Morten Magelssen

• Magelssen, Morten (2025). Bør dødshjelp legaliseres i Norge? En kritisk lesning av Moen og Sterris «Aktiv dødshjelp. Etikk ved livets slutt». Etikk i praksis. ISSN 1890-3991. 19(1), p. 7–24. doi: 10.5324/eip.v19i1.5990. Full text in Research Archive Show summary

  Ole Martin Moen og Aksel Braanen Sterris bok «Aktiv dødshjelp. Etikk ved livets slutt» er den beste og grundigste argumentasjonen på norsk for legalisering av dødshjelp til nå. Denne artikkelen er basert på en kritisk lesning av boken. Kritikken struktureres av fem tematiske «spor» som dødshjelpsdebatten gjerne følger. Jeg argumenterer for at Moen og Sterri ikke har lagt tilstrekkelig vekt på den moralske betydningen av selve dødshjelpshandlingen. Argumentet om at legalisering av dødshjelp kan legge «press på de svake» er et enda sterkere argument enn hva forfatterne får frem. Adgang til dødshjelp kan true profesjonsetiske holdninger nødvendige for lege-pasientrelasjonen. Ved god palliasjon samt klok praktisering av behandlingsbegrensning kan det opplevde behovet for dødshjelp reduseres sterkt. Til sist er det svakheter ved den konkrete modellen for legalisering som Moen og Sterri foreslår; modellen ligger tett opp mot det nederlandske systemet, og er dermed sårbar for innvendinger mot dette.

• Magelssen, Morten; Bringedal, Berit H.; Rø, Karin Isaksson & Dalum, Helene Seljenes (2025). Holdninger til dødshjelp blant leger i Norge. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145. doi: 10.4045/tidsskr.25.0053. Full text in Research Archive Show summary

  Bakgrunn Dødshjelp (eutanasi og assistert selvmord) er ulovlig i Norge. Norske legers syn på dødshjelp ble sist undersøkt i 2016. Vi har nå på ny undersøkt legers holdninger til dødshjelp. Materiale og metode Vi sendte ut en spørreundersøkelse til et utvalg yrkesaktive leger. Legene ble bedt om å ta stilling til seks påstander om legalisering av dødshjelp og tre påstander om vilje til å utføre eller bidra til dødshjelp samt om holdning til reservasjonsrett. Resultater Svarprosenten var 2 010/2 534 (79,3 %), og svarene fra 2 004 leger under 70 år ble inkludert. 723 (36,1 %) svarte at de var svært uenig i at «legeassistert selvmord bør tillates for personer som har en dødelig sykdom med kort forventet levetid». 232 (11,6 %) var svært enig i påstanden. Eldre respondenter var oftere avvisende til legalisering. 410 (20,5 %) var villige til å bidra til legeassistert selvmord, og 1 796 (89,6 %) ønsket reservasjonsrett i forbindelse med dødshjelp hvis dødshjelp skulle bli tillatt. Fortolkning En stor andel av legene i Norge er negative til å legalisere dødshjelp. Samtidig ser det ut til å være en bevegelse i retning av mindre motstand mot legalisering siden 2016.

• Fredheim, Olav Magnus Søndenå; Gravdahl, Eva-Kristin Norum; Skulberg, Ingeborg M & Magelssen, Morten (2025). Attitudes Toward Euthanasia and Physician-Assisted Suicide Among Norwegian Palliative Care Physicians. Palliative Medicine Reports (PMR). 6(1), p. 415–423. doi: 10.1177/26892820251372012. Full text in Research Archive Show summary

  Background: Data from other countries have indicated that palliative care physicians are more opposed to assisted dying compared with other physicians. However, little is known about reasons for support/opposition among palliative care physicians. Objectives: To explore Norwegian palliative care physicians’ attitudes toward assisted dying, with focus on filling knowledge gaps regarding reasons for support/opposition. Methods: The study is a cross-sectional descriptive survey. All 285 members of the Norwegian Association for Palliative Medicine were invited by e-mail to participate. To allow comparison with previous data, most questions and response alternatives were similar to a 2024 study of Norwegian physicians. Results: Among the 117 respondents opposition toward assisted dying was observed with 85 (73%) strongly disagreeing and 14 (12%) somewhat disagreeing with legalization of physician-assisted suicide for patients with short life expectancy. There was a clear pattern of less support for assisted dying if indications were wider, with only one respondent partially agreeing that assisted dying should be legalized for patients without severe illness who are tired of life and want to die. The most common reason for opposition was assisted dying representing a breach with professional ethics (88 subjects). The most common reason for support was that legalization could provide a safety for patients and next of kin that suffering could be avoided (14 subjects). Discussion: A large majority of Norwegian palliative care physicians reject the legalization of assisted dying. Among the small minority who support assisted dying, most believe it should be limited to patients with a short life expectancy.

