Need for ethics support in healthcare institutions: views of Dutch board members and ethics support staff Linda Dauwerse, 1 Tineke Abma, 1 Bert Molewijk, 1,2 Guy Widdershoven 1 ABSTRACT Objective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings Most respondents see a need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. Conclusion There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice. INTRODUCTION Clinical ethics is an emerging field, including various means of ethics support, such as ethics committees, ethics consultants and moral case deliberation. Our working definition of clinical ethics support is: a functionary group or body which is explicitly involved in (the organisation of) ethics in healthcare institutions. The literature describes methods of ethics support 1e3 and char- acteristics of ethics support, like access and work- load. 4e7 Implicitly, this literature presupposes that there is a need for ethics support. Some studies report empirical findings about the need for ethics support. 8e10 For example, 89% of the UK trust respondents were in favour of ethics support 8 and 87% of British hospital CEC chairpersons expressed a need for ethics support. 9 In Canada, 95% of the healthcare providers believed ethics support would answer a need. 10 The need for ethics support is related to the complex, value-laden nature of clinical decision making, the pluralistic societal context and economic constraints. 11e13 However, there is little empirical evidence available about underlying reasons for the need for ethics support. Many of the previous studies did not systematically study why there is a need for ethics support. Moreover, ethics support such as ethics committees are not often consulted in practice. They receive a limited number of cases per year 9 or meet rarely (24% of committees in Canada reported that they only met six or fewer times a year), probably because they have an inactive agenda or are still trying to iden- tify how they can be effective. 14 Also, ethics consultation services (ECS) have a low number of consultations (22% of the ECS in US-Hospitals performed no consultations in 2006, 90% performed fewer than 25). 4 The aim of the present paper is to investigate the need for ethics support of Dutch healthcare insti- tutions and to understand which factors are rele- vant in explaining the presence or absence of such need. We used a mixed methods design, including two survey questionnaires, two focus groups and 17 interviews. This article focuses on the perspec- tives of board members and ethics support in Dutch healthcare institutions. The assumption is that they have a key role in facilitating and prac- tically organising ethics support, and are only willing to facilitate ethics support if they see an intrinsic need for it. 15 16 METHODS Design Quantitative and qualitative methods were used in a mixed methods design. 17 18 The mixed methods design was chosen as it enabled us to collect a broad array of quantitative information on the need for ethics support and helped to gain qualitative infor- mation about the reasons for such (lacking) need. First, two survey questionnaires with closed and open questions were used to assess the need for ethics support and to explore underlying motiva- tions. The first was addressed at board members as they have an important role in facilitating ethics support. The second questionnaire was directed at ethics support staff, as they have an important role in the actual organisation and implementation of ethics support in the institution. The data of ques- tionnaires 1 and 2 were analysed with SPSS 15 for the closed questions and a thematic content anal- ysis of the open ended questions. This means that themes were constructed from the data set. The answers to open questions were read line by line and labelled, compared and then clustered into themes. After reordering them several times, we came to the current categorisation: three pros and three cons. 1 VU University Medical Centre, Department of Medical Humanities, EMGO Institute for Health and Care Research, Amsterdam,The Netherlands 2 GGNet, Institute for Mental Health Care, Warnsveld, The Netherlands Correspondence to Linda Dauwerse, Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; l.dauwerse@vumc.nl Received 2 October 2010 Revised 26 January 2011 Accepted 6 February 2011 Dauwerse L, Abma T, Molewijk B, et al. J Med Ethics (2011). doi:10.1136/jme.2010.040626 1 of 5 Clinical ethics JME Online First, published on April 21, 2011 as 10.1136/jme.2010.040626 Copyright Article author (or their employer) 2011. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on April 26, 2011 - Published by jme.bmj.com Downloaded from