There is no doubt that emotions have an important effect on practices of moral reasoning such as clinical ethics consultation. Empathy is not only a basic human emotion but also an important and learnable skill for health care professionals. A basic amount of empathy is essential both in patient care and in clinical ethics consultation. This article debates the “adequate dose” of empathy in ethics consultations in clinical settings and tries to identify possible situations within the process of consultation in (...) which this crucial feeling is at risk. (shrink)

BackgroundAmidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality (...) of CECons.MethodsGuided by Levac et al’s (2010) methodological framework for conducting scoping reviews, the research team performed independent literature reviews of accounts of assessments of CECons published in six databases. The included articles were independently analyzed using content and thematic analysis to enhance the validity of the findings.ResultsNine thousand sixty-six abstracts were identified, 617 full-text articles were reviewed, 104 articles were analyzed and four themes were identified – the purpose of the CECons evaluation, the various domains assessed, the methods of assessment used and the long-term impact of these evaluations.ConclusionThis review found prevailing assessments of CECons to be piecemeal due to variable goals, contextual factors and practical limitations. The diversity in domains assessed and tools used foregrounds the lack of minimum standards upheld to ensure baseline efficacy.To advance a contextually appropriate, culturally sensitive, program specific assessment tool to assess CECons, clear structural and competency guidelines must be established in the curation of CECons programs, to evaluate their true efficacy and maintain clinical, legal and ethical standards. (shrink)

Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka O. (...) Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Few institutions have published reviews concerning the case consultation history of their ethics committees, and policies used by ethics committees to address inappropriate treatment are infrequently reviewed. We sought to characterize the operation of our institution’s ethics committee as a representative example of a volunteer ethics committee, and outline its use of a policy to address inappropriate treatment, the Conscientious Practice Policy. Patients were identified for retrospective review from the ethics consultation database. Patient demographics, medical admission information, and consultation information (...) were obtained from the medical record. Consultation notes were analyzed with directed content analysis. The use of the CPP was documented in each case. Groups of interest were compared via two-sample t-tests. There were 178 consultations between 2013 and 2018. The majority originated from medicine services. The most common consultation reasons were end-of-life balances of acute and palliative care, best interest standard, medical futility, and code status and intubation status. Average age was 65.5 years and average hospitalization before consultation was 51.4 days. 92 patients had a code status change that occurred after consultation. A policy to address inappropriate treatment was used in 42 of the consultations. Bivariate analysis demonstrated a reduction in policy use over time, with use in 32.1% of consultations from 2013 to 2016 and 11.4% of consultations 2017–2018, p = 0.002. End-of-life issues were the most common reason for consultation. Our consultation volume was lower than previously-published reports. A policy used to address inappropriate treatment was frequently used, although use decreased over time. (shrink)

Guidance for Healthcare Ethics Committees edited by D. Micah Hester and Toby Schonfeld is a comprehensive guide for members of ethics committees. The book is designed to address the three essential missions of healthcare ethics committees : Consultation, Policy Writing, and Education. Although there is already significant literature devoted to ethics consultation, the policy writing and education functions of ethics committees get relatively little attention in the literature. It is valuable to have a source that combines all components of the (...) HEC duties. The book addresses a wide range of topics within each area, with the greatest focus on consultation.Guidance for Healthcare Ethics Committees is divided into four parts. The first is an introductory section that gives a broad overview of ethical theories, legal issues affecting ethics committees, and cultural and religious issues that often impact the work of ethics committees. The latter three sections each t .. (shrink)

Medicine often views hospice care as “giving up,” which results in a reduced quality of end-of-life care for many patients. By integrating a theology of the Sabbath with modern medicine, hospice becomes a sacred and valuable way to honor the dying patient in a comprehensive and holistic way. A theology of Sabbath as “Sacredness in Time” can provide the foundation for a shift in understanding hospice as a legitimate care plan, which shifts the focus from controlling and manipulating space for (...) the body, to rest and enjoyment of time for the whole person. First, I explore vitalism and its negative effects on the institution of hospice. Second, I address the main misconceptions and biases surrounding hospice in order to establish hospice as an appropriate option for the terminally ill. Finally, I argue for a shift away from sacredness in space (as seen in vitalism) to sacredness in time. (shrink)

The goal of an ethics case discussion is to find the best decision for the patient and the other persons involved (relatives, doctors, nurses and others) from an ethical point of view, in a communicative respect and from a psychosocial view. In the end, it may not mean changing one’s view or even one’s own position, but rather to exchange arguments, weight them and come to a consensus as to further action. The latter is important as the topics concern patients (...) and require action. For the moderator an ethics case discussion in this sense is no judgement, no taking over of responsibility for the decision result, no taking over of a leading role, and no team supervision. However, ethics case discussion has become a valuable tool to deal with moral conflicts in hospitals. Opportunities and problems of ethics case discussions are discussed. A 4-step approach for structuring the course of an ethics case discussion is presented. (shrink)