Implementation of Clinical ethics consultation in hospitals Implementation of Clinical ethics consultation in hospitals. Empirical data from Germany and beyond.

Terms Research Ethics Commission / IRB Health Care Ethics Committee founding 1970s 1997 tasks medical research clinical care institution medical faculties state chambers of physicians hospitals nursing homes members research physicians, lawyer, biometrician physicians, nurses, others law German Drug Law German Law for Medical Products professional law no legal status

Tasks ethics consultation developement of guidelines education

Goals organisational level „corporate identity“ quality control development of staff and organisation case-level better patient care support of employees „preventive ethics“

Methods medical directors and directors of nursing of all German university hospitals (n=36) postal survey

Survey closed and open questions 5-level rating scale with equidistant verbal anchor

Survey - items relevance and frequency of ethical problems need of support for physicians and nurses identification of ethical problems reasons for ethical problems suggested measures for improvements institutionalisation quality assurance institutional status

Data analysis SPSS® for Windows, Version 11.0.1 testing of concordance with Cohen‘s Kappa (95%-coinfidence intervall) testing of dichotomy with Pearson‘s Chi-Quadrat-Test interpretation of data with Mann-Whitney‘s U-Test level of significance in all tests 5% ( = 0,05)

Results rate of response: medical directors (M) 75 % (n=27) directors of nursing (N) 89 % (n=32) total 82 % (n=59) response: N faster than M (not significant) sequence of responses gave no evidence of consultations between M and N

Results sex distribution: medical directors male: 100 % directors of nursing male: 37,5 % female: 62,5 %

Most important ethical challenges (%) medical directors directors of nursing total limitation of treatment 70,4 87,5 79,7 informed consent 66,7 59,4 62,7 conflict between beneficence and autonomy 48,1 71,9 61,0 allocation of resources 25,9 21,9 23,7

Relevance of ethical problems (%)

Support of staff in dealing with ethical problems (%) medical directors directors of nursing total pastoral care 63,0 78,1 71,2 interdisciplinary team consultation 66,7 71,9 69,5 reasearch ethics commission* 88,9 46,9 66,1 education and training in ethics 51,9 53,1 52,5 grand rounds* 81,5 21,9 49,2 psychosomatic consultation services 40,7 43,8 42,4 ethical guidelines 28,1 33,9 health care ethics committee 18,5 37,5 28,8 clinical ethics consultation 18,8 18,6 university institute for philosophy 3,7 3,1 3,4 multiple answers possible * relevant difference (  25 Pp)

Estimated need for additional support (%) relevant difference

Measures to improve ethical behaviour (%) * relevant difference (35 Pp)

Problems in implementing measures (%) medical directors directors of nursing total lack of time* 77,8 40,6 57,6 finances 51,9 37,5 44,1 low priority/importance* 11,1 53,1 33,9 lack of acceptance 14,8 34,4 25,4 multiple answers possible * relevant difference (  25 Pp)

Institutional status and measures in institutional ethics (numbers) ethical education and training ethical guidelines health care ethics committees clinical ethics consultation traditional1 56,3 37,5 25,0 12,5 new2 67,6 75,7 35,1 8,1 1 non-independant facility of the university 2 institution of public law, foundation

Discussion response frequent ethical problems differences between M and N economic aspects health care ethics committees / clinical ethics consultation

www.ruhr-uni-bochum.de/malakow thank you !