Qualitative Evaluation ethischer Fallbesprechungen

Qualitative evaluation of ethics consultations

by Anika Scherer
Doctoral thesis
Date of Examination:2018-04-24
Date of issue:2018-03-20
Advisor:Prof. Dr. Friedemann Nauck
Referee:Prof. Dr. Friedemann Nauck
Referee:Prof. Dr. Claudia Wiesemann
Persistent Address: http://dx.doi.org/10.53846/goediss-6778

 

 

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Abstract

English

Background and aims: In order to ensure quality of ethics consultation provided by a clinical ethics committee (CEC), the evaluation of its work is a common process. Yet, evaluations using qualitative interpretative methods are rare. The aim of this study was to evaluate the consultation process of the CEC at the university medical centre Goettingen, which has been implemented in 2010, taking into account the given clinical context and the implementation of the results into practice. The main focus was on the individual perspectives of all involved actors. The results were to be reported to the CEC members to improve their efficiency. Methods: Qualitative study design using a 3-step approach: 1) context of the given ethical conflict, 2) course of the ethics consultation, and 3) implementation into clinical practice. Data collection included the observation of four ethics consultations and open guided interviews with the participants. All interviews were audio recorded, transcribed verbatim, and analysed using grounded theory method. Results: 1) Context of the ethical conflict: a key element seems to be a conflict within the team, based on hierarchical asymmetry and enhanced by problems of communication. 2) Performance of the ethics consultation: key elements also seem to be a conflict within the team, disagreement among care givers and hierarchical interactions within the team and also between participants and members of the CEC. 3) Implementation into practice: Hierarchical asymmetry in the decision-making process, as a part of the conflict within the team, can inhibit the implementation of the consented discussion. Conclusion: Every ethical conflict is unique, contents of all three research focuses seem to depend on each other, and should therefore not be analysed separately; especially with respect to detached structures and team interactions. Hierarchical asymmetry should be recognized and reduced. This could in part be adopted by ethics consultation with its mediating character. Taboo issues should be discussed frankly, perhaps anonymously prior to the consultation. The consented result of the discussion should be realisable. Professional expertise of the participating CEC members would be supportive. The case protocol could help answering open questions and to provide aid to decision-making.
Keywords: Clinical ethics committee; Qualitative interpretative methods; Ethical conflicts; Team conflicts
 
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