Clinical ethics support services initially developed in the United States of America, following court cases such as the Karen Ann Quinlan case, which stressed the need for mechanisms to resolve ethical disputes within health care. The Joint Commission on Accreditation of Healthcare Organizations requirement for hospitals, nursing homes, and home care agencies to have a standing mechanism to address ethical issues has also fostered this development (this requirement no longer appears in the Joint Commission regulations, however).
Despite initial doubts as the possibility of importing what was initially felt to be a specificity of the US system, ethics support services have developed in many other countries, including Canada [1] but also various countries in Europe [2] and Asia. [3]
In order to share experience and resources among these clinical research ethics consultation and support services, networks and platforms have increasingly developed. [4] This page is intended to summarise existing online resources aimed at assisting new and developing clinical ethics support services. Its goal is to make these resources more easily accessible. Listing in this page does not constitute endorsement of the various contents: users will still need to judge the value of these resources for themselves.
It is reasonable to suppose that these resources will increasingly be international. Because of the role of the English language in international communication, multi-lingual resources whose languages include English are given in their English title. Those not available in English are given in their original language.
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Center for Practical Bioethics
Kansas Health Ethics Committee Network
Maryland Healthcare Ethics Committee Network
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Medical ethics recommendations of the Swiss Academy of Medical Sciences
British Medical Association's Medical Ethics portal
British General Medical Council’s Guidance on Good Medical Practice
Many clinical ethics support services develop guidelines and advise policy within the health care setting. While the conclusions of consultations regarding individual patients are, of course, confidential, general ethical guidelines and policy advice regarding ethical difficulties which come up repeatedly in clinical care are not. Some ethics support services make these guidelines available online. Adding yours will make these resources more useful!
Listed by country
Some networks and consultation services have developed tools and guidelines for the practice of clinical ethics consultation, and made them available online. The following sites provide tools, documents, and advice for new or developing clinical ethics support services:
Recommandations on "Ethics Support in medicine" from the Swiss Academy of Medical Sciences
UK Clinical Ethics Network practical guide for clinical ethics support
University of Washington guide on clinical ethics committees and consultation
Veterans' Administration (US) IntegratedEthics Tools and Materials
Principles of Biomedical Ethics (Tom L. Beauchamp, James F. Childress)
Ethics Consultation: from theory to practice (Mark P. Aulisio, Robert M. Arnold, Stuart J. Youngner)
Ethics Consultation (John La Puma, David L. Schiedermayer)
Cambridge textbook of bioethics (Peter A. Singer, Adrian M. Viens)
ASBH Task Force on Health Care Ethics Consultation: Nature, Goals, and Competencies
Clinical bioethics integration, sustainability, and accountability: the Hub and Spokes Strategy by the University of Toronto Joint Centre for Bioethics
Moral Deliberation in the Netherlands
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Skill Building in Ethics Case Consultation at the Neiswanger Institute
International Association of Bioethics
International Conference on Clinical Ethics and Consultation
Société Suisse d'Éthique Biomédicale / Schweizerische Gesellschaft für Biomedizinische Ethik
Applied ethics refers to the practical aspect of moral considerations. It is ethics with respect to real-world actions and their moral considerations in the areas of private and public life, the professions, health, technology, law, and leadership. For example, the bioethics community is concerned with identifying the correct approach to moral issues in the life sciences, such as euthanasia, the allocation of scarce health resources, or the use of human embryos in research. Environmental ethics is concerned with ecological issues such as the responsibility of government and corporations to clean up pollution. Business ethics includes questions regarding the duties or duty of 'whistleblowers' to the general public or their loyalty to their employers.
Informed consent is a principle in medical ethics and medical law and media studies, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treatments, alternative treatments, the patient's role in treatment, and their right to refuse treatment. In most systems, healthcare providers have a legal and ethical responsibility to ensure that a patient's consent is informed. This principle applies more broadly than healthcare intervention, for example to conduct research and to disclosing a person's medical information.
Bioethics is both a field of study and professional practice, interested in ethical issues related to health, including those emerging from advances in biology, medicine, and technologies. It proposes the discussion about moral discernment in society and it is often related to medical policy and practice, but also to broader questions as environment, well-being and public health. Bioethics is concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, theology and philosophy. It includes the study of values relating to primary care, other branches of medicine, ethical education in science, animal, and environmental ethics, and public health.
Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice. Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. It is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation. Medical ethics is particularly relevant in decisions regarding involuntary treatment and involuntary commitment.
The Declaration of Helsinki is a set of ethical principles regarding human experimentation developed originally in 1964 for the medical community by the World Medical Association (WMA). It is widely regarded as the cornerstone document on human research ethics.
The Council for International Organizations of Medical Sciences (CIOMS) is an international non-governmental organization of 40 international, national, and associate member groups representing the biomedical science community. It was jointly established by the World Health Organization (WHO) and United Nations Educational, Scientific and Cultural Organization (UNESCO) in 1949 as a successor to the International Medical Congress that organized 17 conferences from 1867 until the 1913 outbreak of World War One.