• Torvund, Solveig Kristine Kolstad; Thoresen, Lisbeth; Magelssen, Morten & Fredheim, Olav Magnus Søndenå (2025). Conceptual barriers to palliative sedation: insights from focus group interviews with specialist palliative care professionals. BMC Palliative Care. 24(1). doi: 10.1186/s12904-025-01931-y. Full text in Research Archive Show summary

  Palliative sedation is considered an essential measure when other methods cannot provide sufficient symptom control in end-of-life. Prior research suggests that health care professionals find boundaries between palliative sedation, routine symptom management and euthanasia ambiguous. Appropriate implementation of palliative sedation depends on palliative care clinicians being confident in conceptual understanding of palliative sedation. The aim of this study was to understand specialist palliative care professionals' conceptualization of distinctions between symptom management, palliative sedation, and euthanasia; how perceived boundary ambiguities act as barriers to timely initiation of palliative sedation; and potential strategies to overcome these barriers. Methods This is an explorative qualitative phenomenological study, based on focus group interviews, utilizing reflexive thematic analysis. Four focus groups were interviewed at specialist palliative care departments across four Norwegian hospitals. Participants were 11 nurses and 12 physicians with at least one year of experience within specialist palliative care. Results Through thematic analysis two core themes were developed; the distinction between symptom management and palliative sedation, and the distinction between palliative sedation and euthanasia. Important sub-themes were definitional uncertainties, complexity of gradual medication titration, timing of sedation, indications for sedation, communication, and concerns about hastening death. Conclusion Even within specialist palliative care, different end-of-life treatment concepts are not experienced clear-cut. These conceptual ambiguities impede appropriate initiation of palliative sedation. Overcoming such barriers requires multi-level interventions: enhancing practitioners' definitional knowledge, fostering awareness of clinical intention during end-of-life treatment, promoting interprofessional dialogue, and developing more explicit clinical guidelines.

• Perin, Marta; Magelssen, Morten; Crico, Chiara; Ghirotto, Luca; Annoni, Marco & Gualandri, Giorgio [Show all 7 contributors for this article] (2025). 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. 20(5). doi: 10.1371/journal.pone.0318870. Full text in Research Archive Show summary

  Introduction The Clinical Ethics Committee (CEC) of the Local Health Authority (LHA) of Reggio Emilia, Italy, is a multi-professional service established in 2020 to support healthcare professionals (HPs) in dealing with ethical issues in clinical practice. We evaluated the integration of the CEC into routine practice, 24 months after its implementation. Methods We conducted semi-structured interviews with CEC members and LHA stakeholders involved in the service implementation. The interview scripts were outlined and transcript analysis was carried out following the four concepts of Normalization Process Theory (NPT): coherence, cognitive participation, collective action, reflexive monitoring. Results Between June 2022 and January 2023, 15 participants were interviewed (12 CEC members and 3 LHA directors). All participants consider the service an important opportunity for HPs to be supported in complex situations (coherence). The CEC’s President, a bioethicist working at the LHA, played a key role ensuring the CEC’s participation and activation (cognitive participation). The main barriers to the CEC implementation were: financial sustainability, CEC members’ lack of training, absence of in-person relationships (collective action). Overall, participants reported a positive experience with the CEC, however recommended several modifications (reflexive monitoring). Conclusions We identified key components to support the normalization of CECs and enable their activation within a clinical setting. An active and sustainable CEC must be visible, accessible, understood and trusted, clear in purpose, sufficiently integrated into the life of the organisation, adequately resourced, appropriately constituted and competent, accountable and independent. These findings can inform the development of practical strategies for CECs implementation and of appropriate outcomes for further evaluation.

