[Cochin Hospital Clinical Ethics Center: the first two years].
BACKGROUND
In September 2002, Cochin Hospital (Paris, France) opened a Clinical Ethics Center for patients, health proxies and members of the healthcare staff to consult when they face medical decisions raising ethical issues, that is, presenting possible conflicts in values. Three years after the opening of this experimental center that remains unique in France, we evaluated its activities.


OBJECTIVE
To describe and compare consultations in 2003 and 2004 and to compare our activity with that of similar units abroad.


METHODS
The descriptive analysis is based on data routinely collected for all consultations.


RESULTS
The Center received 47 calls in 2003 and 83 in 2004. The most frequent reasons for consultation were: end of life issues (28%), patients' rights (25%), and questions about assisted reproduction technologies (16%). Two factors explain the increase in activity between 2003 and 2004. First, patients and their proxies called much more often: 24 calls in 2004, compared with only 10 in 2003. Second, research protocols designed to focus on specific ethical questions faced by medical teams in their daily practice required them to call systematically in the relevant situations (39 calls in 2004, compared with 15 in 2003). Calls from healthcare workers about one-time or ad hoc ethics questions remained stable (22 in 2003 and 21 in 2004).


CONCLUSIONS
Healthcare staff appear to need clinical ethics consultations less for help on ad hoc issues than for long-term collaboration on specific and frequent ethical issues that remain difficult, despite their familiarity. These findings refute earlier fears that healthcare personnel would use these consultations to avoid their own ethical responsibilities. The increasing direct demand from patients and proxies should continue during the next few years, for it corresponds to a profound social trend, to defend one's autonomy in the face of illness and to make decisions and take responsibility for oneself.
Fournier
Véronique
V
Centre d'éthique clinique, Hôpital Cochin, Paris (75). veronique.fournier@cch.ap-hop-paris.fr
Pousset
Maud
M
D003710:Demography; D026690:Ethics, Clinical; D005260:Female; D005602:France; D006296:Health Services / Q000941:ethics*; D006761:Hospitals / Q000639:trends*; D006801:Humans; D008297:Male; D012017:Referral and Consultation; D034121:Reproductive Health Services / Q000941:ethics / Q000592:standards; D012189:Retrospective Studies