Background: The aim was to explore how the clinical ethics committees in Norway have worked and functioned within mental health care and addiction treatment services. Methods: Analysis of 256 annual reports from clinical ethics committees from 2003 to 2012 and a survey to clinicians who had used a clinical ethics committee. Results: Dilemmas related to coercion, confidentiality, information, and patient autonomy dominated. The committees established only for psychiatric hospitals, had received more cases from mental health and addiction services than the committees also serving somatic services. Many of the case discussions involved both somatic and mental health care, complicated legal issues as well as ethical dilemmas. Mental health care professionals that have used the clinical ethics committees evaluated the clinical ethics committees deliberation as useful. Conclusion: Given the many difficult ethical dilemmas in mental health care ethics work need to be strengthened. The complexity of the cases requires varied and interdisciplinary competence and training among the clinical ethics committee members.
Kliniske etikkomiteer (KEK) har vært etablert i norske helseforetak siden 1996, først som et prøveprosjekt, senere som et permanent tiltak med et nasjonalt mandat. I forbindelse med det nasjonale etikkprosjektet «Samarbeid om etisk kompetanseheving» har det også i noen kommuner blitt etablert KEK. Senter for medisinsk etikk ved Universitetet i Oslo er tildelt ansvaret for oppfølging av KEK i helseforetakene og er i tillegg gitt et langsiktig ansvar for etikkarbeid og forskning i den kommunale helse- og omsorgstjenesten. Hensikten med denne studien har vært å fremskaffe kunnskap om hvordan det står til med KEK som er etablert i kommunene. Hva jobber de med, hvilken betydning erfarer de at KEK har og hvilke ressurser har de? Studien har et kvalitativt design. Materialet er basert på telefonintervjuer med ledere for KEK og gjennomgang av komiteenes årsrapporter. Det er gjennomført en kvalitativ innholdsanalyse av datamaterialet. Komiteene arbeider både med enkeltsaker, saker av mer prinsipiell karakter og etikkskolering. Arbeidet vurderes som betydningsfullt og gjennomføres til tross for få ressurser og svak forankring. Kanskje vil en styrket forankring og ressurssituasjon og et nasjonalt mandat bidra positivt til komiteenes arbeid. Nøkkelord: Kliniske etikkomiteer, kommunal helse- og omsorgstjeneste, evaluering English Summary: Are clinical ethics committees in the municipal health and care services sustainable? Clinical ethics committees (CEC) have been established in Norwegian hospital trusts since 1996, first as a pilot project, later on a permanent basis with a national mandate. As part of the national ethics project "Cooperation on ethical competence" some municipalities have also established a CEC. Centre for Medical Ethics at the University of Oslo is given the responsibility to support CECs in hospital trusts, and is also given a long-term responsibility for ethics support and research in municipal health care services. The purpose of this study was to obtain knowledge about the situation of CECs established in municipalities. What are they working on, what impact do they find that CEC has, and what resources do they have? The study has a qualitative design. The material is based on telephone interviews with CEC chairs, and reviews of the committees' annual reports. We have carried out a qualitative content analysis of the data. The committees work with individual cases, issues of a more principle character, and ethics training. The work is considered to be significant, and is carried out despite limited resources and weak anchoring. Perhaps a stronger anchoring, resource situation and a national mandate could strengthen the committees’ situation. Keywords: Clinical ethics committees, municipal health and care services, evaluation
English summary sammEndrag Student nurses -who are they and what do they do? Background: Nurses are becoming more involved in research projects, but knowledge about the title and the specific tasks they have in Norway is spare. International studies show that there are multiple titles in use and that their duties vary. Overall, there is little knowledge about this profession (Study Nurses).
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