Conflicts of Care

Helen Kohlen, Dr. phil., ist Juniorprofessorin für Care Policy und Gemeindenahe Pflege an der Hochschule Vallendar.

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)

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
"Bioethics is not just Bioethics": Its Make and (Un)Concerns
The 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
Types of Hospital Ethics Committees: From Ad hoc Committee to Optimum Care Committee at Boston Massachusetts General Hospital
The President's Commission and ist 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
Caring as a Women orientated Ethics and a Feminine Model
Caring 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

4 Summary

Practical 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