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Clinical Ethics as Liaison Service: Concepts and Experiences in Collaboration with Operative Medicine


Over the past decade, clinical ethics has received growing attention in Germany as in most European countries. In the mid-1990s, most European countries made efforts to establish healthcare ethics committees (HEC) and clinical ethics consultation (CEC) services. The development of clinical ethics discourse and activities in Germany, however, was delayed and, consequently, is still in its natal phase. Until the end of the 1990s, the only institutionalized bodies of ethical reflection were the research ethics committees at university medical centers and at the State Physician Chambers. In March 1997, the Catholic and Protestant hospital association in Germany recommended the implementation of HECs, modeled after the American HECs. Consequently, the establishment of clinical ethics consultation in the form of HECs started in Germany in denominational hospitals, followed by a small but increasing number of community hospitals.

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1. Vollmann J, Burchardi N, Weidtmann A. Klinische Ethikkomitees an deutschen Universitätskliniken. Deutsche Medizinische Wochenschrift 2004;129:1237–42.

2. Reiter-Theil S, Illhardt FJ. Initiative zur Ethik-Beratung in der Medizin. Ethik in der Medizin 1999;11:219–21.

3. Melley C. Clinical ethics consultation in Germany: A philosopher's prognosis. HEC Forum 2001;13:306–16.

4. Richter G. Ethics consultation at the University Medical Center–Marburg. HEC Forum 2001;13:294–305.

5. See note 2, Reiter-Theil, Illhardt 1999.

6. Fletcher JC, Siegler M. What are the goals of ethics consultation? A consensus statement. Journal of Clinical Ethics 1996;7:122–6; Fletcher JC. Ethics consultation: A service of clinical ethics. Newsletter of the Society for Biomedical Consultation 1991;spring:1–7.

7. Miller FG, Fins JJ, Bacchetta MD. Clinical pragmatism: John Dewey and clinical ethics. The Journal of Contemporary Health Law and Policy 1996;13:27–51; Miller FG, Fletcher JC, Fins JJ. Clinical pragmatism: A case method of moral problem solving. In: Fletcher JC, Lombardo PA, Marshall MF, Miller FG, eds. Introduction to Clinical Ethics, 2nd ed. Frederick, MD: University Publishing Group; 1997:21–40; Fins JJ, Bacchetta MD, Miller FG. Clinical pragmatism: A method of moral problem solving. Kennedy Institute of Ethics Journal 1997;7:129–45; Fins JJ, Miller FG, Bacchetta MD. Clinical pragmatism: Bridging ethical theory and practice. Kennedy Institute of Ethics Journal 1998;8:37–42.

8. See note 7, Miller et al. 1996, Miller et al. 1997, Fins et al. 1997, and Fins et al. 1998.

9. Society for Health and Human Values—Society for Bioethics Consultation, Task Force on Standards for Bioethics Consultation. Core competencies for Health Care Ethics Consultation: The Report of the American Society for Bioethics and Humanities. Glenview, IL: American Society of Bioethics and Humanities, 1998:5–7.

10. See note 9, Society for Health and Human Values 1998:5.

11. See note 9, Society for Health and Human Values 1998:6–7.

12. Kanoti GA, Youngner S. Clinical ethics consultation. In: Post SG, ed. Encyclopedia of Bioethics, 3rd ed. New York: Macmillian; 2003:439–43; Rushton C, Youngner SJ, Skeel J. Models for ethics consultation: Individual, team, or committee. In: Aulisio MP, Arnold RM, Youngner SJ, eds. Ethics Consultation. From Theory to Practice. Baltimore, MD: Johns Hopkins University Press; 2003:88–95.

13. Vollmann J, Weidtmann A. Das klinische Ethikkomitee des Erlanger Universitätsklinikums. Ethik in der Medizin 2003;15:229–38.

14. Agich GJ. Joining the team: Ethics consultation at the Cleveland Clinic. HEC Forum, 2003;15:310–22.

15. See note 4, Richter 2001.

16. Christakis NA. Death Foretold: Prophecy and Prognosis in Medical Care. Chicago: University of Chicago Press; 1999.

17. See note 14, Agich 2003; Fletcher JC, Moseley KL. The structure and process of ethics consultation services. In: Aulisio MP, Arnold RM, Youngner SJ, eds. Ethics Consultation. From Theory to Practice. Baltimore, MD: Johns Hopkins University Press; 2003:96–120.

18. See note 17, Fletcher, Moseley 2003.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
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