Conflicts of Care: Hospital Ethics Committees in the USA and Germany
Biographical note: Helen Kohlen, Dr. phil., ist Juniorprofessorin für Care Policy und Gemeindenahe Pflege an der Hochschule Vallendar.
MARC
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| 100 | 1 | |a Kohlen, Helen |4 aut | |
| 245 | 1 | 0 | |a Conflicts of Care |b Hospital Ethics Committees in the USA and Germany |
| 250 | |a 1. Aufl. | ||
| 264 | 1 | |a Frankfurt am Main |b Campus Verlag GmbH |c 2009 | |
| 300 | |a Online-Ressource (251 S.) | ||
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| 500 | |a PublicationDate: 20090209 | ||
| 505 | 8 | 0 | |a Contents; Acknowledgement; Introduction; State of the Art, Theoretical Framework and Methodological Considerations; 1 State of the Art in Social Science Research; 2 Theoretical Framework and Research Design; 3 Method and Sources of Information; Germany and the United States: Literature Review, Interviews and Pre-Study; Field Research in Germany: Participant Observation and Interviews; Data Collection and Interpretation: Qualitative Content Analysis; Historical Analysis - Bioethics and Hospital Ethics Committees; 1 US-American Bioethics and the Move into the Practical Arena |
| 505 | 8 | 0 | |a "Bioethics is not just Bioethics": Its Make and (Un)ConcernsThe Move of Bioethics into the Practical Arena: "Strangers at the Bedside"; 2 Traces and Beginnings of Consultation by Committees; Traces of Institutionalized Consultation Committees; From Professional Ethical Standards to Governmental Intervention; 3 The Development of Contemporary Hospital Ethics Committees; The Story of Karen Quinlan; Multidisciplinary Advisory Committees as Physicians' Prognosis Committees |
| 505 | 8 | 0 | |a Types of Hospital Ethics Committees: From Ad hoc Committee to Optimum Care Committee at Boston Massachusetts General HospitalThe President's Commission and its Support of Hospital Ethics Committees; From the "Baby Does' Cases" to Infant Bioethical Review Committees; Statutory Authority for Hospital Ethics Committees, Bureaucratization and Evaluation; The Talk and its Performance in Hospital Ethics Committees; The German Development: A Re-Make of the US-American Model; 4 Summary; Relational Analysis - Care and Hospital Ethics Committees; 1 The Care Ethics Debate and Nursing since 1980 |
| 505 | 8 | 0 | |a Caring as a Women orientated Ethics and a Feminine ModelCaring as a Foundational Concept for a Theory of Nursing Ethics; Care Ethics from a Nursing Perspective in Germany; 2 Feminist and Nursing Studies in Care Ethics since 1990; Caring as a Social Practice from a Political Science Perspective; Nursing Practices of Care: Competence and Clinical Realizations; Moral Understandings and Responsibilities; 3 Concerns of Care, Conflicts and Nurses' Participation in Hospital Ethics Committees; Concerns of Care in Hospital Nursing Practice; Nurses' Role and Participation in Hospital Ethics Committees |
| 505 | 8 | 0 | |a 4 SummaryPractical Arena Analysis - Practices in Hospital Ethics Committees in Germany; 1 Introduction of the Field Research; Method; The Case Stories; 2 Analysis of the Field Data; Education and Policy Making: Training, Management and Regulations; Case Discussions and Nursing Issues: The Definition of an Ethical Problem and the Marginalization of Care; Case Discussions and Medical Issues: Age, Isolation and Caring Responsibilities; Evolving Issues of Concern: Exclusions and Questions of End-of-Life Care; 3 Summary; Résumé; List of Abbreviations; References; |
