The “Big Five” in 100 Clinical Ethics Consultation Cases

Abstract Background: The study aims at shedding light into the practice of Clinical Ethics Consultation (EC) thereby making a contribution to bet - ter understanding its triggers, contents and outcomes. It was carried out in 2 (out of 3) local University Hospitals. Material and method: 100 full ECs (50 ECs conducted at the somatic/ USB, 50 at the Psychiatric University Hospital/UPK) over 3 years were analysed on the basis of its rich and highly standardised documentation. Results: Overall, the majority of all ECs (84%) feature ethical issues referring to at least one of the following 5 topics: coercion (28%), care management (24%), treatment-plan evaluation (17%), end-of-life care (16%), or pregnancy / assisted reproduction (12%). In USB ECs, the top 3 main ethical issues concern end-of-life care (28%), pregnancy / assisted reproduction (22%), and coercion (20%), followed by treatment limitation (8%), and care management (6%). The single most significant main ethical issue in UPK ECs is coercion (34%), fol - lowed by care management and treatment-plan evaluation (both 20%). Discussion: The prevalence of end-of-life issues in somatic health care is in line with previous research, while the evidence for coercion as a major topic in ECs in general is new. Comparable studies are hardly available from other European centres, and the existing North American papers do not display a prevalence of this concern. Conclusions: The thematic shift to a double focus on end-of-life deci - sions and coercion and the “big five” themes revealed altogether stim- ulate the catalogue of clinical ethics education, both for ethics consul - tants and health care professions.