Hospital Clinical Ethics Committees. The Geneva Experience - Switzerland

Main Article Content

Jean-Claude Chevrolet
Bara Ricou

Abstract

Hospital ethics committees were created in the United States of America in the 1970s. Their aims were the education of the hospital personnel in the field of ethics, the development of policies and the publication of guidelines concerning ethical issues, as well as consultations and case reviews of hospitalized patients when an ethical concern was present. During the last thirty years, these committees disseminated, particularly in Western Europe. In this manuscript, we describe the benefit, but also some difficulties with these committees, and we propose some solutions. The characteristics of these committees are discussed (i.e. typology of members, functioning and legitimacy). Finally, we carefully describe our local hospital clinical ethics committee in Geneva (Switzerland), which was founded in 1994 and it still very active. After fifteen years of experience, we remain strongly in favour of the implementation of such committees in any modern hospital.

Downloads

Download data is not yet available.

Article Details

How to Cite
Chevrolet, Jean-Claude, and Bara Ricou. 2009. “Hospital Clinical Ethics Committees. The Geneva Experience - Switzerland”. Diametros, no. 22 (December):21-38. https://doi.org/10.13153/diam.22.2009.360.
Section
Special topic - Clinical Ethics Committees
Author Biographies

Jean-Claude Chevrolet

Jean-Claude Chevrolet, MD Intensive Care Service University Hospital Geneva - Switzerland

Bara Ricou

Bara Ricou, MD Intensive Care Service University Hospital Geneva - Switzerland
Share |

References

AAP – American Academy of Pediatrics: Committee on Bioethics. Institutional ethics commit- tee, “Pediatrics” 107, 2001: 205-209.
View in Google Scholar

Ackerman [1989] – T. Ackerman, Conceptualizing the role of the ethics consultant - some theo- retical issues, in: J. Fletcher, N. Quist, A. Jonsen (ed.). Ethics consultation in health care, Ann Harbor (Michigan): Health Administration Press., 1989: 37-52.
View in Google Scholar

Agich [1991] – G. Agich, The question of methods in ethics consultation, “American Journal of Bioethics” 1, 2001: 31-41.
View in Google Scholar

Annas [1991] – G. Annas, Ethics committees: from ethical comfort to ethical cover, “Hastings Center Report” 21, 1991: 18-21.
View in Google Scholar

Aulisio et al. [2000] – M.P. Aulisio, R.M. Arnold, S.J. Youngner, Health care ethics consulta- tion: nature, goals, and competencies. A position paper from the Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation, “Annals of Internal Medicine” 133 (1), 2000: 59-69.
View in Google Scholar

Azoulay et al. [2001] – E. Azoulay, F. Pochard, S. Chevret, Meeting the needs of ICU patients' families: a multicenter study, “American Journal of Respiratory Critical Care Medi- cine” 101, 2001: 135-139.
View in Google Scholar

Barnard [1992] – D. Barnard, Reflections of a reluctant clinical ethicist: ethics consultation and the collapse of critical distance, “Theor Med” 13, 1992: 15-22.
View in Google Scholar

Bartels [1988] – D. Bartels, Ethics committees and critical care: allies or adversaries?, “Perspect.
View in Google Scholar

Crit. Care” 1, 1988: 83-90.
View in Google Scholar

Casarett et al. [1998] – D. Casarett, F. Daskal, J. Lantos, The authority of the clinical ethicist, “Hastings Center Report” 28, 1998: 6-11.
View in Google Scholar

Chevrolet [1998] – J. Chevrolet, Genève. CdECdlHUd., Atitude face à un patient en état végétatif persistant, “Médecine Hygiène” 2222, 1998: 1729-1735.
View in Google Scholar

Chevrolet [1995] – J. Chevrolet, Genève. CdECdlHUd., Transplantation hépatique à partir d'un donneur vivant apparenté: une réflexion éthique, “Médecine Hygiène” 54, 1995: 2089-2092.
View in Google Scholar

Chevrolet, Jolliet [1991] – J. Chevrolet, P. Jolliet, An ethical look at intensive care for patients with malignancies, “European Journal of Cancer” 27, 1991: 210-212.
View in Google Scholar

Chevrolet [1993] – J. Chevrolet, Décisions éthiques et responsabilité médicale, “Médecine Hy- giène” 51, 1993: 2453-2460.
View in Google Scholar

Chevrolet [2002] – J. Chevrolet, Les comités locaux d'éthique clinique hospitaliers, “Médecine Hygiène” 2407, 2002: 1781-1786.
View in Google Scholar

Chevrolet [1994] – J. Chevrolet, Quelques réflexion d'un clinicien sur l'euthanasie et le droit pénal, “Médecine Hygiène” 52, 1994: 2280-2281.
View in Google Scholar

Dowdy et al. [1998] – M. Dowdy, C. Robertson, J. Bander, A study of proactive ethics consultation for critically ill patients with extended length of stay, “Critical Care Medicine” 26, 1998: 252-259.
View in Google Scholar

