Clinical ethics consultation in Japan: What does it mean to have a functioning ethics consultation?

Background: Previous research shows that healthcare ethics consultation (HCEC) services were available in 25% of Japanese teaching hospitals in 2004. Although a system for HCEC in clinical settings has been established in Japan, questions exist regarding its effective functioning. A functioning HCEC system is needed in Japan. Furthermore, its impact and barriers that prevent its functioning must be identified and addressed. This survey examines the current status of HCEC in Japan through a nationwide survey to determine the extent to which the latest system is used. We qualitatively analyzed the HCEC’s benefits and problems related to consultation services in hospitals to identify the key points for HCEC and create a correctly functioning system. Methods A national questionnaire survey was conducted among 1028 hospitals designated for clinical training. Next, semi-structured document analysis was used to evaluate the impact and difficulties encountered after establishing HCEC. The questionnaire comprised the presence/absence of an ethics committee and HCEC services and, if available, HCEC membership; when such services were implemented; service users; and the number of cases handled since inception. In addition, the respondents also provided their impressions of the HCEC system’s impact on their hospital by describing: a) the benefits of having an HCEC system, and b) the ineffectual or harmful aspects of the HCEC system. Results A total of 125 questionnaires were returned from teaching hospitals. Of these, 90 (72%) reported they provided HCEC services. Additionally, 36 respondents (34.6%) reported that their existing research and clinical ethics committees had conducted HCEC services, and 35 (33.7%) respondents reported having a newly established clinical ethics committee conducting HCEC services. Three positive effects of establishing and four challenges in managing HCEC were also identified. Conclusions This study determined the current status of HCEC services in Japan using a nationwide survey to determine the extent of their use. The difficulties with HCEC, such as problems with scheduling requests for ethics support, uncertainty about what kind of consultation should be provided, and misunderstanding of its function, were identified.