Background In our clinical work in the hospice, we are confronted frequently with difficult decisions. Although most clinical staff have had teaching in ethics, it often does not cover the breadth of scenarios encountered in day-to-day practice (Schofield, Dittborn, Huxtable, et al Palliat Med. 2021; 35(2):315–334). Non-clinical staff with no ethics training, or staff rotating from other specialties may find some decisions worrying or hard to understand. These staff are often in close contact with patients and therefore aware of the issues affecting them and may be distressed or confused by the clinical decisions made by the multidisciplinary team (Jors, Tietgen, Xander, et al. Palliat Med. 2017; 31(1): 63–71).
Aim To create an opportunity for all staff to discuss the ethics underpinning complex decisions and enable greater understanding of the decision-making process.
Format The Forum is held every 6 weeks, online, enabling staff at different sites to attend. The discussion topic is decided beforehand, to allow for preparation. We invite suggestions for discussion from all staff. The topics range from anonymised cases to themes such as ‘truth telling’ or current news topics. All staff groups, including non-clinical staff, are welcome. The Forum is advertised widely within the hospice. Each Forum begins with an introduction outlining the ground rules of respect, confidentiality, and tolerance of different viewpoints. The case or topic is then presented, identifying the difficulty, with some explanation as to the ethical approaches that could be considered. The discussion is open to all participants, facilitated by a Chair.
The story so far All respondents to a feedback survey found the Forum to be interesting and useful. A core group of staff attend regularly, including non-clinical staff. We have developed an enhanced understanding that ethics is for everyone. The Forums provide an open platform for deepening understanding and debate. The discussions encompass broader ideas than strict moral theories, although these are used to start the conversation.
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