Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review

Holmes, Alice; Bugeja, Lyndal; Ibrahim, Joseph E.

doi:10.1016/j.jamda.2020.05.053

Cited by 6 publications

(11 citation statements)

References 57 publications

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“…Recent reviews present the literature on CECs and other ethics support in nursing homes/residential long-term care (Holmes et al, 2020;van der Dam et al, 2014). A 2020 review on CECs in this setting found only 13 primary studies, of which four were from Europe and the remainder from the US (Holmes et al, 2020). None of these were rigorous evaluation studies.…”

Section: Research On Cecs In Primary Carementioning

confidence: 99%

Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care

2021

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Would primary care services benefit from the aid of a clinical ethics committee (CEC)? The implementation of CECs in primary care in four Norwegian municipalities was supported and their activities followed for 2.5 years. In this study, the CECs’ structure and activities are described, with special emphasis on what characterizes the cases they have discussed. In total, the four CECs discussed 54 cases from primary care services, with the four most common topics being patient autonomy, competence and coercion; professionalism; cooperation and disagreement with next of kin; and priority setting, resource use and quality. Nursing homes and home care were the primary care services most often involved. Next of kin were present in 10 case deliberations, whereas patients were never present. The investigation indicates that it might be feasible for new CECs to attain a high level of activity including case deliberations within the time frame. It also confirms that significant, characteristic and complex moral problems arise in primary care services.

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Section: Research On Cecs In Primary Carementioning

confidence: 99%

Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care

2021

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“…As NH resident alcohol consumption may raise ethical complexities, an appropriate decisionmaking process may be similar to that followed by clinical ethics committees. 45 It is important to approach decision-making on an individual basis and to involve the resident in this process as much as possible. Where the issues surrounding alcohol consumption are challenging or complex, such as the case examples in the introduction, input from a clinical ethics committee would be prudent.…”

Section: Approach To Decision-makingmentioning

confidence: 99%

Use of Alcohol in Long Term Care Settings: A Comparative Analysis of Personal Choice, Public Health Advice and the Law

Grossi

Holmes

Ibrahim

2021

Journal of the American Medical Directors Association

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Alcohol is one of the most widely available psychoactive substances globally. Many accept the risks associated with alcohol consumption for reasons such as social engagement and feelings of pleasure. Alcohol consumption in a nursing home (NH) setting highlights the moral and logistical challenges of balancing the need for a safe living and working environment with the dignity of risk (DoR) and personal autonomy of residents.This analysis explores public health, human rights, and legal frameworks in their approach to a NH resident's choice to drink alcohol. Key issues under the public health framework include the medical risks associated with alcohol consumption, whether residents with impaired cognitive functioning have the capacity to make a decision about alcohol consumption, and the practical and ethical implications of supplying alcohol to residents. Under a legal framework, NHs must consider the legal imperative to respect residents' rights, the possibility of liability in negligence, duties owed to employees, the existence of substitute decision-makers, and liquor licensing laws. Fundamental considerations under the human rights framework include the damaging psychological effects of risk-avoidance and the importance of inclusive risk assessment processes.Alcohol policies should incorporate elements from all 3 frameworks. There is limited data publicly available about alcohol policies in NHs. Further research is needed to establish current practice and to evaluate the merits and disadvantages of different policies. Establishing inclusive and thorough decisionmaking processes is key to achieving better consumer-directed care.

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“…The United States is an exception; here, CECs have a long history in nursing homes. [5][6][7] Neither in the United States, however, are there any recent systematic overviews of the prevalence and activities of nursing home CECs. A recent review of published research on CECs in residential long-term care found only 13 primary studies (nine from the United States, four from European countries).…”

Section: Introductionmentioning

confidence: 99%

“…The authors of the review called for more research on roles and impact of CECs on patients and institutions. 5 CECs are multi-professional committees charged with improving ethics competence and analysing and giving advice on ethical challenges from daily practice. When deliberating on ethics cases, they typically involve professionals, next of kin or the patient in the deliberations, and produce a written case report detailing the case, the values involved, and potential lines of action.…”

Section: Introductionmentioning

confidence: 99%

“…A recent review of published research on CECs in residential long-term care found only 13 primary studies (nine from the United States, four from European countries). 5 There were no rigorous evaluation studies, i but some studies that describe the activities that the CECs perform. These find that the trio of activities typical for hospital CECs -case consultations, policy review and ethics education for staff -are common activities also for nursing home CECs.…”

Section: Introductionmentioning

confidence: 99%

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Clinical ethics committees in nursing homes: what good can they do? Analysis of a single case consultation

Magelssen¹,

Karlsen

2021

Nurs Ethics

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Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer to this question must begin with an understanding of how a clinical ethics committee might be beneficial in a nursing home context – to patients, next of kin, professionals, managers, and the institution. With the present article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to stakeholders in a nursing home context? We describe in depth a clinical ethics committee case consultation deemed successful by stakeholders, then reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics committee members and interviewed stakeholders consented to study participation, and also gave specific approval for the publication of the present article. Findings/results: Six different roles played by the clinical ethics committee in the case consultation are described: analyst, advisor, support, moderator, builder of consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research is needed to examine whether clinical ethics committees might be suitable as ethics support structures in nursing homes and community care.

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Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review

Cited by 6 publications

References 57 publications

Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care

Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care

Use of Alcohol in Long Term Care Settings: A Comparative Analysis of Personal Choice, Public Health Advice and the Law

Clinical ethics committees in nursing homes: what good can they do? Analysis of a single case consultation

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