Clinical Ethics Study
Professor George Braitberg AM
How well prepared are emergency clinicians to face ethical challenges in clinical practice?
A survey to assess current knowledge and training needs
Emergency clinicians are often faced with stressful situations where they are required to make critical decisions in resource-constrained and time-constrained settings. Many of these critical decisions relate to ethical or moral issues rather than strictly clinical concerns.
While ‘ethics and professionalism’ content is included in the Australasian College of Emergency Medicine (ACEM) curriculum it is not clear how consistently this content is delivered nor how it is translated into preparedness of ACEM Fellows to recognise and respond to ethical challenges in a clinical setting.
Beauchamp and Childress articulated the four principles of Bioethics: respect for autonomy, non-maleficence, beneficence and justice. The relevance of these principles to the practice of critical care clinicians was never more important than it is today however, in critical care settings clinicians regularly encounter situations where these principles may be competing, such as when a patient refuses treatment which the doctor believes is clinically beneficial. Knowing the ethical principles may not be enough. Clinicians need skills to weigh up the significance of the principles in situations where people hold different values and goals about their health. Common areas of ethical decision making include: end of life considerations; futility of treatment; patients who may not be able to provide informed consent and surrogate decision makers; restrictive practices (physical or chemical) for patients with behavioural disturbance; resource triage and allocation; duty of care; treatment decision making; mass casualty and disaster triage; refusal of care; maintaining privacy and confidentiality in a sometimes chaotic space; use of new technologies.
There are very few courses that provide clinicians with a robust understanding of clinical ethics and opportunities to identify and discuss ethical dimensions of clinical practice. There is no mandatory ethics training requirement for most clinical specialties. A recent study profiling the perceptions, attitudes and decisions of emergency clinicians in Australia regarding advance directives (ADs) showed that a large proportion of clinicians had no previous education concerning ADs. Similarly, another study found that in the US, despite recommendations by the Society of Academic Emergency Medicine, emergency medicine trainees and graduates reported gaps in clinical ethics knowledge and ethics-based reasoning, with few training programs having dedicated ethic modules.
The aims of this study are to use a survey to:
- assess the ability of emergency medicine clinicians to identify and appropriately address ethical challenges commonly encountered in the workplace
- identify the challenging or puzzling aspects for participants in each scenario.
This information will be used to inform the development of ethics education to support the ACEM training program and to provide ongoing professional development (PD) support for practising Emergency Department clinicians.
This interactive workshop is designed for doctors, nurses and allied health professionals working in a range of critical care settings. When faced with increasing time and resource constraints there is often limited opportunity to deliberate on the ethical pros and cons of clinical decisions. This workshop will provide you with an opportunity to reflect on your practice and develop practical tools to apply to patient care within an ethical framework.
Presented by the Department of Critical Care, University of Melbourne, the workshop is facilitated by emergency clinicians, clinical ethicists and legal experts. Participants will be provided with opportunities for in depth discussion and interaction with like-minded peers.
Professor George Braitberg
Professor Clare Delany
Professor Rinaldo Bellomo
Professor David Story
A/Professor Jonathan Knott
Dr Nicola Walsham
Dr Marija Kirjanenko
Dr Violet Mukaro
Ms Anna Parker
Ms Sharon Feldman
Royal Melbourne Hospital