Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and questions about patient autonomy. In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan's first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received. Over approximately 15 months (October 2006-December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes.

ObjectiveTo delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care.DesignWe conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis.ParticipantsParticipants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data.ResultsWe performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians’ convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence).ConclusionsThis is the first qualitative study to demonstrate the framework of paediatricians’ decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.

This descriptive study suggests that educators involved in bioethics education for healthcare university students in Japan coped in various ways with ethical disagreement. Further research concerning ethical disagreement in educational settings is needed to provide better bioethics education for healthcare students.

Background: It is an important study to investigate incident reports submitted by multidisciplinaries in the Special Functioning Hospitals of Japan. We clarify the characteristics of the incidents and evaluate the outcomes obtained from a polygonal analysis. Material and Methods: We collected 1638 incident reports submitted by multidisciplinaries for one year from April, 2016 to March, 2017. The incidents were retrospectively analyzed by profile, levels, distribution, and ratios. Results: The majority of incidents (94.7%, 1551/1638) were distributed between the levels 0 to 3a, on the other hand, the incidents of a level higher than 3b occupied 5.3%. The reports from nurses were 75.3% (1234/1638) and those from doctors were 12.8% (209/1638). The level 3b totalled 30.6% (64/209) of the doctor-reported incidents. In contrast, the level 2 totalled 33.8% (417/1234) of the nurse-reported incidents. The levels of the doctor-incidents were comparatively higher than those of the nurse-incidents. The profiles of the incidents were categorized as drug administration (n = 439, 26.8%), nursing care (n = 399, 24.4%), drain and tube (n = 258, 15.8%), medical treatment and care (n = 199, 12.1%), medical examination (n = 141, 8.6%), medical equipment (n = 99, 6.0%), giving instructions (n = 66, 4.0%) and blood transfusion (n = 12, 0.7%). Conclusions: It is important for multidisciplinaries to report incidents because they can learn novel experiences from the incidents for preventing a recurrence. By proper utilizing of the incident-reporting system, it could be an effective tool that helps the medical staff build a strong patient safety culture,

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