Advance Care Planning in Spain.

In the last decade in Spain, an important push has been given to the development of health policies that define the framework of action in the care of people with advanced chronic diseases. Respect for the autonomy of the patient, shared decision-making processes and advance care planning (ACP) are recognized into health plans as a key aspect in chronic care, frailty, and palliative care. A few but significant number of institutions, local governments, and healthcare professionals from different regions of Spain have started a rationale and roadmap for a new twist in Spain's theoretical, ethical and policy development, promoting ACP implementation into public health care systems. In 2020, a working group founded in 2017, evolved into the "Spanish Association of Shared Care Planning" (AEPCA). The Shared Care Planning (SCP) concept grows up after the two international consensus Delphi studies in 2017 and pretends to shift from the framework of ACP programs to a person-centred care approach. In the last years, several experiences show how professionals are more sensible and interested on the ACP process, but it cannot be said, for now, that it has taken effect in the global Spanish health system. Even both ACP and SCP are being used simultaneously in Spain, each day more people and autonomous communities embrace renewed concept and foundations of SCP, supporting the work of AEPCA on spreading the value of this process into the care of people who are coping with chronic diseases, vulnerability, and frailty.

[Clinical Ethics Consultation: current European models and novel approaches in Spain]. / Consultoría en ética clínica: modelos europeos y nuevas propuestas en España.

To date, healthcare ethics committees (HEC) have been the only ethics consultation model in the hospital setting in Spain, though their usefulness for ethical conflict resolution in daily practice has been questioned. Individual clinical ethics consultation (CEC) is a complementary ethics consultation model, which has proved efficacious in real-time ethical problem-solving. Although CEC is widely used in North America, its implementation in Europe is still marginal. In this document we present the general characteristics of CEC services, comparing their potential advantages and risks to those of HECs. We will then share relevant European experiences in CEC, as well as review the few CEC initiatives in Spain. Finally, we will share our recent CEC implementation strategy in a national, medium-sized, teaching hospital. We will summarise the minimum requirements that such a CEC service must meet in order to carry out its consulting activity: organisational flexibility, well-trained professionals, with sufficient clinical experience, economical support, and organisational dependency on HECs.

Consultoría en ética clínica: modelos europeos y nuevas propuestas en España / Clinical Ethics Consultation: current European models and novel approaches in Spain

Los Comités de Ética Asistencial (CEAS) han constituido hasta la actualidad el único modelo de resolu-ción de conflictos éticos en el entorno hospitalario en España, aunque su utilidad para mejorar la prácticaclínica diaria ha sido puesta en duda. La Consultoría individual en Ética Clínica (CEC) es un modelo comple-mentario al CEAS, eficaz para ayudar a tomar decisiones ético-clínicas complejas a tiempo real. Aunque laCEC está muy extendida en el ámbito estadounidense, todavía goza de poca popularidad en Europa. En elpresente trabajo se describen las características generales de los servicios de CEC, remarcando sus ventajasy potenciales riesgos comparándolos con los del modelo basado exclusivamente en los CEAS. En segundolugar, se recogen las experiencias y modelos de CEC en diversos países europeos, y también presentamos lasiniciativas más recientes llevadas a cabo en nuestro país. Tras ello, se propone una estrategia de implanta-ción de un servicio de CEC para un hospital universitario de tamaño medio y se resumen las característicasmínimas que este servicio de CEC debe tener para poder llevar a cabo eficazmente su labor consultiva: fle-xibilidad organizativa, composición por profesionales formados en Bioética, con gran experiencia clínica,remunerados específicamente para esta tarea y con dependencia organizativa del CEAS.(AU)

To date, healthcare ethics committees (HEC) have been the only ethics consultation model in the hospi-tal setting in Spain, though their usefulness for ethical conflict resolution in daily practice has been ques-tioned. Individual clinical ethics consultation (CEC) is a complementary ethics consultation model, whichhas proved efficacious in real-time ethical problem-solving. Although CEC is widely used in North America,its implementation in Europe is still marginal. In this document we present the general characteristics ofCEC services, comparing their potential advantages and risks to those of HECs. We will then share relevantEuropean experiences in CEC, as well as review the few CEC initiatives in Spain. Finally, we will share ourrecent CEC implementation strategy in a national, medium-sized, teaching hospital. We will summarise theminimum requirements that such a CEC service must meet in order to carry out its consulting activity: or-ganisational flexibility, well-trained professionals, with sufficient clinical experience, economical support,and organisational dependency on HECs.(AU)