Background: Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. Objectives: To explore clinical ethics committees’ deliberations and to identify areas for improvement. Design: A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. Participants: Nine hospital ethics committees in Norway. Results and interpretations: Key elements (...) of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient’s situation, the therapists’ perspective, analogous clinical situations, professional uncertainties, the patient’s and relatives’ perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members’ interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. Conclusion: Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training. (shrink)

Assuming that the purpose of research ethics review is to support the ethical conduct and dissemination of good quality research, a question can be raised concerning whether ethics review of research really improves the practice of researchers. Specifically, we might distinguish the activities that go on as part of the review process from those activities that constitute the data collection phase of the research, and ask under what conditions the former have a positive impact on the latter. Two different models (...) of ethics review can be distinguished, term them ‘compliance’ and ‘reflexivity’-based reviews. Compliance-based models of review require researchers to show how they are complying with a given set of rules or protocols for research. Reflexivity-based models require researchers to articulate the ethical issues involved in their research and to explain and justify the way in which they plan to manage them. It is suggested here that there is reason to think that reflexivity-based models of ethics review are more likely to have a positive effect on the practice of social science research than compliance-based reviews. (shrink)