Transcript EIR-A ETHIEK IN RICHTLIJNEN bij Arbeid en gezondheid

Ethics and guidelines,
ethics in guidelines?
EiR-A project
Noks Nauta, André Weel, Jim Faas, Inge den Besten,
Kerst Zwart, Medard Hilhorst
NVAB, NVVG, Welder, ErasmusMC
Olomouc, Nov 2010
Grant from ZonMw, The Netherlands organization for health
research and development
New dimension
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Medicine, 1975
Psychology, 1999
Ethics: new dimension
Essential, could not work without it
One minute with neighbour
• Definition of ‘dilemma’?
Dilemma
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More perspectives
More than one choice
Each supports value(s)
Each harms value(s)
 Ethical sensitive situation
Eir-A project 2009-2010
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Survey: interviews and questionnaire
Focusgroup patients
Working group Moral framework
2 working groups ethics chapters
Start of implementation
Recommendations
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Awareness
Recognition
Explicit description in CPG
Giving clues for dealing
Moral case deliberation
One minute with neighbour
• Barriers to add ethics to guidelines?
• Your opinion and/or others’ opinions
Barriers
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Difficult, vague, subjective
Other things more important
EBM
Autonomy of professionals
How to do this?
One minute with neighbour
• Advantages of adding ethics to CPGs?
• Your opinion and/or others’ opinions
Arguments pro
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What is best for patient
Professionality, reflection
Multidisciplinarity
Transparency of decisions
Quality of care, improvements,
innovations
CPGs and ‘other arguments’
• Patients perspectives
– Social
– Cultural
• Society’s perspective
– Economical
– Political
• Legal aspects
• Collaboration, division of responsibilities
Work and health
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Functioning versus disease/ complaints
Collaboration
Professional roles
Legal issues for insurance physicians
Effects of therapy on capacity for work
Fundamental principles
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Doing well + causing no harm
Respect for autonomy
Justice
Carefulness, attention
Trust
Honesty
Collaboration
Moral case deliberation
• Facts
• Choices
• Values per alternative, from different
perspectives
• Weighting of values
• Choice with argumentation
 Making values explicit
 Trained supervisor
Value-based chapters in
guidelines
• For guidelines
– Depression
– Breast cancer
• Testing by professionals and patients
Ethics chapter Depression
Content
• Introduction, questions, evidence
• Elements of sensitive situations
– Vision of client/ patient
– Interdisciplinary collaboration
– Diagnostics
– Treatment
– Assessment of functioning
– Professional’s self reflection
– Context client/ patient
• Moral case deliberation recommended
Ethics chapter breastcancer
Content (6 of the10 topics)
• Co-operation of medical professionals
• Patients’ participation in treatment and
rehabilitation
• Fatigue: assessment and support
• Cases with bad or moderate prognosis
• Negative feelings about work
• Intercultural and SES aspects
Results EiR-A project
• Strengths and opportunities
– Innovative and challenging
– Many involved, many enthusiastic
– Opportunities for innovating guidelines
• Weaknesses and threats
– Guideline groups Depression and Breast
cancer have not decided how to deal with
the chapter
– How to go on after this project?
Recommendations
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Awareness
Recognition
Explicit description in CPG
Giving clues for dealing
Moral case deliberation
Spin off
• Ethics chapters in other guidelines (NL)
• Training supervisors moral case
deliberation (NL)
• Contact IQ health care (NL)
• Adding ethical criteria to AGREE
(Licenik et al) (international)
• Working group ethics in GIN
(international)
Thank you for your attention!
• Comments are welcome:
• [email protected]