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

2. 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

3. Tasks
ethics consultation
developement of guidelines
education

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

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

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

7. 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

8. 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)

9. 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

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

11. 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

12. Relevance of ethical problems (%)

13. 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)

14. Estimated need for additional support (%)
relevant difference

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

16. 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)

17. 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

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

19.
thank you !