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Introduction
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- By Susan K. MacRae, Deputy Director and the Director of the Clinical Ethics Fellowship University of Toronto Canada
- Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
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- Book:
- The Cambridge Textbook of Bioethics
- Published online:
- 30 October 2009
- Print publication:
- 31 January 2008, pp 309-312
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Summary
A recent study was done in Canada to identify what clinical ethicists felt were the top 10 clinical ethical challenges facing Canadians in healthcare. (Breslin et al., 2005; Table VII.1).
What is clear from this list is that many of these ethical issues are core to challenges of healthcare more broadly today. While this study was conducted in Canada, it is likely these same challenges may be similar in other healthcare systems, at least in the developed world.
Clinical ethics is a comparatively recent endeavor in healthcare, but despite its relative newness it provides an ideal model for initiatives that can impact healthcare because of its inherent interdisciplinary make-up and its unique capacity to impact care across the healthcare spectrum from “boardroom to bedside.” While clinical ethics offers this unique perspective to address healthcare problems, it is often missing from the meetings where significant system-wide decisions are made. Many decision makers miss the key point that much of healthcare is grounded in values and many of the solutions may be found in the ethical field of inquiry. The most likely reason for this absence of clinical ethics at the decision tables in healthcare is related to the still developing nature of this work. What the chapters in this section show, however, is that perhaps clinical ethics is “coming of age” and is beginning to make serious arguments to the healthcare community about how its activities and frameworks can offer useful, real-world contributions to help to guide system decision makers, healthcare professionals, and the public.
40 - Clinical ethics and systems thinking
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- By Susan K. MacRae, Deputy Director and the Director of the Clinical Ethics Fellowship Joint Centre for Bioethics University of Toronto, Canada, Ellen Fox, Director National Center for Ethics in Health Care Washington DC, USA, Anne Slowther, Senior Lecturer University of Warwick Medical School Coventry, UK
- Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
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- Book:
- The Cambridge Textbook of Bioethics
- Published online:
- 30 October 2009
- Print publication:
- 31 January 2008, pp 313-321
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Summary
A health region, with multiple hospitals and community healthcare organizations, is faced with increased pressures to improve the ethical care of patients and improve staff experience across the system. Currently the patient satisfaction scores at many of the sites are quite low and recent Health Commission inspections in some hospitals have highlighted management of consent issues and patient-centered care as areas of major concern. The staff 's morale is waning and moral distress seems to be increasing. The CEO of the Strategic Health Authority believes that clinical ethics could potentially make a significant difference to the overall culture of the system but feels that the existing mechanisms are not that effective. She begins to consult with experts in the field to discuss how clinical ethics can help her to improve her health system.
“ABC Health Care” has an established clinical ethics program that performs a variety of functions including case consultation, education, policy work, and scholarly writing. Although ABC has received positive accreditation ratings relating to clinical ethics, many within ABC – including both administrators and clinical staff – have a general sense that ABC's current clinical ethics program may not be fully addressing the organization's needs. For example, the program tends to focus on a narrow range of ethical concerns, mostly related to high-profile acute situations in the intensive care and emergency units. In contrast, staff experience a much broader range of ethical issues in their work day to day, and many issues and areas go unserved. Although the clinical ethics program devotes many hours to ethics consultation, similar ethical issues continue to recur again and again.[…]
Section VII - Using clinical ethics to make an impact in healthcare
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- By Susan K. MacRae, Deputy Director and the Director of the Clinical Ethics Fellowship University of Toronto Canada
- Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
-
- Book:
- The Cambridge Textbook of Bioethics
- Published online:
- 30 October 2009
- Print publication:
- 31 January 2008, pp 307-308
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41 - Innovative strategies to improve effectiveness in clinical ethics
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- By Jennifer L. Gibson, Assistant Professor University of Toronto, M. Dianne Godkin, Clinical Ethicist and Manager Center for Clinical Ethics Toronto, Canada, C. Shawn Tracy, Research Associate, Primary Care Research Unit University of Toronto, Canada, Susan K. MacRae, Deputy Director and the Director of the Clinical Ethics Fellowship University of Toronto, Canada
- Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
-
- Book:
- The Cambridge Textbook of Bioethics
- Published online:
- 30 October 2009
- Print publication:
- 31 January 2008, pp 322-328
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Summary
A large tertiary healthcare organization has a full-time clinical ethicist who is responsible for ethics consultation, education, policy development, and research. A recent accreditation survey identified a number of gaps in clinical ethics services across the organization. The clinical ethicist is already over-extended and is at risk of burning out. The Vice-President responsible for overseeing the ethics portfolio wonders what can be done to enhance support for the clinical ethicist, strengthen ethics capacity across the organization, and improve the overall effectiveness of clinical ethics services.
What is clinical ethics effectiveness?
The ultimate goal of any clinical ethics delivery model is improved patient care. As more healthcare resources are invested in clinical ethics services, questions are increasingly raised about whether these services are effective in improving the quality of patient care and whether they justify investments of limited healthcare resources. In this chapter, we identify some key challenges to existing clinical ethics delivery models and suggest four innovative strategies to improve effectiveness in clinical ethics services in healthcare organizations.
Since 1995, when James Tulsky and Ellen Fox convened the Conference on Evaluation of Case Consultation in Clinical Ethics (AHCPR, 1995), there has been a marked increase in scholarly attention to the study and evaluation of clinical ethics, particularly related to the ethics consultation component of clinical ethics (e.g., McClung et al., 1996; Orr et al., 1996; Schneiderman et al., 2000). This has been described as a new phase in the clinical ethics movement (Aulisio, 1999).