• Hertzberg, Cecilie Knagenhjelm; Magelssen, Morten & Heggestad, Anne Kari Tolo (2025). Seeing several sides of the story: Unpacking an ethical dilemma in home-based care. Journal of Aging Studies. ISSN 0890-4065. 73. doi: 10.1016/j.jaging.2025.101323. Full text in Research Archive Show summary

  Healthcare professionals in home-based care face various challenges at the system and patient levels, which can lead to ethical dilemmas. In addition, home-based care workers lack arenas to share their experiences, as they are often scattered across the care district, work alone, and do not have the immediate support of a colleague. Based on ethnographic fieldwork among professional caregivers in home-based care in Norway, we present a case of an ethical dilemma that occurred during a patient visit. Using a narrative ethics approach, we unpack the case into six “stories” and show the context of the ethical dilemma. Home-based care staff may not be aware of an ethical dilemma as it unfolds. Reflection on the case leads us to suggest that staff would benefit from some form of clinical ethics support to learn, share stories, and receive support. We also suggest that professional caregivers and patients would benefit from advance care planning as a way to clarify expectations between patients and healthcare professionals. Clinical ethics support and advance care planning are ways for staff and patients, respectively, to let their voices and stories be heard.

• Fredheim, Olav Magnus Søndenå; Torvund, Solveig Kristine Kolstad; Thoresen, Lisbeth & Magelssen, Morten (2024). How should respiratory depression and loss of airway patency be handled during initiation of palliative sedation? Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 68(5), p. 675–680. doi: 10.1111/aas.14396. Full text in Research Archive Show summary

  Background Loss of airway patency has been reported during initiation of palliative sedation. In present guidelines the loss of airway patency during initiation of palliative sedation is not addressed. Airway patency can be restored by jaw thrust/chin lift or placing the patient in the recovery position. Aim A structured ethical analysis of how respiratory depression and loss of airway patency during initiation of palliative sedation should be handled. The essence of the dilemma is whether it is appropriate to apply simple non-invasive methods to restore airway patency in order to avoid the patient's immediate death. Design A structured analysis based on the four principles of healthcare ethics and stakeholders' interests. Results Beneficence and autonomy support a decision not to regain airway patency whereas non-maleficence lends weight to a decision to restore airway patency. Whether the proportionality criterion of the principle of double effect is met depends on the features of the individual case. The ethical problem appears to be a genuine dilemma where important values and arguments point to different conclusions. Conclusion Whether to restore airway patency when the airway is obstructed during initiation of palliative sedation will ultimately be based on clinical judgment taking into account both any known patient preferences and relevant clinical information. There are strong arguments favoring both options in this clinical and ethical dilemma. The fact that a clear and universal recommendation cannot be made does not imply indifference regarding what is the clinically and ethically best option for each individual patient.

• Karlsen, Heidi; Magelssen, Morten & Thoresen, Lisbeth (2024). Kommunale etikkomiteer kan ikke bæres av enkeltpersoners engasjement alene. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 20(2). doi: 10.7557/14.7168. Full text in Research Archive Show summary

  Mange ansatte i kommunale helse- og omsorgstjenester som opplever etiske utfordringer i sin arbeidshverdag, mangler arenaer for å diskutere slike problemstillinger. I et prosjekt fikk fire kommuner implementeringsstøtte til å etablere kommunale etikkomiteer, et tverrfaglig forum hvor ansatte, pasienter og pårørende kan få hjelp til å drøfte etisk krevende problemstillinger. I kommunehelsetjenesten er etablering av etikkomiteer å anse som et nybrottsarbeid, som hittil har vært lite systematisk undersøkt. Ved prosjektstart oppnevnte deltakerkommunene to ressurspersoner, og disse ble komiteenes ledere eller sekretærer. I denne studien har vi undersøkt disse ressurspersonenes erfaringer med å koordinere og lede kommunenes etikkarbeid, inkludert å lede konkrete etikkdrøftinger. Data fra tre fokusgrupper, supplert og validert med data fra fem dialogseminarer over tre år, ble analysert ved hjelp av refleksiv tematisk analyse. Funnene viser at refleksjon over etiske spørsmål kan ha betydning utover enkeltstående saker, men også at ressurspersonene fikk omfattende arbeidsoppgaver og ansvar innen implementering, kompetansebygging, markedsføring og forankring. For å unngå å være avhengig av enkeltpersoners innsats, bør komiteenes rammevilkår forbedres.

