The growth of clinical ethics in a multilingual country: challenges and opportunities

The Swiss experience with clinical ethics committees and consultation services is a relatively recent development. When ethics committees offering clinical case consultation were first identified in a 2002 survey, only 18 % of Swiss hos- pitals reported a clinical ethics committee. However, 84 % of these reported offering case consultation. The oldest known clinical ethics committee was founded in 1988, at a psychiat- ric hospital in the German speaking region. The two oldest clinical ethics committees in the French speaking part of the country were founded in 1994, at two major teaching hospi- tals (1). In 2004, only 16 % of physicians reported access to ethics consultation for individual cases (2). Ethics consultation services grew out of locally perceived needs, with locally determined structures and processes. At- tempts at establishing networks between these services are Abstract _French and German abstracts see p. 23 Background: Clinical ethics committees and consultation services are a new development in Switzerland. These services grew out of locally perceived needs, with locally determined structures and processes. They were first listed in a 2002 survey, and the first national meeting of clinical ethics committees took place in 2004. Attempts at establishing bridges and networks between these services are very recent, and are made more difficult by the multi-cultural and multi-lingual structure of Switzerland. Method: We describe how different clinical ethics support services developed in Switzerland, and outline the diversity of structures, languages and cultural sources that these services are based on. Results: Despite differences in models and processes, common elements emerge: reliance on principlism, citizen involvement, interdisciplinarity, as well as the - implicit or explicit - reluctance to rely too strictly on rigid rules or processes for ethics consultation. The multi-lingual and multi-cultural structure of Switzerland results in unique difficulties in setting up a national network. Working in three different languages gives rise to logistical obstacles not present in most other countries. With each language also comes a literature corpus relevant to medical ethics, which is used alongside the English language bioethics literature with different degrees of salience in different regions. Discussion and Conclusion: This environment renders attempts to establish national networking for clinical ethics support services more difficult. However, it also presents what could be unique opportu- nities. Coordinated exchange of experience will grow in importance as challenges continue to face clinical ethics as a whole.