Perception, knowledge, and access to Clinical Bioethics Committees in the CCSS: results of an institutional survey
Sandra Rodríguez-Ocampo- Alejandro Marín-Mora
- Natasha Mendoza-Betrano
- Ana Catalina Quirós-Masís
Published 2026-09-09
Keywords
- Bioethics, Ethics Committees Clinical, Hospitals, Health Services, Costa Rica.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
How to Cite
Abstract
Objective: To describe the perception, knowledge, and access to Clinical Bioethics Committees (CBCs) in healthcare facilities of the Costa Rican Social Security Fund (CCSS), to assess the extent to which this institutional capacity is recognized and used by healthcare and administrative personnel.
Materials and methods: A descriptive, cross-sectional, exploratory study was conducted using a voluntary, anonymous, self-administered survey administered between February and April 2025 to healthcare and administrative personnel from different disciplines. The survey was disseminated through the CCSS WebMaster platform, institutional social media channels, and the CENDEISSS website. Closed-ended questions were analyzed using descriptive statistics. Open-ended responses were examined through thematic content analysis, using manual coding and grouping of recurrent themes related to visibility, functional knowledge, perceived accessibility, and improvement proposals.
Results: A total of 558 responses were obtained. Overall, 57.5% of respondents reported being aware of the existence of CBCs; 46.2% identified their functions; 15.8% had requested ethical consultation; and 41.6% perceived them as accessible. Among those who had requested consultation, 80.7% reported that the committee response helped resolve the bioethical problem. In addition, 92.7% identified that anyone who recognizes an ethical problem may consult a CBC. The most frequently identified areas requiring bioethical guidance were informed consent, protection of the rights of persons in vulnerable situations, ethical-clinical decision-making in critical situations, and confidentiality. Open-ended responses pointed to barriers related to institutional visibility, limited knowledge of consultation procedures, and insufficient integration of committees into clinical and educational settings.
Conclusions: CBCs constitute a strategic institutional capacity for quality of care, protection of rights, and the legitimacy of clinical decision-making. However, respondents reported a low level of committee use. Strengthening their visibility, consultation procedures, bioethics training, and integration into clinical practice and institutional management is essential to consolidate them as an effective resource for supporting ethically justified decision-making.
References
- Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura. Creación de comités de bioética [Internet]. París: UNESCO; 2005 [Consultado el 16 de marzo de 2026]. Disponible en: https://unesdoc.unesco.org/ark:/48223/pf0000139309_spa
- Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura. Funcionamiento de los comités de bioética: procedimientos y políticas [Internet]. París: UNESCO; 2006 [Consultado el 16 de marzo de 2026]. Disponible en: https://unesdoc.unesco.org/ark:/48223/pf0000147392_spa
- Gracia D. La deliberación moral: el método de la ética clínica. Madrid: Triacastela; 2001.
- Braun V, Clarke V. Thematic analysis: a practical guide. London: SAGE Publications; 2021. DOI: https://doi.org/10.4135/9781036232078.n9
- Crico C, Sanchini V, Casali PG, Pravettoni G. Evaluating the effectiveness of clinical ethics committees: a systematic review. Med Health Care Philos. 2021;24:135-151. DOI: https://doi.org/10.1007/s11019-020-09986-9
- Perin M, Magelssen M, Crico C, Ghirotto L, Annoni M, Gualandri G, De Panfilis L. How to implement a clinical ethics committee in an oncological research hospital: qualitative results from a process evaluation study using normalization process theory (EVACEC). PLoS One. 2025; 20(5):e0318870. DOI: https://doi.org/10.1371/journal.pone.0318870
- Pergert P, Svantesson M, Bartholdson C, Bremer A, Brännström M, Fischer Grönlund C, Juth N, Björk J. Case-Based Clinical Ethics Support - a description and normative discussion of methodological issues from the Swedish perspective. HEC Forum. 2026;38(2):191-206. DOI: https://doi.org/10.1007/s10730-025-09566-5
- Caja Costarricense de Seguro Social. Área de Bioética: pasado, presente y futuro [Internet]. San José: Editorial Nacional de Salud y Seguridad Social; 2025 [Consultado el 16 de marzo de 2026]. Disponible en: https://www.binasss.sa.cr/memoriabioetica.pdf
- Caja Costarricense de Seguro Social. Manual Funcionamiento de Comités de Bioética Clínica y en Gestión. Código GM-CENDEISSS-AB-MA-001 [Internet]. San José: CCSS, CENDEISSS, Área de Bioética; 2024 [Consultado el 16 de marzo de 2026]. Disponible en: https://www.cendeisss.sa.cr/wp-content/uploads/2025/02/GM-CENDEISSS-AB-MA-001-Manual-de-Funcionamiento-de-CBC-noviembre-2024-1.pdf
- Caja Costarricense de Seguro Social. Manual para la redacción de aspectos bioéticos y derechos humanos en protocolos de atención clínica. Código GM-CENDEISSS-AB-MA-005. [Internet]. San José: CCSS, CENDEISSS, Área de Bioética; 2024 [Consultado el 16 de marzo de 2026]. Disponible en: https://www.cendeisss.sa.cr/wp-content/uploads/2024/04/Manual-para-la-redaccion-de-aspectos-Bioeticos-y-Derechos-Humanos-en-Protocolos-de-Atencion-Clinica.pdf
- Organización Panamericana de la Salud. Bioética: hacia la integración de la ética en el ámbito de la salud. Documento conceptual [Internet]. Washington, D.C.: OPS; 2012 [Consultado el 16 de marzo de 2026]. Disponible en: https://iris.paho.org/handle/10665.2/4457
- World Health Organization. WHO global strategy on people-centred and integrated health services: interim report [Internet]. Geneva: WHO; 2015 [Consultado el 16 de marzo de 2026]. Disponible en: https://iris.who.int/items/152dc918-25da-4102-a29a-4be173c84a03
- Caja Costarricense de Seguro Social. Registro institucional de Comités de Bioética Clínica inscritos ante el Área de Bioética. San José: CCSS, CENDEISSS, Área de Bioética; 2025.