Evaluating clinical ethics support in mental healthcare

Abstract

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded 'grey zone articles', in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients' and caregivers' views on ethical challenges, is presented.

Staff’s normative attitudes towards coercion: the role of moral doubt and professional context—a cross-sectional survey study

“…Earlier implementation and evaluation studies found that clinical ethics support, such as moral case deliberation or ethics reflection groups, helped the health care staff to better deal with ethical challenges [36, 37, 52–57]. In moral case deliberation, a trained facilitator uses a specific methodology for moral reasoning in order to scrutinize specific decisions and actions, and to reflect upon ethical challenges from various angles.…”

“…3See for related publications from this larger study on coercion, ethics and ethics reflection groups in psychiatry: [36, 49–51, 58, 59]. …”

Clarifying perspectives

“…In a previous study, decision sharing emerged. 28 Because the medical and legal responsibility of the decision in care will be with the physicians, we believe that there is a risk with false notions of decision sharing. We will discuss the related categories below.…”

Clinical Ethics Support Services Are Not as Well-Established in Forensic Psychiatry as in General Psychiatry

“…In Germany, the number of hospitals offering clinical ethics consultation has steadily increased in the last two decades (7). In psychiatry, however, structured ethics consultation has developed at a slower rate than in other medical disciplines, but it is considered to be relevant and helpful for moral case deliberation and an unprejudiced decision-making process (8)(9)(10). A study on clinical ethics consultations in Norway showed that 144 of 775 cases between 2003 and 2012 related to mental health and addiction treatment cases; among the most prominent ethical dilemmas were confidentiality and information (33 cases), drug dependency (27 cases), formal and informal coercion (23 cases), and competence to consent and patient autonomy (16 cases) (11).…”