Clinical Ethics Committee

The Clinical Ethics Committee is an interdisciplinary team that is supposed to contribute in an advisory capacity to ensure that responsibility, the right to self-determination, trust, respect, consideration and compassion as moral values of clinical ethics within the framework of medical ethics, the decisions and dealings with people ( Patients ) in a hospital through ethics counseling .

It is therefore aimed at patients, relatives, nurses, doctors , but also all other hospital staff. Competent and prompt help is to be given to reflecting on upcoming or already made decisions in the various areas such as medicine , nursing and economics ethically and to process them.

In contrast to the medical ethics committee , the clinical ethics committee is not responsible for assessing research projects that include the participation of healthy volunteers or patients.

The establishment of clinical ethics committees is based on ethical uncertainty in medicine due to increasing possibilities to decisively influence life in its course and in its forms, and with the intention of making these possibilities in harmony with the (presumed) will of a patient bring.

As a result of the interdisciplinary cooperation, recommendations and statements are issued that can facilitate decision-making, especially in ethical border areas.

Practical philosophy, as it is also used in philosophical practice, is a basis for ethics advice by a clinical ethics committee (as a form of applied ethics ) .

Goal setting

The task of the Clinical Ethics Committee (KEK) is to be available for advice in the form of an Ethical Consultation (EK) in ethical crisis situations. An EK is ethical consultation among all those involved in treating a patient when there is uncertainty about further treatment. It relates to a specific case that occurs on one of the wards or departments.

At the ethical consultation, when making a decision about further therapy for critically ill patients, the (presumed) will of the sick person in their current situation should be determined and taken into account so that everyone involved in the therapy can assume that they will continue to benefit the patient act.

Another aim is to develop guidelines for the ethical handling of recurring clinical problem situations. They give a well-founded orientation for the formation of judgment in the specific individual case of medical and nursing decisions.

Scope, application, information channels

These procedural instructions apply to all employees in the corresponding clinic. It is sent to all departments. The cover letter refers to the offer to personally present the concept of the Clinical Ethics Committee (KEK) in the departments and wards. In any case, this happens in the intensive care units, the oncology wards and the internal medicine wards with a high proportion of geriatric patients.

The concept is to be presented to all interested employees at a central event as part of an “ethics day”. External speakers, who should also be available for working groups, are invited to share experiences. The organizational implementation can be handed over to the institute for basic, advanced and advanced training of the clinic concerned.

Consequences and implementation of the recommendations

The recommendations of the EK and KEK are made by consensus. In exceptional cases, the alternative votes are shown. Patients and relatives are informed by the treating doctor.

Since the legal responsibility for the further course of action always rests with the responsible doctor, the decision of the EK can only be expressed as a recommendation. If the attending physician does not follow her, he informs the KEK / EK and in turn gives an additional reason for his deviation.

documentation

With the help of a suitable questionnaire, mostly based on the Nijmegen model (also known as the Nijmegen model ), the committee creates a protocol as part of an ethics consultation in which the participants' statements are reproduced anonymously. The protocol becomes part of the medical record, at least the final vote. After the patient data has been anonymized, the KEK receives a copy. The obligation of confidentiality and the regulations of the applicable data protection must be observed.

Economic impact

The resulting costs are mainly caused by the working hours of the employees involved, by the meetings of the KEK and the convening of an EK, as well as by the advanced training of the members of the KEK and the events relevant to the public.

literature

Regina Bannert, Ulrich Fink: Ethical action in institutional reality. In: Bannert, Fink, Heimernmann, Lätzsch (eds.): Werkbuch Medizinethik 1. Münster 2005, pp. 447–481.
Axel W. Bauer: The Clinical Ethics Committee (KEK) in the field of tension between hospital certification, moral pragmatics and scientific standards. In: Wiener Medical Wochenschrift. No. 157, 2007, pp. 201-209.
Axel W. Bauer, Laura K. Dewies: Clinical ethics advice: high requirements, restrained implementation. In: Deutsches Ärzteblatt. Volume 115, 2018, pp. A1046-A1048.
Ethics advice in the hospital. Internet portal for clinical ethics committees, consulting and liaison services, www.ethikkomitee.de.
Hospital Ethics Committee. Extracts from the joint recommendation of the German Evangelical Hospital Association and the Catholic Hospital Association Germany eV (May 1997) at www.gwdg.de.
Gisela Klinkhammer: Ethics advice in hospitals: “Acting for the benefit of the patient” . In: Deutsches Ärzteblatt. No. 104, No. 6, 2007, pp. A-324 / B-285 / C-273.
Arnd May: Ethical Decision Making in Clinical Practice. In: Ethics in Medicine. Volume 16, 2004, pp. 242-252.
Alfred Simon, Arnd May, Gerald Neitzke: Curriculum “Ethics Advice in Hospitals”. In: Ethics in Medicine. Volume 17, 2005, pp. 322-326.
Norbert Steinkamp: Instruments for ethical case discussions. Department of Ethics, Philosophy and History of Medicine, Catholic University of Nijmegen (Nijmegen), July 1998.

Web links

www.ethikkomitee.de