Journal Article

CES Staff's Moral Challenges Related to Confidentiality and Transparency: Needs for Moral Guidance When Offering Ethics Support?

Molewijk, Bert, Larsen, Berit Hofset

2025

Overview

Introduction: Clinical ethics support (CES) never takes place in an a-political context. In and outside health care institutions, CES seems to become increasingly vulnerable to, and involved in, political and (social) media sensitive domains. We will present two self-experienced morally challenging situations that we encountered as CES staff, including: conflicting values, protecting users of CES, CES staff and the integrity of CES itself, moral responsibilities, and, how we responded. Norwegian case: Staff from the maternity ward at a Norwegian hospital asked the clinical ethics committee (CEC) for advice regarding women in labor opposing recommended interventions, raising concerns about the child's welfare. A birth right activist group member, also being a journalist, contacted the hospital claiming access to all minutes from meetings - where CEC had discussed the dilemma when the mother opposes interventions in connection with pregnancy and childbirth, obstetric violence, the legal protection of the unborn child or related issues. Dutch case: Due to a serious incident in a Dutch hospital a patient died (not because of the illness or treatment). The head of the department asked the internal Ethics Support team for a Moral Case Deliberation to focus on the moral stress of the team members and to reflect upon various moral questions related to this tragic incident. Afterwards, the Ombudsman and the Health Inspectorate asked for the minutes from that specific MCD session, and requested an interview with the MCD facilitator. Discussion: After comparing the facts and moral reasoning in both examples of ethics support staff's moral challenges, we will present an innovative ethics support tool specifically developed for CES staff experiencing moral challenges when offering CES ina political context (the Confidentiality Compass). During the last part of our presentation, we will engage with the audience in discussions about future needs of CES staff for related moral guidance.

• Publisher: MedStar Washington Hospital Center
• Subject: Confidentiality / Ethics