Implicit and explicit clinical ethics support in The Netherlands: a mixed methods overview study.

Area of Science:

• Healthcare Ethics
• Public Health Policy
• Organizational Management

Background:

• Clinical ethics support (CES) has seen increased international adoption.
• Prior research predominantly focused on ethics committees and consultations in hospital settings.
• A gap exists in understanding the prevalence of diverse CES forms across various healthcare domains.

Purpose of the Study:

• To investigate the prevalence of different types of clinical ethics support (CES) in Dutch healthcare.
• To examine CES across hospital care, mental health care, elderly care, and intellectual disability care sectors.
• To differentiate between explicit and implicit CES and their interrelation.

Main Methods:

• Mixed methods design incorporating two survey questionnaires distributed to all healthcare institutions.
• Qualitative data collection through two focus groups.
• In-depth insights gathered from 17 interviews with managing directors or ethics support staff.

Main Results:

• Ethics committees are highly prevalent, particularly within hospitals.
• Moral case deliberation (MCD) is accessible in approximately 50% of Dutch healthcare institutions, rising to two-thirds in mental health care.
• Ethics consultants are less prominent; explicit and implicit CES forms frequently coexist, with MCD potentially bridging them.

Conclusions:

• Both explicit and implicit forms of clinical ethics support are vital in healthcare delivery.
• Further research is recommended to explore effective integration strategies for explicit and implicit CES.
• Understanding the interplay of these CES forms can enhance ethical practice across diverse healthcare settings.