The ‘Big Five’ in 100 Clinical Ethics Consultation Cases. Evaluating three years of ethics support in the Basel University Hospitals

Abstract
Background:
The study aims at shedding light into the practice of
Clinical Ethics Consultation (EC) thereby making a contribution to bet
-
ter understanding its triggers, contents and outcomes. It was carried out
in 2 (out of 3) local University Hospitals.
Material and method:
100 full ECs (50 ECs conducted at the somatic/
USB, 50 at the Psychiatric University Hospital/UPK) over 3 years were
analysed on the basis of its rich and highly standardised documentation.
Results:
Overall, the majority of all ECs (84%) feature ethical issues
referring to at least one of the following 5 topics: coercion (28%), care
management (24%), treatment-plan evaluation (17%), end-of-life care
(16%), or pregnancy / assisted reproduction (12%).
In USB ECs, the top 3 main ethical issues concern end-of-life care (28%),
pregnancy / assisted reproduction (22%), and coercion (20%), followed
by treatment limitation (8%), and care management (6%). The single
most significant main ethical issue in UPK ECs is coercion (34%), fol
-
lowed by care management and treatment-plan evaluation (both 20%).
Discussion:
The prevalence of end-of-life issues in somatic health care
is in line with previous research, while the evidence for coercion as a
major topic in ECs in general is new. Comparable studies are hardly
available from other European centres, and the existing North American
papers do not display a prevalence of this concern.
Conclusions:
The thematic shift to a double focus on end-of-life deci
-
sions
and
coercion and the “big five” themes revealed altogether stim-
ulate the catalogue of clinical ethics education, both for ethics consul
-
tants and health care professions.