Clinical Ethics Support in Contemporary Health Care

Abstract

This chapter concerns current initiatives to create and maintain specialized services to help respond to ethical issues that arise in the practice of health care. These initiatives, the obstacles they face, and the controversies they engender should be of considerable interest to those concerned with the management of health care organizations. This is because ethics is and should be intrinsic to routine health care practice. Also, no less, it is because ethical disputes and controversies, even if they seldom occur, can severely disrupt the complex organizations that deliver health care in modern societies. Clinical ethics support services (CES services) are comprised of an individual or group, usually in an organization, who can provide a suite of services to support all stakeholders in identifying and managing the ethical issues that inevitably arise in the design and delivery of health care. While there is a degree of consensus about the potential value of such services, they are also the focus of ongoing theoretical, methodological and political debates. This chapter does not aim to resolve these debates. Rather, our aim is to provide health care managers with an account of how and why CES services are becoming a part of the contemporary organizational landscape of health care, and describe the concerns that bioethicists and observers and critics of bioethics have raised regarding their role, function, and dissemination. We first describe the origins of CES services, to provide a context for the following discussion about the goals, functions and models of support that exist across this discipline—drawing on some relevant examples. We then describe how CES services can be evaluated. Third, we discuss initiatives that aim to optimise quality of CES services and some of the criticisms and suspicions that these initiatives have engendered. Finally, we offer some reflections on the direction that CES services may take in the future.