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Original research
How is clinical ethics reasoning done in practice? A review of the empirical literature
  1. Sharon Feldman1,2,
  2. Lynn Gillam1,2,
  3. Rosalind J McDougall3,
  4. Clare Delany4
  1. 1Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2Children’s Bioethics Centre, The Royal Children’s Hospital, Melbourne, Victoria, Australia
  3. 3Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4Department of Medical Education, The University of Melbourne, School of Medicine, Melbourne, Victoria, Australia
  1. Correspondence to Ms Sharon Feldman; s.feldman{at}student.unimelb.edu.au

Abstract

Background Clinical ethics reasoning is one of the unique contributions of clinical ethicists to healthcare, and is common to all models of clinical ethics support and methods of case analysis. Despite being a fundamental aspect of clinical ethics practice, the phenomenon of clinical ethics reasoning is not well understood. There are no formal definitions or models of clinical ethics reasoning, and it is unclear whether there is a shared understanding of this phenomenon among those who perform and encounter it.

Methods A scoping review of empirical literature was conducted across four databases in July 2024 to capture papers that shed light on how clinical ethicists undertake or facilitate clinical ethics reasoning in practice in individual patient cases. The review process was guided by the Arksey and O’Malley framework for scoping reviews.

Results 16 publications were included in this review. These publications reveal four thinking strategies used to advance ethical thinking, and three strategies for resolving clinical ethics challenges in individual patient cases. The literature also highlights a number of other influences on clinical ethics reasoning in practice.

Conclusion While this review has allowed us to start sketching the outlines of an account of clinical ethics reasoning in practice, the body of relevant literature is limited in quantity and in specificity. Further work is needed to better understand and evaluate the complex phenomenon of clinical ethics reasoning as it is done in clinical ethics practice.

  • Clinical Ethics
  • Ethics Committees
  • Ethics- Medical
  • Decision Making

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jme-2024-110569

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • X @ethicsros

    • Contributors All authors (SF, LG, RJM, CD) substantially contributed to the conception or design of the work, including revising it critically for important content. SF conducted the literature search and initial title and abstract review, led the data collection and analysis, and wrote the first draft of the manuscript. All authors (SF, LG, RJM, CD) approved the final version of the text. SF is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.