The growth of clinical ethics in a multilingual country: challenges and opportunities

Background: \udClinical ethics committees and consultation services are a new development in Switzerland. These services grew out of locally perceived needs, with locally determined structures and processes. They were first listed in a 2002 survey, and the first national meeting of clinical ethics committees took place in 2004. Attempts at establishing bridges and networks between these services are very recent, and are made more difficult by the multi-cultural and multi-lingual structure of Switzerland.\udMethod: \udWe describe how different clinical ethics support services developed in Switzerland, and outline the diversity of structures, languages and cultural sources that these services are based on.\udResults: \udDespite differences in models and processes, common elements emerge: reliance on principlism, citizen involvement, interdisciplinarity, as well as the – implicit or explicit – reluctance to rely too strictly on rigid rules or processes for ethics consultation. The multi-lingual and multi-cultural structure of Switzerland results in unique difficulties in setting up a national network. Working in three different languages gives rise to logistical obstacles not present in most other countries. With each language also comes a literature corpus relevant to medical ethics, which is used alongside the English language bioethics literature with different degrees of salience in different regions.\udDiscussion and Conclusion: \udThis environment renders attempts to establish national networking for clinical ethics support services more difficult. However, it also presents what could be unique opportunities. Coordinated exchange of experience will grow in importance as challenges continue to face\udclinical ethics as a whole