| 505 | 8 | 0 | |a ContentsAcknowledgementIntroductionState of the Art, Theoretical Framework and Methodological Considerations1 State of the Art in Social Science Research2 Theoretical Framework and Research Design3 Method and Sources of InformationGermany and the United States: Literature Review, Interviews and Pre-StudyField Research in Germany: Participant Observation and InterviewsData Collection and Interpretation: Qualitative Content AnalysisHistorical AnalysisBioethics and Hospital Ethics Committees1 US-American Bioethics and the Move into the Practical Arena"Bioethics is not just Bioethics": Its Make and (Un)ConcernsThe Move of Bioethics into the Practical Arena: "Strangers at the Bedside"2 Traces and Beginnings of Consultation by CommitteesTraces of Institutionalized Consultation CommitteesFrom Professional Ethical Standards to Governmental Intervention3 The Development of Contemporary Hospital Ethics CommitteesThe Story of Karen QuinlanMultidisciplinary Advisory Committees as Physicians´ Prognosis CommitteesTypes of Hospital Ethics Committees: From Ad hoc Committee to Optimum Care Committee at Boston Massachusetts General HospitalThe President´s Commission and ist Support of Hospital Ethics CommitteesFrom the "Baby Does´ Cases" to Infant Bioethical Review CommitteesStatutory Authority for Hospital Ethics Committees, Bureaucratization and EvaluationThe Talk and its Performance in Hospital Ethics CommitteesThe German Development: A Re-Make of the US-American Model4 SummaryRelational AnalysisCare and Hospital Ethics Committees1 The Care Ethics Debate and Nursing since 1980Caring as a Women orientated Ethics and a Feminine ModelCaring as a Foundational Concept for a Theory of Nursing EthicsCare Ethics from a Nursing Perspective in Germany2 Feminist and Nursing Studies in Care Ethics since 1990Caring as a Social Practice from a Political Science PerspectiveNursing Practices of Care: Competence and Clinical RealizationsMoral Understandings and Responsibilities3 Concerns of Care, Conflicts and Nurses´ Participation in Hospital Ethics Committees Concerns of Care in Hospital Nursing Practice Nurses´ Role and Participation in Hospital Ethics Committees4 SummaryPractical Arena AnalysisPractices in Hospital Ethics Committees in Germany1 Introduction of the Field ResearchMethodThe Case Stories2 Analysis of the Field DataEducation and Policy Making: Training, Management and RegulationsCase Discussions and Nursing Issues: The Definition of an Ethical Problem and the Marginalization of CareCase Discussions and Medical Issues: Age, Isolation and Caring ResponsibilitiesEvolving Issues of Concern: Exclusions and Questions of End-of-Life Care3 SummaryRésuméList of AbbreviationsReferences |
| 520 | |a Biographical note: Helen Kohlen, Dr. phil., ist Juniorprofessorin für Care Policy und Gemeindenahe Pflege an der Hochschule Vallendar. | ||
| 520 | |a Long description: Ethikkomitees sind neu an deutschen Kliniken. Mit Blick auf die US-amerikanische Geschichte dieser Einrichtung beleuchtet Helen Kohlen deren Praxis und den Nutzen im medizinischen und pflegerischen Feld. Wem dienen die Beratungsgremien und wessen Stimme wird bei der Definition ethischer Konflikte gehört? Sie erkennt, dass die Logik und Sprache des Managements zunehmend die klinische Ethik prägt und dass fürsorgliche Praxis im Klinikalltag keine Selbstverständlichkeit mehr ist. Nachwuchspreis des Instituts für Mensch, Ethik und Wissenschaft (IMEW) | ||
| 520 | |a Long description: Since the 1980s, increasing numbers of hospitals in the United States have formed internal ethics committees to help doctors and other health care professionals deal with complicated ethical questions, especially those regarding the end of a life. But it is only in recent years that German hospitals have followed suit. In Conflicts of Care, Helen Kohlen offers the first comprehensive look at the origin and function of these committees in German hospitals. Using a mix of archival research, participant observation, and interviews, Kohlen explores the debates that surrounded their formation and the functions they have taken on since their creation.Ethikkomitees sind neu an deutschen Kliniken. Mit Blick auf die US-amerikanische Geschichte dieser Einrichtung beleuchtet Helen Kohlen deren Praxis und den Nutzen im medizinischen und pflegerischen Feld. Wem dienen die Beratungsgremien und wessen Stimme wird bei der Definition ethischer Konflikte gehört? Sie erkennt, dass die Logik und Sprache des Managements zunehmend die klinische Ethik prägt und dass fürsorgliche Praxis im Klinikalltag keine Selbstverständlichkeit mehr ist. Nachwuchspreis des Instituts für Mensch, Ethik und Wissenschaft (IMEW) | ||