• Hertzberg, Cecilie Knagenhjelm; Magelssen, Morten & Heggestad, Anne Kari Tolo (2024). Putting patients first: when home-based care staff prioritise loyalty to patients above the system and themselves. An ethnographic study. BMC Medical Ethics. 25(1). doi: 10.1186/s12910-024-01094-0. Full text in Research Archive Show summary

  Background The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients’ needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints. Methods An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis. Results Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient’s formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient’s home. Conclusion The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff’s emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care.

• Schauber, Stefan; Olsen, Anne Olaug; Werner, Erik Lønnmark & Magelssen, Morten (2024). Inconsistencies in rater-based assessments mainly affect borderline candidates: but using simple heuristics might improve pass-fail decisions. Advances in Health Sciences Education. ISSN 1382-4996. doi: 10.1007/s10459-024-10328-0. Full text in Research Archive Show summary

  Introduction Research in various areas indicates that expert judgment can be highly inconsistent. However, expert judgment is indispensable in many contexts. In medical education, experts often function as examiners in rater-based assessments. Here, disagreement between examiners can have far-reaching consequences. The literature suggests that inconsistencies in ratings depend on the level of performance a to-be-evaluated candidate shows. This possibility has not been addressed deliberately and with appropriate statistical methods. By adopting the theoretical lens of ecological rationality, we evaluate if easily implementable strategies can enhance decision making in real-world assessment contexts. Methods We address two objectives. First, we investigate the dependence of rater-consistency on performance levels. We recorded videos of mock-exams and had examiners (N=10) evaluate four students’ performances and compare inconsistencies in performance ratings between examiner-pairs using a bootstrapping procedure. Our second objective is to provide an approach that aids decision making by implementing simple heuristics. Results We found that discrepancies were largely a function of the level of performance the candidates showed. Lower performances were rated more inconsistently than excellent performances. Furthermore, our analyses indicated that the use of simple heuristics might improve decisions in examiner pairs. Discussion Inconsistencies in performance judgments continue to be a matter of concern, and we provide empirical evidence for them to be related to candidate performance. We discuss implications for research and the advantages of adopting the perspective of ecological rationality. We point to directions both for further research and for development of assessment practices.

• Egeland, Tone; Ruud, Tor K.; Hanevik, Hans Ivar & Magelssen, Morten (2023). A study of the experience of Norwegian IVF physicians in evaluating the parenting capacity of patients. Reproductive Biomedicine Online. ISSN 1472-6483. 47(6), p. 1–7. doi: 10.1016/j.rbmo.2023.103368. Full text in Research Archive Show summary

  Research question: How do Norwegian fertility doctors assess the parenting capacity of applicants, and how do they experience and evaluate the assessment practice? Design: Qualitative interview study with 14 Norwegian fertility doctors. Interviews were analysed with systematic text condensation, a qualitative analysis framework. Results: Norwegian fertility doctors deem parenting capacity assessments of applicants to be straightforward and simple in most cases. Yet, some cases of doubt pose difficulties. Physicians can then draw on resources such as colleagues, physicians from other specialties who know the patient and patient records. All the participating physicians agreed with the principle of parenting capacity assessment for patients seeking fertility treatment. The assessment enabled physicians to refuse patients whom they thought should definitely not have responsibility for children. The physicians' main argument was their own felt responsibility for the future child. Even though assessments could be challenging, the participants all thought of themselves as competent to perform them. Indeed, some thought that delegating the assessments would imply abdicating a responsibility that was properly theirs. Although national guidelines might aid decision-making, the physicians would not want guidelines to curtail the significant discretion that they exercised. Conclusions: Whether societies should assess applicants' capacity for parenthood before fertility treatment is an ethical and political question. Although sometimes a difficult task, Norwegian fertility doctors see it as important, and as something they are competent and suited to undertake.

