Managing ethical issues in patient care and the need for clinical ethics support

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: Cross-sectional survey of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Results: Sixty-two (59%) respondents reported occasionally to often having ethical concerns. Forty-six (44%) reported often to occasionally having legal concerns. The three most common response to concerns was: talking to colleagues (96, 91.4%); raising the issue in a group forum (68, 65%) and consulting a relevant guideline. Most respondents were highly (62%) or moderately (31%) satisfied with the ethical environment of the hospital. Twenty-two (22%) were highly satisfied with the ethical environment of their department and 74 (75%) were moderately satisfied. A majority 72 (69%) of 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. While this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, the majority of 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. Key Question Summary 1. What is known about the topic? Clinicians working in hospitals in the USA, Canada and the United Kingdom 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 2. 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. 3. 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.