Patient involvement in clinical ethics support services (CESS) is increasingly recognized as important, yet global practices vary widely and comprehensive theoretical or empirical studies are scarce. Limited evidence from Europe suggests that patient participation in CESS (hereafter referred to as PP) differs by region and type of service, ranging from being entirely absent to patients acting as full dialogue partners. In contrast, North America appears to have more uniform adoption of PP. Although there are indications that PP is growing in Europe, no concrete data confirm this trend. This study aimed to gain an in-depth understanding of Dutch practices and attitudes toward PP, exploring both practical experiences and normative perspectives of respondents. A national survey targeting Dutch CESS staff was developed, consisting of 25 questions—both open and closed—covering four main areas: (1) the objectives of CESS, (2) current practices of PP, (3) ideas and ideals regarding PP, and (4) barriers to PP. Four key findings emerged: (1) PP in Dutch CESS is not yet routine; (2) perspectives on PP are closely linked to the perceived goals of ethics support; (3) hesitations or perceived obstacles to PP were generally practical rather than principled; and (4) most respondents view PP positively but emphasize the need for additional training, practical guidance, and hands-on experience. There are several normative arguments supporting PP. Nonetheless, it remains relatively uncommon and far from standard in Dutch CESS. Respondents expressed few principled objections; instead, limited PP appears connected to how CESS goals are understood, often focusing primarily on supporting healthcare professionals. Training and practical guidance were identified as crucial for building competence and experience for both CESS staff and healthcare providers.
