Ethical decision making within multidisciplinary teams

• Main Author: Woodley, Julie S.
• Published: University of the West of England, Bristol 2012
• Subjects: 174.2
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.572854

To date research exploring the nature of ethical deliberations and decision making by healthcare teams has been largely ignored. However studying inter-professional approaches to ethical dilemmas may be valuable in offering insights into the processes of shared decision making and how such problems are addressed. Aim To investigate whether healthcare professionals working in teams embrace ethical and philosophical principles in their decisions. A secondary aim was to construct a model for ethical education informed by study data. Design A multi-methods approach comprising of a comprehensive review of the literature focus group interviews and a survey. Sample/participants A total of 112 healthcare personnel representing 15 disciplines were recruited from four large teaching hospitals within the Southwest region. Recruitment was through a lead consultant in each team who distributed invitations, participant information sheets (that outlined the study) and consent forms. Data collection Following ethical approval, 14 clinical teams were presented with profession specific vignettes and invited to engage in a facilitated discussion. Each team's interactions and decisions were tape recorded. Individuals also completed a modified version of the Decisional Conflict Scale (O'Connor 1995) to elicit their degree of comfort with decision making processes. Data analysis The transcripts from the 14 focus groups interactions were thematically analysed by employing Boyatzis (1998) model. Numerical data from the Decision Conflict questionnaire (DCQ) were entered into SPSS software for descriptive statistical analysis. Results The survey and the focus group data indicated that practitioners experienced varying degrees of conflict with the decision making process and displayed limited articulation and evidence of ethical principles that could be mapped to existing theories or methods. Participants did however employ strategies and shared expertise to overcome imposed restrictions through compromised solutions. The research identified eight key areas for consideration in the decision making process and these areas were developed to create a model for future ethics education and framing of ethical debate. The concept of restricted beneficence was also identified as being an over arching consideration in this area. The DCQ also highlighted that particular elements of the decision making process caused more concern but it highlighted that the team members opinions were valued and this supported the qualitative findings which identified evidence of a team ethos and value system. Conclusion The teams employed a very pragmatic approach to decision making within an environment that reflected the notion of restricted beneficence. It is suggested that the integration of such strategies ethical education this may result in a more practically relevant approach and enrich the quality of reflective debate in this area.