ACCORD – ACCESSING CLINICAL ETHICS COMMITTEES FOR RAPID DISCUSSION

: What approach(es) should be adopted by clinical ethics support services (CESS) for advising on urgent decisions in healthcare?

Abstract

Clinical ethics support services (CESS) have a broad and developing – but loosely defined – role, which may include policy input, education, and case consultation. The latter is established for when there is time for deliberation. Less appears to be known about what CESS role is – and should be – regarding urgent decision-making. This empirical bioethics project uses the framework, mapping-framing-shaping, to present the approach(es) which should be adopted by clinical ethics support services for advising on urgent decisions in healthcare.
In the mapping stage, a narrative review presents an understanding of current CESS practice. A systematic review found that the most popular approach to urgent decisions is the rapid response group, made up of subset of members from the larger committee. In some cases, the rapid response team was combined with education of the clinical team, guidelines, escalating within the team and expecting clinicians to have ethical reasoning skills.
In the framing stage, focus groups with three key stakeholder groups (clinicians in England, committee members in England and committee members/ethicists in United States) underwent reflexive thematic analysis. An urgent decision was defined by stakeholders as when there is limited time with a risk of harm and commonly involved capacity or conflict between the family and medical team. Clinicians defined decisions as legal rather than ethical and expressed some negative perceptions of CESS. The response time and committee structure differed between the stakeholders. Patient involvement in CESS committee meetings was not routinely facilitated in England.
Finally, I present the ‘prepare and respond model’ which proposes timely available case consultation, guidelines for system wide rationing decisions and education of the clinical team to facilitate discussion of ethical conflict. It is recommended that there is further research to understand how patients would like to be involved in the CESS process.

Date of Award	19 Mar 2024
Original language	English
Awarding Institution	University of Bristol
Supervisor	Richard Huxtable (Supervisor), Dani M O'Connor (Supervisor), Dani M O'Connor (Supervisor) & Richard Huxtable (Supervisor)