Building Clinical Ethics Capacity, Final Report of the Developing Clinical Ethics Capacity in NSW Partnership project 2014

摘要

Clinical ethics support services are an established feature of health care in the US and Canada udand are becoming so in the UK, France, Belgium and elsewhere in Europe. They are yet to be udwidely established in NSW or elsewhere Australia. Clinical ethics support typically involves the udprovision of expert ethics input into clinical education, policy development and the care of udindividual patients, particularly where this involves value, rather than clinical, or scientific, udconflict. Ethics support is generally provided by an individual consultant, an ethics committee udor some combination of the two. In its case consultation function, expert support is intended udto clarify the values that are in tension and through promoting open and inclusive discussion, udfacilitate consensus on the appropriate next steps. Internationally, the guidance and udrecommendations issued by a support service on a particular case are, in most cases, advisory udand not binding. udAdvocates argue that clinical ethics support is necessary because contemporary clinical work udtakes place in a technologically, socially and ethically complex environment. The medical udencounter has become far more open to scrutiny and is accountable to a more diverse public udholding often quite different interests, ideas and values. In a more pluralist society, udprofessional training, professional codes and institutional polices aren’t sufficient to establish udethical practices and procedures or resolve the ethical dilemmas that arise in the care of udindividual patients. The ethics expertise provided by an ethicist or a panel of ethically trained udclinicians is necessary to astutely appraise the values and arguments and generate consensus. udWithout such expertise the ethicality of practices cannot be assured. udClinical ethics support is intended to promote ethically sound clinical and organisational udpractices and decision-making and thereby contribute to health organisation and system udquality improvement.udThe under-developed state of clinical ethics support in Australia and NSW prompted NSW udHealth, in partnership with the Centre of Values Ethics and Law in Medicine and the Centre udfor Health Law and Governance , to ask:ud1. Do changes to the environment in which clinical practice occurs mean there is a need udto change the way we deal with ethical dilemmas?ud2. Is more formalised support for clinicians, when making difficult and possibly udcontroversial ethical decisions, desirable or warranted?ud3. If it is agreed that clinical ethics support should be enhanced, what model is most udappropriate for local conditions?