Potential Pitfalls in the Evaluation of Ethics Consultation: The Case of Ethical Counseling

Linkeviciute, Alma; Dierickx, Kris; Sanchini, Virginia; Boniolo, Giovanni

doi:10.1080/15265161.2015.1134708

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Clearly, ethical consultation is perceived as the main core business of CECs. Unfortunately, assessing its efficacy is problematic (Hoffmann 1993 ; Linkeviciute et al 2016 ). There is no consensus about which tools to use (Ramsauer and Frewer 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluating the effectiveness of clinical ethics committees: a systematic review

Crico

Sanchini

Casali

et al. 2020

Med Health Care and Philos

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Clinical Ethics Committees (CECs), as distinct from Research Ethics Committees, were originally established with the aim of supporting healthcare professionals in managing controversial clinical ethical issues. However, it is still unclear whether they manage to accomplish this task and what is their impact on clinical practice. This systematic review aims to collect available assessments of CECs’ performance as reported in literature, in order to evaluate CECs’ effectiveness. We retrieved all literature published up to November 2019 in six databases (PubMed, Ovid MEDLINE, Scopus, Philosopher’s Index, Embase and Web of Science), following PRISMA guidelines. We included only articles specifically addressing CECs and providing any form of CECs performance assessment. Twenty-nine articles were included. Ethics consultation was the most evaluated of CECs’ functions. We did not find standardized tools for measuring CECs’ efficacy, but 33% of studies considered “user satisfaction” as an indicator, with 94% of them reporting an average positive perception of CECs’ impact. Changes in patient treatment and a decrease of moral distress in health personnel were reported as additional outcomes of ethics consultation. The highly diverse ways by which CECs carry out their activities make CECs’ evaluation difficult. The adoption of shared criteria would be desirable to provide a reliable answer to the question about their effectiveness. Nonetheless, in general both users and providers consider CECs as helpful, relevant to their work, able to improve the quality of care. Their main function is ethics consultation, while less attention seems to be devoted to bioethics education and policy formation.

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Section: Discussionmentioning

confidence: 99%

Evaluating the effectiveness of clinical ethics committees: a systematic review

Crico

Sanchini

Casali

et al. 2020

Med Health Care and Philos

Self Cite

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show abstract

“…From what emerged from the interviews, it seems that the management of the most ethically complex issues is often left to the common sense and good will of single individuals, that would be the only guiding criteria in the absence of specific dedicated guidelines or other institutional support [18,63]. This means that a key part of care is left to be handled by individual clinicians on the basis of their own personal skills and ethical awareness.…”

Section: Strategies To Address Clinical Ethics Issuesmentioning

confidence: 99%

Ethical issues in oncology practice: a qualitative study of stakeholders’ experiences and expectations

et al. 2022

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Background Clinical Ethics Support Services (CESS) have been established to support healthcare professionals in addressing ethically sensitive issues in clinical practice and, in many countries, they are under development. In the context of growing CESS, exploring how healthcare professionals experience and address clinical ethics issues in their daily practice represents a fundamental step to understand their potential needs. This is even more relevant in the context of extremely sensitive diseases, such as cancer. On this basis, we carried out a qualitative study conducting in-depth semi-structured interviews with stakeholders of a major comprehensive cancer centre in Italy, with the twofold aim of investigating what ethical issues arise in the context of clinical oncology and how they are addressed, as well as stakeholders’ expectations about a potential CESS to be implemented within the Institution. Methods The study was conducted within the theoretical framework of Grounded Theory. Participants were healthcare professionals and other key stakeholders working within the cancer centre. The semi-structured interview aimed at exploring common ethical aspects of oncology, investigating stakeholders’ professional experience in dealing with clinical ethics issues, their expectations and requests regarding ethics support services. Transcripts of the interviews were coded and analysed according to the principles of Grounded Theory. Results Twenty-one stakeholders were interviewed. Our analysis showed a wide consensus on the identification of ethically relevant issues, above all those concerning communication, end-of-life, and resource allocation. The absence of institutional tools or strategies to address and manage ethical issues at the patient bedside emerged, and this is reflected in the widespread request for their development in the future. The ideal support service should be fast and flexible in order to adapt to different needs and clinical cases. Conclusions The interviewees showed a limited degree of ‘ethical awareness’: despite having reported many issues in clinical practice, they could hardly identify and describe the ethical aspects, while complaining about a lack of ethical resources in their management. To build a truly effective support service, it therefore seems appropriate to take such context into consideration and address the emerged needs. Ethical sensitivity seems to be key and it becomes even more relevant in critical clinical areas, such as the therapeutic pathways of terminally ill patients.

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“…Finally, the authors seem to assume that MCD, leads to some improvement in quality of care by providing structure to moral reasoning. Since they do not mention at all the methodologies potentially in place, the question is whether the methodology through which MCD is conducted plays a role or impacts on the quality of the process itself?5 Or does any methodology, as long as it geared towards promoting moral reasoning as a rational process (as in the authors’ view), lead to the same outcome in any case? Our contention is that, in order to address the question raised by Kok et al —whether and how MCD, but more generally CESS, improves quality of care at the organisational level—transparency with respect to the methodology used and the ethical approaches of the professionals who lead or mediate the discussion of cases is crucial—as distinct methodologies may lead to different outcomes 6…”

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confidence: 99%

Measuring the impact of clinical ethics support services: further points for consideration

et al. 2022

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Potential Pitfalls in the Evaluation of Ethics Consultation: The Case of Ethical Counseling

Abstract: We discuss our account of ethical counseling in comparison with the American ethical consultatio

Cited by 3 publications

References 7 publications

Evaluating the effectiveness of clinical ethics committees: a systematic review

Evaluating the effectiveness of clinical ethics committees: a systematic review

Ethical issues in oncology practice: a qualitative study of stakeholders’ experiences and expectations

Measuring the impact of clinical ethics support services: further points for consideration

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