Doyal [2001] – L. Doyal, Clinical ethics committees and the formulation of health care policy, “Journal of Medical Ethics” 27, 2001 (suppl. 1): i44-i49.
View in Google Scholar

DuVal [1997] – G. DuVal, Liability of ethics consultants - a case analysis, “Cambridge Quar- terly of Healthcare Ethics” 6, 1997: 269-281.
View in Google Scholar

Fleetwood, Unger [1994] – J. Fleetwood, S. Unger, Institutional ethics committees and the shield of immunity, “Annals of Internal Medicine” 120, 1994: 320-325.
View in Google Scholar

Fletcher, Hoffmann [1994] – J. Fletcher, D. Hoffmann, Ethics committees: time to experiment with standards, “Annals of Internal Medicine” 120, 1994: 335-338.
View in Google Scholar

Fox, Tulsky [1996] – E. Fox, J. Tulsky, Evaluation research and the future of ethics consultation, “Journal of Clinical Ethics” 7, 1996: 146-149.
View in Google Scholar

Frader [1992] – J. Frader, Political and interpersonal aspects of ethics consultation, “Theor Med” 13, 1992: 31-44.
View in Google Scholar

Fry-Revere [1993] – S. Fry-Revere, Some suggestions for holding bioethics committees and con- sultants accountable, “Cambridge Quarterly Healthcare Ethics” 2, 1993: 449-455.
View in Google Scholar

Guerrier [2006] – M. Guerrier, Hospital based ethics, current situation in France: between "Espaces" and committees, “Journal of Medical Ethics” 32, 2006: 503-506.
View in Google Scholar

Heilicser [2000] – B. Heilicser, D. Meltzer, M. Siegler, The effect of clinical ethics consultations on healthcare costs, “Journal of Clinical Ethics” 11, 2000: 31-38.
View in Google Scholar

Hurst et al. [2006] – S. Hurst, J. Chevrolet, F. Loew, Methods in clinical ethics: a time for eclectic pragmatism?, “Journal of Clinical Ethics” 1, 2006: 159-164.
View in Google Scholar

Hurst et al. [2005] – S. Hurst, S. Hull, G. DuVal, M. Danis, How physicians face ethical diffi- culties: a qualitative analysis, “Journal of Medical Ethics” 31, 2005: 7-14.
View in Google Scholar

Hurst et al. [2007a] – S. Hurst, A. Perrier, R. Pegoraro, S. Reiter-Theil, R. Forde, A. Slowther, et al., Ethical difficulties in clinical practice: experiences of European doctors, “Jour- nal of Medical Ethics” 33, 2007: 51-57.
View in Google Scholar

Hurst et al. [2007b] – S. Hurst, S. Reiter-Theil, A. Perrier, R. Forde, A. Slowther, R. Pegoraro, et al., Physicians’ access to ethics support services in four European countries, “Health Care Anal” 15, 2007: 321-335.
View in Google Scholar

Hurst [2006] – S. Hurst, La consultation d'éthique: à quoi ça peut servir?, “Rev Méd Suisse” 2, 2006: 2195-2199.
View in Google Scholar

Kelly, Hoyt [1996] – D. Kelly, J. Hoyt, Ethics consultation, “Critical Care Clinics” 12, 1996: 49-70.
View in Google Scholar

LaPuma, Schiedermayer [1991] – J. LaPuma, D. Schiedermayer, Ethics consultation - skills, roles, and training, “Annals of Internal Medicine” 114, 1991: 155-160.
View in Google Scholar

Lebeer [2005] – G. Lebeer, Clinical ethics support services in Europe, “Medicinska Etika & Bioetika/Medical Ethics & Bioethics” 11, 2005 (suppl.): 8-11.
View in Google Scholar

Leeman et al. [1997] – C. Leeman, J. Fletcher, E. Spencer, S. Fry-Revere, Quality control for hospitals’ clinical ethics services: proposed standards, “Cambridge Quarterly of Health- care Ethics” 6, 1997: 257-268.
View in Google Scholar

Lilje [1993] – C. Lilje, Ethics consultation: a dangerous, antidemocratic charlatanry?, “Cambridge Quarterly of Healthcare Ethics” 2, 1993: 438-442.
View in Google Scholar

Lo, Schroeder [1981] – B. Lo, S. Schroeder, Frequency of ethical dilemmas in a medical inpatient service, “Archives of Internal Medicine” 141, 1981: 1062-1064.
View in Google Scholar

McClung et al. [1996] – J.A. McClung, R.S. Kamer, M. DeLuca, H.J. Barber, Evaluation of a medical ethics consultation service: opinions of patients and health care providers, “American Journal of Medicine” 100 (4), 1996: 456-60.
View in Google Scholar

Meulenberg et. al. [2007] – T. Meulenberg, J. Vermylen, P. Schotsmans, The current state of clinical ethics and healthcare ethics committees in Belgium, “Journal of Medical Ethics” 31, 2007: 318-321.
View in Google Scholar

