Managing ethical issues in patient care and the need for clinical ethics support
Evan Doran A D , Jennifer Fleming A , Christopher Jordens A , Cameron L Stewart B , Julie Letts C and Ian H Kerridge A
+ Author Affiliations
- Author Affiliations
A Centre for Values, Ethics and Law in Medicine, University of Sydney, Medical Foundation Building, 92–94 Parramatta Road, Camperdown, NSW 2006, Australia. Email: jennifer.fleming@sydney.edu.au; chris.jordens@sydney.edu.au; ian.kerridge@sydney.edu.au
B Centre for Health Governance, Law and Ethics, University of Sydney, New Law Building, Camperdown, NSW 2006, Australia. Email: cameron.stewart@sydney.edu.au
C Office of the Chief Health Officer, NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia. Email: jlett@doh.health.nsw.gov.au
D Corresponding author. Email: Evan.doran@sydney.edu.au
Australian Health Review 39(1) 44-50 https://doi.org/10.1071/AH14034
Submitted: 14 February 2014 Accepted: 22 September 2014 Published: 17 December 2014
Journal Compilation © AHHA 2015
Abstract
Objective To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia.
Methods A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals.
Results Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful.
Conclusion Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia.
What is known about the topic? Clinicians working in hospitals in the US, Canada and UK have access to ethics expertise to help them manage ethical issues that arise in patient care. How Australian clinicians currently manage the ethical issues they face has not been investigated.
What does this paper add? This paper describes the types of ethical issues faced by Australian clinicians, how they manage these issues and whether they think ethics support would be helpful.
What are the implications for practitioners? Clinicians frequently encounter ethically and legally difficult decisions and want additional ethics support. Helping clinicians to provide ethically sound patient care should be a priority of public hospitals in NSW and elsewhere in Australia.
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