• Aarseth, Svein; Horn, Morten Andreas; Dahlberg, Jørgen & Magelssen, Morten (2023). Befolkningens kunnskaper og holdninger om beslutninger ved livets slutt. Michael. ISSN 1893-9651. 20(1), p. 11–22. Full text in Research Archive Show summary

  Bakgrunn: Medisinske beslutninger når pasientens liv nærmer seg slutten, gir noen ganger opphav til etiske problemer. Formålet med studien var å kartlegge befolkningens kunnskaper og holdninger på feltet. Materiale og metode: Nettbasert undersøkelse til et representativt utvalg av voksne nordmenn. Respondentene tok stilling til fire påstander om norsk helselovgivning, og anga holdning til åtte påstander om behandling og beslutninger ved livets slutt. Svarene ble analysert med deskriptiv statistikk. Resultater: 1167 personer fullførte undersøkelsen (svarprosent 23,7). 78 % trodde feilaktig at når pasienten selv ikke lenger kan ta beslutninger om behandling, er det pasientens nærmeste pårørende som fatter beslutningen. På de øvrige kunnskapsspørsmål svarte et flertall korrekt. Holdninger til helsehjelp ved livets slutt varierte. Samtidig som et flertall (67 %) mener at mange pasienter holdes i live mot sin vilje, har hele 79 % tillit til at de vil få god lindrende behandling hvis de får en dødelig sykdom. Fortolkning: Kunnskapen om helselovgivningen er ufullstendig i befolkningen. Det er viktig for leger å kjenne til utbredte feiloppfatninger.

• Brøderud, Linn Benita; Pedersen, Reidar & Magelssen, Morten (2023). Balancing burdens of infection control: Norwegian district medical officers’ ethical challenges during the COVID-19 pandemic. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09573-7. Full text in Research Archive Show summary

  Background In several countries, district medical officers (DMOs) are public health experts with duties including infection control measures. The Norwegian DMOs have been key actors in the local handling of the COVID-19 pandemic. Methods The aim of the study was to explore the ethical challenges experienced by Norwegian DMOs during the COVID-19 pandemic, and how the DMOs have handled these challenges. 15 in-depth individual research interviews were performed and analyzed with a manifest approach. Results Norwegian DMOs have had to handle a large range of significant ethical problems during the COVID-19 pandemic. Often, a common denominator has been the need to balance burdens of the contagion control measures for different individuals and groups. In another large set of issues, the challenge was to achieve a balance between safety understood as effective contagion prevention on the one hand, and freedom, autonomy and quality of life for the same individuals on the other. Conclusions The DMOs have a central role in the municipality’s handling of the pandemic, and they wield significant influence. Thus, there is a need for support in decision-making, both from national authorities and regulations, and from discussions with colleagues.

• Hertzberg, Cecilie Knagenhjelm; Heggestad, Anne Kari Tolo & Magelssen, Morten (2023). Blurred lines: Ethical challenges related to autonomy in home-based care. Nursing Ethics. ISSN 0969-7330. doi: 10.1177/09697330231215951. Full text in Research Archive Show summary

  Background Home-based care workers mainly work alone in the patient’s home. They encounter a diverse patient population with complex health issues. This inevitably leads to several ethical challenges. Aim The aim is to gain insight into ethical challenges related to patient autonomy in home-based care and how home-based care staff handle such challenges. Research design The study is based on a 9-month fieldwork, including participant observation and interviews in home-based care. Data were analysed with a thematic analysis approach. Participants and research context The study took place within home-based care in three municipalities in Eastern Norway, with six staff members as key informants. Ethical considerations The Norwegian Agency for Shared Services in Education and Research evaluated the study. All participants were competent to consent and signed an informed consent form. Findings A main challenge was that staff found it difficult to respect the patient’s autonomy while at the same time practicing appropriate care. We found two main themes: Autonomy and risk in tension; and strategies to balance autonomy and risk. These were explicated in four sub-themes: Refusing and resisting care; when choosing to live at home becomes risky; sweet-talking and coaxing; and building trust over time. Staff’s threshold for considering the use of coercion appeared to be high. Conclusions Arguably, home-based care staff need improved knowledge of coercion and the legislation regulating it. There is also a need for arenas for ethics reflection and building of competence in balancing ethical values in recurrent ethical problems.