Mino [2001] – J. Mino, Why are there no clinical ethicists in France?, “Cambridge Quarterly of Healthcare Ethics” 10, 2001: 341-344.
View in Google Scholar

Mitchell, Swartz [1990] – S. Mitchell, M. Swartz, Is there a place for a lawyer on ethics commit- tees? A view from the inside, “Hastings Center Report” 20, 1990: 32-33.
View in Google Scholar

Moreno [1991] – J. Moreno, Ethics consultation as moral engagement, “Bioethics” 5, 1991: 44- 56.
View in Google Scholar

Orlowski et al. [2006] – J. Orlowski, S. Hein, J. Christensen, R. Meinke, T. Sincich, Why doctors use or do not use ethics consultation, “Journal of Medical Ethics” 32, 2006: 499- 502.
View in Google Scholar

Paris, Reardon [2001] – J.J. Paris, F.E. Reardon, Ethics committees in critical care, “Critical Care Clinics” 2 (1), 1986: 111-21.
View in Google Scholar

Pochard [2001] – F. Pochard, E. Azoulay, S. Chevret, R. Zittoun, Toward an ethical consulta- tion in intensive care?, “Critical Care Medicine” 29, 2001: 1489-1490.
View in Google Scholar

Reither-Theil [2001] – S. Reither-Theil, Ethics consultation in Germany: the present situation, “HEC Forum” 13, 2001: 265-280.
View in Google Scholar

Salathé et al. [2003] – M. Salathé, M. Leuthold, M. Amstad, M. Valloton, Comités d'éthique en Suisse: un état des lieux, “Bull. Méd Suisses” 84, 2003: 2264-2267.
View in Google Scholar

Schiedermayer, LaPuma [1993] – D. Schiedermayer, J. LaPuma, The ethics consultant and ethics committees, and their acronyms: IRBs, HECs, RM, QA, UM, PROs, IPCs, and HREAPs, “Cambridge Quarterly of Healthcare Ethics” 2, 1993: 469-475.
View in Google Scholar

Schneiderman et al. [2000] – L.J. Schneiderman, T. Gilmer, H.D. Teetzel, Impact of ethics consultations in the intensive care setting: a randomized, controlled trial, “Critical Care Medicine” 28 (12), 2000: 3920-3924.
View in Google Scholar

Scofield [1993] – G. Scofield, Ethics consultation: the least dangerous profession, “Cambridge Quarterly Healthcare Ethics” 2, 1993: 417-448.
View in Google Scholar

Self [1993] – D. Self, Is ethics consultation dangerous?, “Cambridge Quarterly of Healthcare Ethics” 2, 1993: 442-445.
View in Google Scholar

Siegler, Singer [1988] – M. Siegler, P. Singer, Clinical ethics consultation - Godsend or god squad?, “American Journal of Medicine” 85, 1988: 759-760.
View in Google Scholar

Siegler [1986] – M. Siegler, Ethics committees - decisions by bureaucracy, “The Hastings Center Report” 16, 1986: 22-24.
View in Google Scholar

Slomk [1994] – J. Slomka, The ethics committee: providing education for itself and others, “HEC Forum” 6, 1994: 31-38.
View in Google Scholar

Slowther et al. [2001] – A. Slowther, T. Hope, R. Ashcroft, Clinical ethics committees: a worldwide development, “Journal of Medical Ethics” 27, 2001 (suppl. 1): i1.
View in Google Scholar

Spielman [1993] – B. Spielman, Invoking the law in ethics consultation, “Cambridge Quarterly of Healthcare Ethics” 2, 1993: 457-467.
View in Google Scholar

Spike, Greenlaw [2000] – J. Spike, J. Greenlaw, Ethics consultation: high ideals or unrealistic expectations?, “Annals of International Medicine” 133 (1), 2000: 55-57.
View in Google Scholar

Swenson, Miller [1992] – M. Swenson, R. Miller, Ethics case reviews in health care institution. Committees, consultants or teams?, “Archives of Internal Medicine 149, 1992: 1109- 1112.
View in Google Scholar

Szeremeta et al. [2001] – M. Szeremeta, J. Dawson, D. Manning, A. Watson, M. Wright, W. Notcutt, et al., Snapshots of five ethical committees in the UK, “Journal of Medical Eth- ics” 27, 2001 (suppl. 1): i9-i17.
View in Google Scholar

Tuskey, Lo [1992] – J. Tulskey, B. Lo, Ethics consultation: time to focus on patients, “American Journal of Medicine” 92, 1992: 343-345.
View in Google Scholar

Warnock [1991] – M. Warnock, Ethics committees, “Baillières Clin Obstet Gynecol” 5, 1991: 761-777.
View in Google Scholar

Weeks, Nelson [1993] – W. Weeks, W. Nelson, The ethical role of the consultant, “Cambridge Quarterly of Healthcare Ethics” 2, 1993: 477-483.
View in Google Scholar