Medical-ethical decision-making ranges between the poles of the medical indication on the one hand and the will of the informed and advised patient on the other, which do not necessarily have to coincide. Even if the definitive choice of action is made by the attending physician/the treatment team, it is particularly helpful in problematic conflicting situations to set up the corresponding decision-making as broadly as possible, with the result that ultimately an appropriate, acceptable, and well-founded decision is made for all parties involved. The clinical ethics committee (CEC) can perform the task of providing the most comprehensive and structured support possible in decision-making and problem-solving in a medical-ethical context with all its instruments of ethics consultation as well as by the development of \"ethical guidelines\". The CEC is not a decision-making body that makes unilateral decisions on its own authority and relieves the directly treating persons of the decision-making responsibility, but an advisory and supporting authority. For recurring, similar ethically sensitive questions, ethical guidelines can be created by the CEC of an institution with the aim of facilitating decision-making in a corresponding ethical problem situation. An ethical guideline provides orientation that can increase the quality of decision-making and relieve decision-makers ethically and legally. In doing so, the ethical guideline grants the decision-maker a range of possibilities by specifying a meaningful corridor for action, from which, in justified cases, deviations can also be made after individual evaluation.
UNASSIGNED: Die medizinisch-ethische Entscheidungsfindung bewegt sich zwischen den Polen der medizinischen Indikation einerseits und dem Willen des informierten und aufgeklärten Patienten andererseits, die nicht zwangsweise übereinstimmen müssen. Auch wenn die definitive Handlungsentscheidung durch den behandelnden Arzt/das behandelnde Therapeutenteam getroffen wird, ist es gerade in problematischen Konfliktsituationen hilfreich, die entsprechende Entscheidungsfindung möglichst breit aufzustellen, sodass schließlich eine für alle Beteiligten angemessene, tragbare und fundierte Entscheidung getroffen werden kann. Die Aufgabe der möglichst umfassenden und strukturierten Unterstützung bei der Entscheidungsfindung und Problemlösung im medizinisch-ethischen Kontext kann das Klinische Ethik-Komitee (KEK) mit all seinen Instrumenten der Ethikberatung sowie durch die Erstellung von „Ethik-Leitlinien“ wahrnehmen. Dabei ist das KEK keine Entscheidungsinstanz, die eigenmächtige und einseitige Entscheidungen trifft und den direkt behandelnden Personen die Entscheidungsverantwortung abnimmt, sondern eine beratende und unterstützende Institution. Für immer wiederkehrende, ähnlich geartete ethisch sensible Fragestellungen können durch das KEK einer Institution ethische Leitlinien mit dem Ziel erstellt werden, die Entscheidungsfindung in einer entsprechenden ethischen Problemsituation zu erleichtern. Eine Ethik-Leitlinie stellt eine Orientierungshilfe dar, die die Entscheidungsqualität erhöhen und die Entscheidungsträger ethisch und juristisch entlasten kann. Dabei räumt die Ethik-Leitlinie dem Entscheidungsverantwortlichen einen Entscheidungsspielraum ein, indem sie einen sinnvollen Handlungskorridor vorgibt, von dem in begründeten Fällen nach individueller Prüfung aber auch abgewichen werden kann.

Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations.

International policies regulating clinical ethics committees\' (CEC) roles are non-existent. Nonetheless, CECs have established themselves in several countries and there exist striking differences in the way these work. This international practice variation stems from the ways CECs developed, within particular legal, political, social and professional contexts. National guidelines and normative documents have been published in many countries regarding CECs. To better understand CECs\' evolution and differences in various countries, we reviewed guidelines, position statements and normative papers which describe and frame the development of CECs in the United States, the United Kingdom, Canada and France. Systematic content analysis addressed guideline development, CECs\' roles, consultation methods and CEC members\' education requirements. Differing contexts informed the ways in which guidelines were developed. American CECs, established within a strongly litigious context are perceived to play strong decision-making roles, whereas British CECs, encouraged by clinicians, endorse a more supportive model. Canadian guidelines focus on the role of the ethicist, while the French model is interested in a theoretical interdisciplinary approach. This analysis shows important challenges facing the implementation of accountable CECs in different contexts and can help inform future policy development.

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In 2001, leaders with palliative care convened to discuss the standardization of palliative care and formed the National Consensus Project for Quality Palliative Care. In 2004, the National Consensus Project for Quality Palliative Care produced the first edition of Clinical Guidelines for Quality Palliative Care. The Guidelines were developed by leaders in the field who examined other national and international standards with the intent to promote consistent, accessible, comprehensive, optimal palliative care through the health care spectrum. Within the guidelines there are eight domains to the provision of palliative care. This article focuses on the last, but very significant Domain 8--Ethical and Legal Aspects of Care.

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Hospital ethics committees provide education, assist in policymaking, and deliver consultation services. In this article, we describe the structure, operation, and institutional framework within which an ethics committee fulfills its missions, with emphasis on the consultation process.

Arguments for liberty, mercy, and dignity support the legalization of euthanasia, but there remains a possibility of undesirable social consequences should this occur. Accordingly, proposals must prevent involuntary euthanasia, prevent unconscious coercion of the terminally ill to request euthanasia, protect and enshrine the availability of first-class palliative care, ensure documentation for purposes of enforcement and study, and spell out enforceable consequences for violations. Guidelines set by the Royal Dutch Medical Association have largely failed to meet these requirements. In North America, proposals for legalization, such as Oregon\'s Measure 16 and the minority opinion in Canada\'s Rodriguez case, also have flaws in meeting these criteria. Legislation in the Northern Territory of Australia came closest to meeting the requirements outlined, but was overruled after a brief period in effect. In Canada, a comprehensive survey of current euthanasia practices and improved availability of palliative care must precede attempts at legalization. A specific proposal is made for ethics committees operating at a regional health board level to approve legal euthanasia fitting within careful guidelines. Composition, procedures and mandate are described. If a set of guidelines, balancing any right there is \"to die with dignity\" with a responsibility to protect the weakest in society, is proposed first by the medical community, Parliament may have the courage to enact legislation.