| 520 | |a Excerpt from book: 3 Concerns of Care, Conflicts and Nurses´ Participation in Hospital Ethics CommitteesThe complexity of the health care system makes it difficult to locate the problems and concerns experienced by nurses. One way of sorting it out is as suggested above, to divide the places of action and decision-making into three levels. Described by an inside-out perspective there can be understood: First, the individual level; second, the institutional level, and third, the societal-political level. While conscientious objection is the resource to take a stand on the individual level, raising one´s voice in public debates and going on strike marks taking a stand on the societal-political level. Besides joining the works council, participation in Hospital Ethics Committees offers a way to take a stand on the institutional level. One would expect that taking a stand on caring concerns and conflicts falls into the realm of nurses since they represent the biggest group to be involved in care practices. But, as this chapter will focus on: Empirical studies will reveal different findings.Concerns of Care in Hospital Nursing PracticeConcerns of care in nursing practice are not uniquely a North American or German phenomena. Nurses in countries with distinctly different health care systems like England and Scotland, report similar shortcomings in their work environments and the quality of hospital care. A study in 2001 of more than 43,000 nurses practicing in more than 700 hospitals in five countries indicates that fundamental problems in the design of work are widespread in hospitals in Europe and North America (Aiken, Clarke, Sloane et al. 2001). Several studies have shown: while discontent among hospital nurses is high, a vast majority believes that the competence of and relation between nurses and physicians is satisfactory.In North America and Germany, nurses reported spending time performing functions that did not call upon their professional training (delivering and retrieving food trays or transporting patients), while care practices requiring their skills and expertise (oral hygiene, skin care) were left undone (Aiken, Clarke, Sloane et al. 2001). Nevertheless, the problems of hospital nursing do not represent the entire profession. Tasks and settings vary widely.Everyday Nursing Concerns and InvisibilitiesThe dominant concerns found in stories and narratives of everyday nursing practice are the ones of caring, responsiveness to the other, and responsibility (Benner, Tanner, Chesla 1996). Since responsiveness and responsibility can be described as elements of a caring practice (see Tronto in Relational Analysis, chapter two), it is the caring practice itself to be the issue of concern. What else has been found about nursing conflicts and concerns?When the nurse scientist, and director of the Kennedy Institute Carol Taylor (1997) interviewed nurses to get to know their ethical concerns, she had to realize that most of the nurses felt hard-pressed to describe the nature of these everyday nursing concerns that had ethical significance. She states "[?] while some everyday nursing concerns are unique to nursing, most derive from tensions that involve the interdisciplinary team and raise broader issues about the human well-being that are best addressed by the institution or health care system at large" (1997: 69). In order to reveal their concerns, she then analyzed her collected case studies that lead nurses to request ethical consultation. She identified that nurses mostly struggle for (1) the respect for human dignity, (2) a commitment to holistic care, (3) a commitment to individualized care which is responsive to unique needs of the patient, and (4) the responsibility for a continuity of care and the scope of authority, and (5) identifying the limits of care-giving (Taylor 