problems that arise as patients and physicians make decisions together. Such decisions are based primarily on medical indications and patient preferences. Clinical ethics identifies, analyses and attempts to resolve concrete problems that arise in patient care. Clinical ethics must confront and resolve conflicts of values among physicians, patients, families, legal requirement, social mores, religious convictions, institutional consideration and economic constraints. The goal of clinical ethics is to enhance the standard of care by emphasizing that good ethical decision-making is a vital component of good clinical medicine. In the past, the major ethical concern was physician competence and beneficence. Although these retain their importance, consideration of patient goals, values and preference are of importance too. (Siegler and Singer 1988).

Clinical ethics support is the specific sub-domain of clinical ethics. It focuses on providing support for healthcare professionals in order to deal with ethical clinical issues, by the provision of ethics input into clinical education, policy development and the care of individual patients. Formal/explicit services include clinical ethics committees (CEC) and ethics consultation, and the evolution of the concept is inclusive of informal/implicit support services such as Moral Case Deliberation (MCD), ethics rounds, ethics forums and ethics reflection groups. Clinical ethics support aims to improve the ethical quality of patient care practices (McClimans et al 2007). Clinical Ethics Support Services (CESS) have been endorsed by numerous governmental and professional bodies and have been legally mandated in several states in the United States of America (Tulsky et al 1996).

CESS will be most useful if they are designed to match the ethical concerns of the clinicians’ (Hurst et al 2007). In addition, it must function within the policy and procedural framework of the institution providing the service and within the legal framework of the country. Legislation regarding healthcare differs from country to country, so what may be ethical and/or legal in one nation, may not be likewise in another.

The purpose of this project, is to propose, the best service to suit the healthcare institution that has charged me with the development and establishment of CESS. Knowledge of the tried and tested models, is a must. The following will include, investigation of the roles and functions of prevalent models and strategies, their strengths and weaknesses, and ethical and legal considerations and constraints. The information reviewed will then be discussed in relation to the CESS relevant to the aforementioned healthcare facility.

Prior to recommendation of a particular model of a CESS, each prevalent model requires review and evaluation. Although there are many variations in practices and procedures they may not necessarily be problematic as long as practices are justified and consistent. The service must be fit for purpose and meet the ethical needs of the potential users, for whom the service is established