Quality Development in Medical and Nursing Care Through a Modular, Ethical Treatment Allocation Process (METAP) in Vulnerable Patient Groups

Project summary: Vulnerable patient groups face several risks that are of ethical relevance. Over-treatment in the light of unfavourable prognosis as well as under-treatment regarding providing palliative care until the end of life can be observed. Difficulties that the staff may have with the decision-making process regarding limitation of treatment, possibly under economic pressure, may trigger moral distress. Evidence for these phenomena was found in national and international literature, as well as in our own previous research. Ethical aspects need to be integrated in practical models dedicated to problem solution. This shall be carried out in a paradigmatic way in the fields of intensive and geriatric patient care, combined with the effort to create a general model for clinical ethical decision-making.

It is planned to elaborate a multidimensional model consisting of several modules for clinical ethical decision-making on the ward that can improve quality in several ways by

• increasing participation of the staff involved,
• creating or supporting transparency,
• appropriately and reliably respecting the needs and rights of patients,
• including the involvement of relatives,
• integrating clinical and ethical aspects.

The project works with different methods from social science to be applied to clinical ethics research. Both the empirical data as well as the practical experiences of developing, implementing, observing and evaluating the instrument, will be submitted to rigorous ethical analysis, especially from the point of view of the ethics of allocation.

Vulnerable patients such as the severely ill, old and dying, require particular attention and protection. Although the risks of over-treatment as well as under-treatment are now being acknowledged, their ethical significance has not been sufficiently addressed and elaborated. The same is also true for the perception of economic pressure at the bedside, where many questions remain open. Issues of micro-allocation ethics require a practically relevant clinical ethical investigation, an approach that has been greatly neglected. These objectives will be in the center of the project.

The model to be developed in the project will contribute to better meeting and managing these challenges in the clinical setting, in an ethically reflected and participative manner. After completion of the project, the model will be made available to other clinical institutions for their use.