1997: 69-82). Taylor discusses that none of the concerns are unique to nursing although they may be experienced with greater immediacy and urgency by nurses as well as other care givers. She also observed that more nurses described their moral orientation as care-based rather than justice-based (Holly 1986).The US-American nurse researcher, Joan Liaschenko (1993a) and the Canadian nurse researcher Patricia Rodney (1997) have specifically investigated into concerns of practicing nurses. In an ethnographic study of nurses practicing on two acute medical units, Rodney has explored the situational constraints that made it difficult for nurses to uphold their professional standards. Other research (Varcoe et al. 2004) supports her findings of experienced serious structural and interpersonal constraints, e.g. excessive workloads for nurses, the absence of interdisciplinary team rounds, conflicts between team members inside and outside nursing, and conflicts with patients and family members. Rodney gives examples of interviews with nurses where they described their attempt to provide nursing care for the elderly and critically ill patients as a race against the clock (Rodney 1997). She explains that the inability of nurses to arrange space to talk with patients, constrains their ability to truly focus and being attentive to the authentic needs of the patients and families. In a further study with her colleagues (Storch et al. 2002), in addition to a lack of time, another predominant theme was the nurses´ concern about appropriate use of resources. They struggled with decisions made by others regarding the allocation of scarce resources. Some of the interviewed nurses in this study, described physicians as not willing to listen or to receive the nurses´ point of view and were reluctant to accept that nurses have any independent moral responsibility when caring for patients (Storch et al. 2002). Megan-Jane Johnstone (1989) is convinced: "Anecdotal evidence abounds worldwide on how nurses are continually told by doctors that nursing practice is devoid of any sort of moral implication, and that it is nonsense for nurses assume that they have any independent moral responsibilities when caring for patients" (Johnstone 1989: 3). Yarling and McElmurry cite the case of an American physician who objected strongly to the suggestion that nurses have a moral duty, even though an attending physician has expressly ordered that not information be given out, to disclose information to terminally ill patients who request it (1986: 65-66 ).Moreover, the study gave evidence that the organizational climate, including policy development had been problematic for nurses. Sometimes this was related to a lack of policy, sometimes to the presence of a binding policy, and more dominantly, to an ambiguous policy. For example, policies that were considered to be too binding, such as the resuscitation policies were related to patients whose best interest were overseen by following a code (Storch et al. 2002). Central to the concerns given voice by nurses that were interviewed in Liaschenko´s study, was their sensitivity to patient need. They were aware of the"[?] increased vulnerability to loss of [?] agency in the face of disease, illness. [?] Need was not seen solely in terms of a biomedical model of altered physiology but was conceived broadly to include those things which helped the individual to initiate or re-establish routines of lived experience and to cope with the settings in which they found themselves. [?] In this view, need was relative to the realities of the patient´s day-to-day life" (Liaschenko 1993: 262).The meeting of patients´ and families´ needs for emotional support, Liaschenko (1993a), Rodney (1997) and Varcoe et al. (2003) identified as being undervalued and overlooked in the work of nursing. "Because emotional work is a social transaction and not a product, it is invisible in a productdriven society. New nurses learn very quickly what the ´official´ work is and what the