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• Solberg, Berge & Magelssen, Morten (2026). Abort og fosterdiagnostikk. Full text in Research Archive
• Materstvedt, Lars Johan & Magelssen, Morten (2024). Livshjelp og dødshjelp. I dag kan vi forlenge livet og bremse alvorlig sykdom. Det gir oss en rekke nye etiske dilemmaer. [Radio]. NRK Verdibørsen. Full text in Research Archive
• Solberg, Carl Tollef & Magelssen, Morten (2024). Helsegapet, prioriteringskriteriene og veien fremover for helseprioriteringer. Full text in Research Archive Show summary

  Hva skal vi med helseprioriteringer? Hva går prioriteringskriteriene ut på? Hvordan forholder man seg til prioriteringer i arbeidet i sykehus og kommunehelsetjenesten, og, ikke minst: Hva kan kliniske etikk-komiteer bidra med i prioriteringsarbeidet? Dette er noen spørsmål som vil berøres i kurset. I tillegg vil Henriette Sinding Aasen snakke om juridiske aspekter ved helseprioriteringer, Jan Frich om systemet Nye metoder og blåreseptordningen, og Andrea Melberg vil gi en levnetsbeskrivelse fra sykehuset. Målgruppen for kurset er medlemmer av KEK og etikkråd i sykehus og kommuner.

• Solberg, Carl Tollef & Magelssen, Morten (2024). Hva skal vi med helseprioriteringer? Full text in Research Archive Show summary

  Hva skal vi med helseprioriteringer? Hva går prioriteringskriteriene ut på? Hvordan forholder man seg til prioriteringer i arbeidet i sykehus og kommunehelsetjenesten, og, ikke minst: Hva kan kliniske etikk-komiteer bidra med i prioriteringsarbeidet? Dette er noen spørsmål som vil berøres i kurset. I tillegg vil Henriette Sinding Aasen snakke om juridiske aspekter ved helseprioriteringer, Jan Frich om systemet Nye metoder og blåreseptordningen, og Andrea Melberg vil gi en levnetsbeskrivelse fra sykehuset. Målgruppen for kurset er medlemmer av KEK og etikkråd i sykehus og kommuner.

• Magelssen, Morten & Solberg, Carl Tollef (2023). Bør dødshjelp legaliseres i Norge? Fem spor i dødshjelpsdebatten. Intensjon og dobbelteffekt. Full text in Research Archive
• Perin, Marta; Magelssen, Morten; Ghirotto, Luca & Panfilis, Ludovica De (2023). Evaluating a clinical ethics committee (CEC) implementation process in an oncological research hospital: Protocol for a process evaluation study using normalisation process theory (EvaCEC). BMJ Open. 13(3). doi: 10.1136/bmjopen-2022-067335. Full text in Research Archive Show summary

  Introduction A Clinical Ethics Committee (CEC) is a multi-professional service whose aim is to support healthcare professionals (HPs) and healthcare organisations to deal with the ethical issues of clinical practice. Although CEC are quite common worldwide, their successful implementation in a hospital setting presents many challenges. EVAluating a Clinical Ethics Committee implementation process (EvaCEC) will evaluate the implementation of a CEC in a comprehensive cancer centre in Northern Italy 16 months after its establishment. Methods and analysis EvaCEC is a mixed-method study with a retrospective quantitative analysis and a prospective qualitative evaluation by a range of data collection tools to enable the triangulation of data sources and analysis. Quantitative data related to the amount of CEC activities will be collected using the CEC's internal databases. Data on the level of knowledge, use and perception of the CEC will be collected through a survey with closed-ended questions disseminated among all the HPs employed at the healthcare centre. Data will be analysed with descriptive statistics. The Normalisation Process Theory (NPT) will be used for the qualitative evaluation to determine whether and how the CEC can be successfully integrated into clinical practice. We will perform one-to-one semistructured interviews and a second online survey with different groups of stakeholders who had different roles in the implementation process of the CEC. Based on NPT concepts, the interviews and the survey will assess the acceptability of the CEC within the local context and needs and expectations to further develop the service. Ethics and dissemination The protocol has been approved by the local ethics committee. The project is co-chaired by a PhD candidate and by a healthcare researcher with a doctorate in bioethics and expertise in research. Findings will be disseminated widely through peer-reviewed publications, conferences and workshops.

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