Education and the improvement of clinical ethics services

BMC Medical Education

George J Agich¹ 

[1] Co-Director, International Conferences on Clinical Ethics & Consultation, 6805 Via Correto Dr, Austin, TX, 78749-2757, USA

关键词: Quality improvement;    Education;    Ethics committees;    Ethics consultation;    Clinical ethics;   

Others  :  1138974
DOI  :  10.1186/1472-6920-13-41

 received in 2013-03-12, accepted in 2013-03-12,  发布年份 2013

【 摘 要 】

The proliferation of clinical ethics in health care institutions around the world has raised the question about the qualifications of those who serve on ethics committees and ethics consultation services. This paper discusses some of weaknesses associated with the most common educational responses to this concern and proposes a complementary approach. Since the majority of those involved in clinical ethics are practicing health professionals, the question of qualification is especially challenging as the role of ethics committees and, increasingly, ethics consultation services are becoming increasingly important to the functioning of health care institutions. Since the challenging nature of health care finances often leads institutions to rely on voluntary participation of committed health professional with only token administrative or clerical support to provide the needed ethics services, significant challenges are created for attaining competence and functional effectiveness. The article suggests that a complementary approach should be adopted for sustaining and building capacity in clinical ethics. Ethics committees and consultation services should systematically adopt quality improvement techniques to effect designed changes in clinical ethics performance and to build ethical capacity within targeted clinical units and services. Demonstrating improvements in functioning can go a long way to build confidence and capacity for clinical ethics and can help in justifying the need for support. To do so, however, requires that ethics committees and consultation services first shift attention to those areas that demonstrate weak or questionable ethical performance, including the established practices of the ethics committee and consultation service, and second seek collaboration with the involved health care providers to pursue demonstrable change. Such an approach has a much better chance of improving the capacity for clinical ethics in health care institutions than relying on educational approaches alone.

【 授权许可】

   
2013 Agich; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Clinical Ethics Task Force of the American Society for Bioethics and Humanities: Improving competencies in clinical ethics consultation: an education guide. Glenville, IL: American Society for Bioethics and Humanities; 2009.
• [2]Downing MT, Way DP, Caniano DA: Results of a national survey on ethics education in general surgery residency programs. Am J Surg 1997, 174(3):364-368.
• [3]Roberts LW, Warner TD, Hammond KA, Geppert CM, Heinrich T: Becoming a good doctor: perceived need for ethics training focused on practical and professional development topics. Acad Psychiatr 2005, 29(3):301-9.
• [4]Silverman HJ, Dagenais J, Gordon-Lipkin E, Caputo L, Christian MW, Maidment BW III, Binstock A, Oyalowo A, Moni M: Perceived comfort level of medical students and residents in handling clinical ethics issues. J Med Ethics 2013, 39:55-58.
• [5]Johnston C, Williams C, Dias C, Lapraik A, Marvdashti L, Norcross C: Setting up a student clinical ethics committee. Clin Ethics 2012, 7(2):51-53.
• [6]Agich GJ: Defense mechanisms in ethics consultation. HEC Forum 2011, 23(4):269-279.
• [7]Molewijk B, Slowther A, Aulisio M: The practical importance of theory in clinical ethics support services. Bioethics 2011, 25(7):ii-iii.
• [8]Agich GJ: Joining the team: ethics consultation at the Cleveland clinic. HEC Forum 2003, 15(4):310-322.