unofficial work is. Emotional work is extra, frequently coming out of the personal time of nurses" (Liaschenko 2001: 2). The authors argue that economically driven changes imply that only certain processes are remunerated. Consequently, only certain, measurable aspects of care are accounted for and funded, while other tasks of nursing care are ignored. Hereby, different values underlie what gets accounted for and what is overlooked in an evaluation and a decision-making process that follows economic rules. What also gets invisible in the work of nursing, is their dealing with social issues that have actually no place in the sphere of medicine and the mandate of the hospital like homelessness and poverty (Varcoe, Rodney 2001).Liaschenko´s identifies an unseen gendered space that nurses occupy in the larger bioethical landscape. She has shown how nurses can become actors who speak for others as "artificial persons", for instance, at the end of a person´s life (1995b). Nurses bear witness to suffering at the end of life and try to alleviate that suffering when medical intervention stops. Liaschenko begins w ... | ||
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| SUB | |a REL | ||
| SYE | 0 | 0 | |a Allgemeine Soziologie,Gesellschaftslehre,Gesellschaft,Gesellschaftstheorie,Sozialtheorie,Soziallehre , Gesellschaft,Medizin,Medizinische Soziologie , Klinische Ethikkommission,Krankenhaus,Krankenhaus , BRD,Bundesrepublik Deutschland,DDR,Deutsche Demokratische Republik,Germany,Amerikanische Zone Deutschlands,BRD,Britische Zone Deutschlands,Bundesrepublik Deutschland,Französische Zone Deutschlands,Vereinigtes Wirtschaftsgebiet Deutschlands , Vereinigtes Wirtschaftsgebiet,Bizone,Verwaltung des Vereinigten Wirtschaftsgebietes,Britische Zone,British occupation zone,Britische Besatzungszone,British Zone of Control,Britisches Kontrollgebiet,British Element,Britisches Element,Amerikanische Zone,American occupation zone,Amerikanische Besatzungszone,ABZ,United States Area of Control,Amerikanisches Kontrollgebiet,U.S. zone of occupation,United States Zone,U.S. Zone,US-Zone,Westzonen,Westliche Besatzungszonen,Trizone,Französische Zone,Zone Française d'Occupation,Französische Besatzungszone,ZFO,Länder,Westliche Bundesländer,Alte Bundesländer,Deutschland,Westdeutschland,Deutschland,Östliche Bundesländer,Neue Bundesländer,Länder,Deutschland,Ostdeutschland,Deutschland,Deutschland,Sowjetische Zone,Russische Zone,Sowjetische Besatzungszone,Russische Besatzungszone,Sowjetische Besatzungszone Deutschlands,Sowjetische Besatzungszone in Deutschland,Sowjetisch Besetzte Zone,Sowjetzone,Ostzone,SBZ,Alemanha,Alemania,Allemagne,Almanija,Almāniyā,Bondsrepubliek Duitsland,BRD,BRD,Bundesrepublik Deutschland,Deutschland,Deutschland,Federal Republic of Germany,Förbundsrepubliken Tyskland,Förbundsrepublikken Tyskland,FRG,Germany,Németországi Szövetségi Kőztársaság,Niemiecka Republika Federalna Niemiecka Republika Federalna,NRF,Repubblica Federale di Germania,Republic of Germany,República Federal da Alemanha,República Federal de Alemania,Republik Federasi Djerman,Republika Federalna Niemiec,République Fédérale d'Allemagne,RFN,Saksan Liittotasavalta,Westdeutschland,Deutsche Demokratische Republik,DDR,Deutschland,German Democratic Republic,GDR,République Démocratique Allemande,RDA,Germanskaja Demokratičeskaja Respublika,Demokratičeskaja Respublika,Democratic Republic,Demokratische Republik,Niemiecka Republika Demokratyczna,NRD,Ǧumhūrīyat Almāniyā ad-Dīmuqrāṭīya,República Democrática Alemana,Saksan Demokraattisen Tasavallan,Repubblica Democratica Tedesca,Mitteldeutschland,Ostdeutschland,East Germany,Ostzone,Deutsche Länder,Germany,Heiliges Römisches Reich,Rheinbund,Deutscher Bund,Norddeutscher Bund,Deutsches Reich,Deutschland,Deutschland,BRD,Federal Republic of Germany,Republic of Germany,Allemagne,Ǧumhūrīyat Almāniyā al-Ittiḥādīya,Bundesrepublik Deutschland,BRD,Niemcy,République Fédérale d'Allemagne,Repubblica Federale di Germania,Germanija,Federativnaja Respublika Germanija,FRG,Deyizhi-Lianbang-Gongheguo |