The Johns Hopkins Berman Institute of Bioethics in Baltimore, Maryland, United States, is an interdisciplinary center serving the entire Johns Hopkins University and Health System. It is dedicated to the study of complex moral and policy issues in biomedical science, health care, and health policy. Established in 1995, the Institute seeks answers to ethical questions by promoting research in bioethics and encouraging moral reflection among a broad range of scholars, professionals, students, and citizens. Contributing to its mission are four divisions of the University: the Zanvyl Krieger School of Arts and Sciences, the Johns Hopkins School of Medicine, the Bloomberg School of Public Health, and the Johns Hopkins School of Nursing.
Albert R. Jonsen was one of the founders of the field of Bioethics. He was Emeritus Professor of Ethics in Medicine at the University of Washington, School of Medicine, where he was Chairman of the Department of Medical History and Ethics from 1987-1999. After retiring from UW, he returned to San Francisco where he co-founded the Program in Medicine and Human Values at Sutter Health's California Pacific Medical Center in 2003.
An ethics committee is a body responsible for ensuring that medical experimentation and human subject research are carried out in an ethical manner in accordance with national and international law.
Ethics or moral philosophy is a branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct. The field of ethics, along with aesthetics, concern matters of value, and thus comprise the branch of philosophy called axiology.
The philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. For the most part, however, the philosophy of healthcare is best approached as an indelible component of human social structures. That is, the societal institution of healthcare can be seen as a necessary phenomenon of human civilization whereby an individual continually seeks to improve, mend, and alter the overall nature and quality of their life. This perennial concern is especially prominent in modern political liberalism, wherein health has been understood as the foundational good necessary for public life.
The National Core for Neuroethics at the University of British Columbia was established in August 2007, with support from the Canadian Institutes of Health Research, the Institute of Mental Health and Addiction, the Canada Foundation for Innovation, the British Columbia Knowledge Development Fund, the Canada Research Chairs program, the UBC Brain Research Centre and the UBC Institute of Mental Health. Co-founded by Judy Illes and Peter Reiner, the Core studies neuroethics, with particular focus on ethics in neurodegenerative disease and regenerative medicine, international and cross-cultural challenges in brain research, neuroimaging and ethics, the neuroethics of enhancement, and personalized medicine.
Tia Powell is an American psychiatrist and bioethicist. She is Director of the Montefiore-Einstein Center for Bioethics and of the Einstein Cardozo Master of Science in Bioethics Program, as well as a Professor of Clinical Epidemiology and Clinical Psychiatry at the Albert Einstein College of Medicine in The Bronx, New York. She holds the Trachtenberg Chair in Bioethics and is Professor of Epidemiology, Division of Bioethics, and Psychiatry. She was previously executive director of the New York State Task Force on Life and the Law and director of Clinical Ethics at Columbia-Presbyterian Hospital in New York City.
The Nuffield Council on Bioethics is a UK-based independent charitable body, which examines and reports on bioethical issues raised by new advances in biological and medical research. Established in 1991, the Council is funded by the Nuffield Foundation, the Medical Research Council and the Wellcome Trust. The Council has been described by the media as a 'leading ethics watchdog', which 'never shrinks from the unthinkable'.
Human subject research legislation in the United States can be traced to the early 20th century. Human subject research in the United States was mostly unregulated until the 20th century, as it was throughout the world, until the establishment of various governmental and professional regulations and codes of ethics. Notable – and in some cases, notorious – human subject experiments performed in the US include the Tuskegee syphilis experiment, human radiation experiments, the Milgram obedience experiment and Stanford prison experiments and Project MKULTRA. With growing public awareness of such experimentation, and the evolution of professional ethical standards, such research became regulated by various legislation, most notably, those that introduced and then empowered the institutional review boards.
The MacLean Center for Clinical Medical Ethics, founded in 1981, is a non-profit clinical medical ethics research institute based in the United States. Founded by its director, Mark Siegler, the MacLean Center for Clinical Medical Ethics aims to improve patient care and outcomes by promoting research in clinical medical ethics by educating physicians, nurses, and other health care professionals and by helping University of Chicago Medicine patients, families, and health care providers identify and resolve ethical dilemmas. The center has trained over 410 fellows, including many physicians, attorneys, PhDs and bioethicists.
Mark Siegler is an American physician who specializes in internal medicine. He is the Lindy Bergman Distinguished Service Professor of Medicine and Surgery at the University of Chicago., He is the Founding Director of Chicago's MacLean Center for Clinical Medical Ethics. Siegler has practiced and taught internal medicine at the University of Chicago for more than 50 years.
Françoise Elvina Baylis is a Canadian bioethicist whose work is at the intersection of applied ethics, health policy, and practice. The focus of her research is on issues of women's health and assisted reproductive technologies, but her research and publication record also extend to such topics as research involving humans, gene editing, novel genetic technologies, public health, the role of bioethics consultants, and neuroethics. Baylis' interest in the impact of bioethics on health and public policy as well as her commitment to citizen engagement]and participatory democracy sees her engage with print, radio, television, and other online publications.
Christine I. Mitchell is an American filmmaker and bioethicist and until her retirement in September 2022, the executive director of the Center for Bioethics at Harvard Medical School (HMS).
Marion Danis is an American bioethicist and physician-scientist. She is head of the section on ethics and health policy and chief of the bioethics consultation service at the National Institutes of Health Clinical Center.
