that communication appears to be optimally
a process through which constant 3-way
discussion occurs between the healthcare
team, the patient, and the family. MCD
participants in some countries, like the
Netherlands, Hungary, Romania, and Spain,
emphasized the importance of recording the
patients' wishes in advance when they still
have capacity; such discussions were
reported as a practice in the Netherlands
and Spain. Advance care planning was
mentioned by healthcare professionals from
Italy, Germany, the UK, and Spain. In some
countries, for example, in Hungary, MCD
participants considered communication
limited: it was often left to the last minute,
and decision-making was often a one-time
discussion in which the family members
were more involved than the patient.
36
healthcare professionals are prepared
to identify ethical issues,
healthcare professionals are trained to
discuss ethical issues with patients and
family members, and are provided with
the place and time to do so in the
institution,
Healthcare professionals from the eight
countries had various levels of
understanding and addressed ethical issues
very differently. Based on the MCD sessions,
it can be concluded that healthcare
professionals reported significantly fewer
ethical dilemmas if decision-making was
medically supported if it could be made
after a good relationship had been built
with the patient and family through
communication as part of a process, and if
the professionals' medical opinion agreed
with the patient's and the family's wishes.
Ethical issues related to palliative sedation
can be managed more efficiently if:
Summary and Conclusion
healthcare professionals are prepared
to discuss ethical issues as a team and
are provided with the place and time to
do so in the institution (e.g., MCD
sessions),
guidelines and protocols support
healthcare professionals in applying
medical ethical principles and this is put
into practice in the given institution
(e.g., discussing goals of care).
MCD participants across all consortium
countries appreciated the opportunity to
discuss ethically difficult cases and
formulate possible solutions. The healthcare
professionals from Belgium, Germany, Italy,
the Netherlands, and the UK reported that
they had previously attended an ethical
discussion (e.g., in a MDC session) at their
workplace. Almost all participants from
Hungary, Romania, and Spain agreed that
MCD should be introduced as part of their
clinical practice.
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