Trust relationships are important elements in the organization of health care and in decisions about priorities in situations where resources are limited. At Akademiska sjukhuset (Uppsala University Hospital), we have developed a model for ethical management characterized by team building with a strong emphasis on ethics as a learning process. In this model, dialogue is the key.
Ethical rounds use realistic patient cases as basis for reflection and discussion about values that are at stake for individual patients, relatives, doctors and nurses. The rounds serve as a help in building trust relationships between professionals. Cases are chosen and presented by doctors and nurses on the basis of what they themselves find morally problematic in everyday medical treatment and care.
The discussions during these rounds raise a broad spectrum of problems in both medical and moral decision making: When is it right to withdraw treatment in this individual case? When and how should the “do not resuscitate” order be implemented for this patient? When should we move from a curative to palliative perspective in the treatment of this patient? Should we go against the will of the patients children and start tube feeding?
In this kind of clinical ethics, imagination is the key faculty at play. Imaginative ethics starts with the moral problem and encourages sensitivity to particular needs, desires, risks and benefits. It is the doctors and nurses who have first hand experience of a patient who are most likely to identify the values at stake in a situation of treatment and care. They have knowledge of the patient’s medical history and they can benefit from listening to the perspectives of colleagues who are involved in the care of this particular patient. Listening to other perspectives and descriptions of the care of a patient illuminates and improves ethical praxis in everyday medicine.
Research on ethics rounds
We recently finished a post doc project to investigate whether supervised ethical rounds to can improve ethical climate in psychiatry outpatient clinics. The project has been developed as a result of existing collaborations between CRB, the Uppsala County Council and Akademiska Sjukhuset (Uppsala University Hospital).
Publications from CRB
Silén, M., Haglund, K., Hansson, M. G. & Ramklint, M. (2015). Ethics rounds do not improve the handling of ethical issues by psychiatric staff. Nordic Journal of Psychiatry, 69(6), 1700-1707.
Silén, M., Ramklint, M., Hansson, M. G. & Haglund, K. (2014). Ethics rounds: An appreciated form of ethics support. Nursing Ethics, 1-11.
Hansson MG, Imaginative Ethics – Bringing Ethical Praxis into Sharper Relief, Medicine, Health Care and Philosophy, 2002;5:33-42.
Kälvemark S, Höglund AT, Hansson MG, Westerholm P, Arnetz B, Living with Conflicts. Ethical Dilemmas and Moral Distress in the Health Care System, Social Science and Medicine, 2004;58:1075-1084.
Kälvemark Sporrong S, Höglund AT, Hansson MG, Westerholm P, Arnetz B, ”We are White Coats Whirling Round”. Moral Distress in Swedish Pharmacies, Pharmacy World and Science 2005;27: 223-229.
Kälvemark Sporrong S, Höglund AT, Arnetz B, Measuring Moral Distress in Pharmacy and Clinical Practice, Nursing Ethics, 2006;13(4): 416-427.
Kälvemark Sporrong S, Arnetz B, Hansson MG, Westerholm P, Höglund AT, Developing Ethical Competence in Health Care Organizations, Nursing Ethics, 2007:14(6):825-837.
Kälvemark Sporrong S, Ethical Competence and Moral Distress in the Health Care Sector. A Prospective Evaluation of Ethics Rounds, Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 224. Uppsala: Acta Universitatis Upsaliensis. 2007.