School of Public Health, The University of Adelaide, PO Box 5005, Adelaide, SA, 5005, Australia.
Adelaide Medical School, The University of Adelaide, PO Box 5005, Adelaide, SA, 5005, Australia.
BMC Med Ethics. 2023 Aug 11;24(1):62. doi: 10.1186/s12910-023-00942-9.
Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting.
HOW THE STUDY WAS PERFORMED AND STATISTICAL TESTS USED: A qualitative case study approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies.
THE MAIN FINDINGS: An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service's role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating.
尽管临床伦理在当代临床环境中的重要性已得到确立，但迄今为止，澳大利亚卫生系统中正式的临床伦理服务的发展一直是临时性的。本研究旨在系统地跟踪和反思新成立的服务机构的头 18 个月的活动，以研究在澳大利亚医院环境中建立新服务的主要障碍和促进因素。
研究的进行方式和使用的统计检验：采用定性案例研究方法。该研究通过观察服务委员会会议、对议程和记录的文件分析以及对委员会成员的半结构化访谈来收集和分析数据，以生成语义主题。通过参照国家能力建设资源来解释主题发现，本研究还旨在为其他卫生机构提供基于实践的反思。
主要发现：数据中确定的一个总体主题是强烈承诺支持面临困难的患者护理决策的临床医生，并与患者和家属进行困难的讨论。另一个关键主题是新的临床伦理支持服务在为临床医生提供一条途径，以便向组织执行人员提出全系统问题方面的作用。尽管有强烈的临床参与，但消费者和社区的参与仍然是一个挑战，还有未解决的治理问题以及服务与组织之间更明确的政策关系的需求。考虑到这些主题与国家能力建设资源的关系，该研究确定了三个可能需要持续发展和协商的领域。这些是：临床伦理支持服务作为劳动力与执行人员之间联系的作用；纳入消费者和患者；以及伦理推理。为了提高服务的有效性，有必要在治理和政策层面上提高服务的角色清晰度，并制定吸引消费者、患者和家庭的策略。最后，通过明确讨论各种不同的伦理框架和审议方式，可以提高服务对复杂案例进行反思的能力。
