Clinical ethics support for health care practitioners in hospitals would help clinicians to provide ethically sound patient care, even though doctors generally feel they get the ethics of practice "mostly right", according to research published in the Medical Journal of Australia.
Dr Evan Doran and colleagues from the Centre for Values, Ethics and the Law in Medicine and the Faculty of Law at the University of Sydney, and the NSW Ministry of Health, found evidence suggesting that formal clinical ethics support would be beneficial.
The authors conducted 30 interviews between April and November 2011 with 11 medical staff, 18 nursing and midwifery staff, and one psychologist in a large NSW urban hospital with newborn care, maternity and oncology departments. Twenty-four of the interviewees were women, six were men.
"Clinicians' accounts conveyed the impression that they assessed ethics management as being "mostly right", and that they were generally satisfied with the ethics of the hospital, their division and their colleagues", the researchers wrote.
"They believed that the ethics of clinical care was generally handled well, primarily because ethics was perceived as "woven into" the culture of the hospital, and also because clinicians assumed that their colleagues were competent in dealing with basic moral questions and aimed to optimise patient care."
Nevertheless, most of the participants in the survey expressed a desire for formal clinical ethics support because ethics is integral to health care practice, is not always "done well", and may be the source of conflict.
"It is naturally dangerous to be too tolerant of imperfection by, for example, overlooking rather than tackling difficult but important ethical problems."
The researchers found that "even profound moral disquiet is not always expressed. This can be a source of frustration for clinicians and may contribute to "moral distress"; that is, the potential or actual threat to the moral agency and integrity of an individual clinician which, if not appropriately managed, can have a negative effect on staff morale and the quality of care."
They recommended that "clinical ethics support, expressly intended to raise awareness, encourage open discussion and minimise uncertainty and distress, should be considered as a means for providing support.
"Finally, we also believe that serious consideration of clinical ethics support is ultimately a normative question, and should involve broad professional and public discussion on whether explicit engagement with ethics is integral to patient care in a democratic and inclusive society."