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Melanie

Melanie Jansen

Year of Award: 2016 Award State: Queensland Health And Medicine > Obstetrics And Paediatrics
To enrich and inform development of paediatric clinical ethics services in Australia - Italy, UK, Canada, USA
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Conclusions & Recommendations 

The key theme emerging from my Churchill Fellowship experience is that relational skills are at the core of meaningful clinical ethics consultation. In fact, they are at the core of good medical practice, and, to go even further, at the core of living the good life. By relational skills, I refer not just to the mechanical aspects of communication that are so commonly taught to healthcare professionals - such as paying attention to body language and speaking without jargon – but to the skills required to authentically connect with other human beings. The many and varied pressures on clinical staff have led to an erosion of these skills, as more urgent, but not necessarily more important, tasks press out these less tangible aspects of medical practice. Perhaps clinical ethics services can be one of the instruments that helps claw back these rich resources. Clinical ethics needs to distinguish itself from bioethics by making the ethics of everyday practice its central task. The other key theme is that critical reasoning and argumentation are central parts of a deliberative approach to clinical ethics consultation and that these skills need to be explicitly taught. Collaboration within and between clinical ethics services, with humanities departments, and with all clinical departments and healthcare professions will be the key to developing a rich pedagogy and practice of clinical ethics. This pedagogy needs to be informed by robust research, both normative and empirical, to define efficacy in clinical ethics and develop meaningful ways to evaluate our services. Evaluation needs also to look at other, perhaps not originally intended functions of clinical ethics, such as staff wellbeing.

Recommendations 

  1. Clinical Ethics Education programmes addressing the varied skills that are required for consultation need to be developed. Specific areas that need to be addressed are critical reasoning and argumentation skills teaching, and high level communication skills training. 
  2. Clinical Ethics Services should engage with the medical humanities, advocating for their teaching in medical education as an ethical imperative. 
  3. Deliberative models need to be normatively developed, and qualitatively and quantitatively assessed, in order to build a quality framework for clinical ethics deliberation. 
  4. The impact of clinical ethics services on clinician wellbeing should be explored.
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