| SYG | 0 | 0 | |a BRD,Bundesrepublik Deutschland,DDR,Deutsche Demokratische Republik,Germany,Amerikanische Zone Deutschlands,BRD,Britische Zone Deutschlands,Bundesrepublik Deutschland,Französische Zone Deutschlands,Vereinigtes Wirtschaftsgebiet Deutschlands , Vereinigtes Wirtschaftsgebiet,Bizone,Verwaltung des Vereinigten Wirtschaftsgebietes,Britische Zone,British occupation zone,Britische Besatzungszone,British Zone of Control,Britisches Kontrollgebiet,British Element,Britisches Element,Amerikanische Zone,American occupation zone,Amerikanische Besatzungszone,ABZ,United States Area of Control,Amerikanisches Kontrollgebiet,U.S. zone of occupation,United States Zone,U.S. Zone,US-Zone,Westzonen,Westliche Besatzungszonen,Trizone,Französische Zone,Zone Française d'Occupation,Französische Besatzungszone,ZFO,Länder,Westliche Bundesländer,Alte Bundesländer,Deutschland,Westdeutschland,Deutschland,Östliche Bundesländer,Neue Bundesländer,Länder,Deutschland,Ostdeutschland,Deutschland,Deutschland,Sowjetische Zone,Russische Zone,Sowjetische Besatzungszone,Russische Besatzungszone,Sowjetische Besatzungszone Deutschlands,Sowjetische Besatzungszone in Deutschland,Sowjetisch Besetzte Zone,Sowjetzone,Ostzone,SBZ,Alemanha,Alemania,Allemagne,Almanija,Almāniyā,Bondsrepubliek Duitsland,BRD,BRD,Bundesrepublik Deutschland,Deutschland,Deutschland,Federal Republic of Germany,Förbundsrepubliken Tyskland,Förbundsrepublikken Tyskland,FRG,Germany,Németországi Szövetségi Kőztársaság,Niemiecka Republika Federalna Niemiecka Republika Federalna,NRF,Repubblica Federale di Germania,Republic of Germany,República Federal da Alemanha,República Federal de Alemania,Republik Federasi Djerman,Republika Federalna Niemiec,République Fédérale d'Allemagne,RFN,Saksan Liittotasavalta,Westdeutschland,Deutsche Demokratische Republik,DDR,Deutschland,German Democratic Republic,GDR,République Démocratique Allemande,RDA,Germanskaja Demokratičeskaja Respublika,Demokratičeskaja Respublika,Democratic Republic,Demokratische Republik,Niemiecka Republika Demokratyczna,NRD,Ǧumhūrīyat Almāniyā ad-Dīmuqrāṭīya,República Democrática Alemana,Saksan Demokraattisen Tasavallan,Repubblica Democratica Tedesca,Mitteldeutschland,Ostdeutschland,East Germany,Ostzone,Deutsche Länder,Germany,Heiliges Römisches Reich,Rheinbund,Deutscher Bund,Norddeutscher Bund,Deutsches Reich,Deutschland,Deutschland,BRD,Federal Republic of Germany,Republic of Germany,Allemagne,Ǧumhūrīyat Almāniyā al-Ittiḥādīya,Bundesrepublik Deutschland,BRD,Niemcy,République Fédérale d'Allemagne,Repubblica Federale di Germania,Germanija,Federativnaja Respublika Germanija,FRG,Deyizhi-Lianbang-Gongheguo , Klinik,Klinikum,Krankenanstalt,Krankenhauswesen,Spital , Ethikkomitee,Ethikkommission,Ethik-Beirat , United States,United States of America,Vereinigte Staaten,Vereinigte Staaten von Amerika , USA,Südost,Südöstliche Vereinigte Staaten,USA,Nordwestamerika,USA,Nordwest,Pazifischer Nordwesten,USA,Ost,Östliche Vereinigte Staaten,USA,Nord,Nördliche Vereinigte Staaten,Südwestliche USA,USA,Südweststaaten,Südwestliche Vereinigte Staaten,USA,Südwest,United States of America,Vereinigte Staaten von Amerika,Amerika <USA>,Mittlerer Westen,USA,Middle West,Mittelwesten,Midwest,Nordamerikanische Südstaaten,Konföderierte Staaten von Amerika,Confederate States of America,Südliche Vereinigte Staaten,Südatlantische Staaten,Südöstliche Staaten,United States of America,Vereinigte Staaten von Amerika,Amerika <USA>,USA,Nordost,Nordöstliche Vereinigte Staaten,USA,West,Westliche Vereinigte Staaten,United States of America,Vereinigte Staaten von Amerika,Nordamerika,Amerika,United States,United States of America,Etats Unis,Etats-Unis,Vereinigte Staaten,Estados Unidos de America,EEUU,Vereinigte Staaten von Nordamerika,Soedinennye Štaty Ameriki,SŠA,Stany Zjednoczone Ameryki Północnej,Hēnōmenai Politeiai tēs Boreiu Amerikēs,Hēnōmenes Politeies tēs Amerikēs,HēPA,Ēnōmenes Politeies tēs Amerikēs,ĒPA,Meiguo,Etats-Unis d'Amérique,US |
| TIM | |a 100019901003_100020241231 |b 1990-10-03 - 2024 | ||