Schmitz Dagmar, Groß Dominik, Pauli Roman
Institute for History, Theory and Ethics in Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
BMC Med Ethics. 2021 Mar 2;22(1):20. doi: 10.1186/s12910-021-00590-x.
The theory and practice of ethics consultations (ECs) in health care are still characterized by many controversies, including, for example, the practice of giving recommendations. These controversies are complicated by an astonishing lack of evidence in the whole field. It is not clear how often a recommendation is issued in ethics consultations and when and why this step is taken. Especially in a facilitation model in which giving recommendations is optional, more data would be helpful to evaluate daily practice, ensure that this practice is in line with the overarching goals of this approach and support the development of standards.
We analyzed all consultations requested from an EC service working under a facilitation approach at a maximum-care university hospital in Germany over a period of more than 10 years. Our aim was to better understand why-and under what circumstances-some consultation requests result in a recommendation, whereas others can be sufficiently addressed solely by facilitated meetings. We especially wanted to know when and why clients felt the need for clear advice from the EC service while in other cases they did not. We compared ethics consultations in terms of the differences between cases with and without recommendations issued by the ethics consultants using χ difference tests and Welch's t-test.
A total of 243 ECs were carried out between September 2008 and December 2019. In approximately half of the cases, a recommendation was given. All recommendations were issued upon the request of clients. When physicians asked for an EC, the consultation was significantly more likely to result in a recommendation than when the EC was requested by any other party. ECs in cases on wards with ethics rounds resulted in comparably fewer recommendations than those in wards without ethics rounds. When interpersonal conflicts were part of the problem or relatives were present in the meeting, clients less frequently asked for a recommendation.
From the client's point of view, there does not seem to be only one "right" way to provide ethics consultations, but rather several. While facilitated meetings are obviously appreciated by clients, there also seem to be situations in which a recommendation is desired (especially by physicians). Further empirical and theoretical research is needed to validate our single-center results and re-evaluate the role of recommendations in ethics consultations.
医疗保健领域伦理咨询（EC）的理论与实践仍存在诸多争议，例如提供建议的做法。整个领域令人惊讶地缺乏证据，这使这些争议变得更加复杂。目前尚不清楚在伦理咨询中建议的发布频率，以及采取这一步骤的时间和原因。特别是在一种建议为可选项的促进模式中，更多数据将有助于评估日常实践，确保这种实践符合该方法的总体目标，并支持标准的制定。
我们分析了德国一家大型大学医院以促进模式运作的伦理咨询服务机构在10多年时间里收到的所有咨询请求。我们的目的是更好地理解为什么以及在何种情况下，一些咨询请求会导致给出建议，而其他一些请求仅通过促进会议就能充分解决。我们特别想知道客户何时以及为何觉得需要伦理咨询服务提供明确建议，而在其他情况下则不需要。我们使用χ差异检验和韦尔奇t检验，对比了有伦理顾问给出建议和未给出建议的案例之间的差异。
2008年9月至2019年12月期间共进行了243次伦理咨询。在大约一半的案例中给出了建议。所有建议都是应客户要求发布的。当医生请求进行伦理咨询时，与由其他任何一方请求相比，咨询更有可能导致给出建议。有伦理查房的病房中的伦理咨询导致给出建议的情况比没有伦理查房的病房少。当人际冲突是问题的一部分或会议中有亲属在场时，客户较少要求给出建议。
从客户的角度来看，提供伦理咨询似乎不止一种“正确”方式，而是有多种方式。虽然促进会议显然受到客户的欢迎，但似乎也存在需要建议的情况（尤其是医生）。需要进一步的实证和理论研究来验证我们单中心的结果，并重新评估建议在伦理咨询中的作用。
