ethics and guidelines, ethics in guidelines? eir-a project noks nauta, andré weel, jim faas, inge...
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Ethics and guidelines,ethics in guidelines?
EiR-A project
Noks Nauta, André Weel, Jim Faas, Inge den Besten, Kerst Zwart, Medard Hilhorst
NVAB, NVVG, Welder, ErasmusMC
Olomouc, Nov 2010 Grant from ZonMw, The Netherlands organization for health
research and development
New dimension
• Medicine, 1975
• Psychology, 1999
• Ethics: new dimension
• Essential, could not work without it
One minute with neighbour
• Definition of ‘dilemma’?
Dilemma
• More perspectives
• More than one choice
• Each supports value(s)
• Each harms value(s)
Ethical sensitive situation
Eir-A project 2009-2010
• Survey: interviews and questionnaire
• Focusgroup patients
• Working group Moral framework
• 2 working groups ethics chapters
• Start of implementation
Recommendations
• Awareness
• Recognition
• Explicit description in CPG
• Giving clues for dealing
• Moral case deliberation
One minute with neighbour
• Barriers to add ethics to guidelines?
• Your opinion and/or others’ opinions
Barriers
• Difficult, vague, subjective
• Other things more important
• EBM
• Autonomy of professionals
• How to do this?
One minute with neighbour
• Advantages of adding ethics to CPGs?
• Your opinion and/or others’ opinions
Arguments pro
• What is best for patient
• Professionality, reflection
• Multidisciplinarity
• Transparency of decisions
• Quality of care, improvements, innovations
CPGs and ‘other arguments’
• Patients perspectives– Social – Cultural
• Society’s perspective– Economical– Political
• Legal aspects • Collaboration, division of responsibilities
Work and health
• Functioning versus disease/ complaints
• Collaboration
• Professional roles
• Legal issues for insurance physicians
• Effects of therapy on capacity for work
Fundamental principles
• Doing well + causing no harm
• Respect for autonomy
• Justice
• Carefulness, attention
• Trust
• Honesty
• Collaboration
Moral case deliberation
• Facts• Choices • Values per alternative, from different
perspectives• Weighting of values• Choice with argumentation
Making values explicit Trained supervisor
Value-based chapters in guidelines
• For guidelines – Depression– Breast cancer
• Testing by professionals and patients
Ethics chapter DepressionContent
• Introduction, questions, evidence
• Elements of sensitive situations – Vision of client/ patient– Interdisciplinary collaboration – Diagnostics– Treatment – Assessment of functioning – Professional’s self reflection– Context client/ patient
• Moral case deliberation recommended
Ethics chapter breastcancerContent (6 of the10 topics)
• Co-operation of medical professionals• Patients’ participation in treatment and
rehabilitation• Fatigue: assessment and support • Cases with bad or moderate prognosis • Negative feelings about work • Intercultural and SES aspects
Results EiR-A project• Strengths and opportunities
– Innovative and challenging– Many involved, many enthusiastic– Opportunities for innovating guidelines
• Weaknesses and threats– Guideline groups Depression and Breast
cancer have not decided how to deal with the chapter
– How to go on after this project?
Recommendations
• Awareness
• Recognition
• Explicit description in CPG
• Giving clues for dealing
• Moral case deliberation
Spin off
• Ethics chapters in other guidelines (NL)• Training supervisors moral case
deliberation (NL)• Contact IQ health care (NL) • Adding ethical criteria to AGREE
(Licenik et al) (international)• Working group ethics in GIN
(international)
