Clinical ethics consultation service at the Ev. Krankenhaus Bielefeld - Background, concepts and strategies for evaluation

Abstract

Definition of the problem: How should an ethics consultation service be structured in order to meet the needs of clinical practice, which are required in morally difficult situations, and give support to those asking for advice? According to which criteria should the consultation services be evaluated? Methods: To answer these questions, theory-driven concepts from Nimwegen, Leuven and Basel are reflected on the background of more than 10 years of ethical experience at the Ev. Krankenhaus Bielefeld (EvKB). Results: We present a structured, multidisciplinary approach by which the ethical dimension of various opinions can be analyzed and (when possible) reconciled towards agreement. Using the EvKB as an example, it is illustrated that an ethics consultation service can be implemented, even in times of scarce resources. Along with the servicebased "communication culture", new criteria for our own evaluation strategy emerged with key aspects being "change of perspectives" and "procedural justice". The state of international research with respect to evaluation is discussed critically. Preliminary concepts and results of evaluation are introduced. Conclusion: With this publication we hope to intensify discussions about these issues with those working in related fields. © Springer Medizin Verlag GmbH 2008.