Ethics consultation in the ambulatory care sector: an evaluation of the consultation service in the districts of Traunstein and Berchtesgadenerland by means of a document analysis and interviews with primary care physicians

Definition of the problemWhile the implementation and use of ethics consultation services in the clinical setting have progressed in Germany during the last 20years, ethics consultation services in the non-clinical area have only become established in the last few years. In 2012, an extra-clinical ethics consultation service was implemented in the South Bavarian districts of Traunstein and Berchtesgadener Land.MethodsWithin apreliminary evaluation, adocument analysis and aquestionnaire survey among family practitioners in the two districts were conducted to gain information about the need of, the use of and the satisfaction with the ethics consultation service. Altogether, 58 of 195 contacted family practitioners participated in the survey (response rate 29.7%).ResultsThe document analysis revealed that most requests for an ethics consultation came from family members and from nursing homes. The survey results showed that family practitioners faced various ethical issues. However, only 17physicians used the extra-clinical ethics consultation service to solve ethical conflicts. Alack of familiarity with the ethics consultation service, no need for ethics support and the organizational and time effort were among the main reasons for not using the ethics consultation service. However, about half of the family practitioners, who participated in an ethical case discussion, would consider using the ethics support again (n=9) and found the result of the ethics consultation helpful (n=8). Thus, the results of our study show that although family practitioners perceive various ethical issues in their daily work, they still rarely consider an external counseling service to help solve ethical conflicts.