Implementation of Clinical Ethics Consultation in German Hospitals

Abstract

In order to build on the information that was obtained in the course of the first study, a follow-up survey was conducted first by phone and subsequently in a written form between August and October 2014. We contacted 1.858 hospitals in all of Germany for the follow-up survey by phone. In cases where a hospital had not participated in the first study, the willingness to participate in the follow-up survey was established in advance. The survey's dispatch was ensured in the case of acceptance. The same structured survey was used as a research tool. The data of the first study and the follow-up survey were merged and evaluated. 654 surveys (response rate 35.2 %) could be evaluated altogether. Our survey by phone revealed that 912 hospitals in all of Germany have at least one form of clinical ethics consultation available. The health care ethics committee is the most frequently implemented structure of clinical ethics consultation. The implementation of clinical ethics consultation is dependent on sponsorship and hospital size. Recommendations to deliver structures of clinical ethics consultations (ZEKO 2006, AEM 2010) have a smaller influence on the implementation compared to the certification by KTQ respectively proCum Cert. The rate of implementation in regard to the structures of clinical ethics consultation has steadily increased for years. The establishment of clinical ethics consultation in German hospitals should be further promoted. It would be desirable further to develop suitable juridical regulations in order to implement clinical ethics consultation as well as structural parameters.

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

“…Although we obtained a broad range of information on CES in German forensic psychiatric institutions, our study has several limitations. First, although the overall response rate of 36% corresponds with those of comparable studies (7), it cannot be considered as being representative. Ethics might not play a significant role in non-responding hospitals; consequently, they would not participate in a survey assessing ethics support.…”

“…Special curricula have been developed to train clinical ethics consultants in the required competences [see, for example, (6)]. 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).…”

Therapiezielfindung und Kriterien der Entscheidungsfindung

“…B. klinische oder ambulante Ethikkomitees) sowie konkrete Beratungsangebote (wie z. B. moderierte Fallbesprechungen), wie sie inzwischen in jedem zweiten Krankenhaus [20] sowie vereinzelt auch in Pflegeeinrichtungen und im ambulanten Bereich [21] angeboten werden, zielen darauf, besonders in Dissenssituationen den Entscheidungsprozess zu moderieren und zu erleichtern und eine Kultur der strukturierten Entscheidungsfindung zu fördern [4,22,23].…”

Responding to Hospital Staff’s Paranormal Experiences Related to a Medical Assistance in Dying Room

“…Germany The establishment of a HEC is mandatory in all hospitals registered in the Christian Association of Hospitals in Germany (22). According to a new study in Germany, the percentage of hospitals with HECs was found to be 86.4% (45). Croatia Among European countries, Croatia achieved the legal requirements for the establishment of ethics committees around 1997.…”