Evaluation and perceived results of moral case deliberation

Janssens, Rien; Zadelhoff, Ezra van; Loo, Ger van; Widdershoven, Guy; Molewijk, Bert

doi:10.1177/0969733014557115

Cited by 49 publications

(71 citation statements)

References 18 publications

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“…In the context of ethics applied in the clinical context, the top‐down approach has been defined as the application of knowledge in a process of deduction in light of relevant empirical facts, and in an impartial and value‐free manner . But ethical deliberation should occur both top‐down (here, according to the legal criteria that apply in the institution where the decision‐making takes place) as well as bottom‐up, in connection to the care practice . The care practices in which decision‐making about CCC is embedded emerge from the relationship between the care receiver and caregiver.…”

Section: A Care‐ethical Analysismentioning

confidence: 99%

Substance use disorder and compulsory commitment to care: a care‐ethical decision‐making framework

Nicolini

Vandenberghe

Gastmans

2017

Scandinavian Caring Sciences

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In the era of deinstitutionalisation of psychiatric patients, steady or even increasing rates of compulsory commitment to care (CCC) are an intriguing phenomenon to analyse. From a clinical, legal and ethical perspective, CCC continues to be a controversial practice in psychiatry, and perhaps even more so when applied to patients with severe substance use disorder (SUD). Several reasons make it controversial. The lack of consensus about the benefits of CCC and professional disagreement about what mental illness and autonomy mean in the case of SUD make it difficult to apply ethically sound clinical decision-making in CCC. Also, the medico-legal framework underlying CCC use sometimes appears to foster the use of reductionist clinical evaluation. Layered on top of these issues is how stakeholders view coercion. There is a discrepancy between clinicians' and patients' perception of coercion, which leads to clinician-patient differences on whether CCC is necessary. Moreover, the way in which the evaluation is typically carried out influences patients' perception of coercion and subsequently their motivation for participating fully in treatment. In this article, we explore the value of care ethics, often applied to care practices such as nursing, when applied to more procedural medical practices, such as decision-making regarding CCC. The care-ethical approach views decision-making as part of a dynamic care process, within which the lived experience, interpretative dialogue and promotion of dignity are core features. Embracing this new framework means a paradigm shift in when the therapeutic relationship begins, namely, investing in it occurs while conducting an evaluation for a possible CCC procedure. Unlike in current typical evaluations, early cultivation of the therapeutic relationship enables the patient to participate in the definition of his needs, reduces perceived coercion and negative emotions and enhances treatment motivation. Finally, implications of this novel approach for clinical practice are formulated and discussed.

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Section: A Care‐ethical Analysismentioning

confidence: 99%

Substance use disorder and compulsory commitment to care: a care‐ethical decision‐making framework

Nicolini

Vandenberghe

Gastmans

2017

Scandinavian Caring Sciences

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“…2 Further issues were to strengthen moral competencies and to develop routine in case of difficult questions. [3][4][5][6] Ethics consultations are also referred to as moral distress consultations 7 or moral case deliberations, 4 whereby the latter is described as being a part of ethics consultations. To ensure the quality of ethics consultations, evaluations of CECs were first discussed in 1996 8,9 and are now requested as standard in Germany by the Academy for Ethics in Medicine.…”

Section: Introductionmentioning

confidence: 99%

Team members perspectives on conflicts in clinical ethics committees

Scherer¹,

Alt-Epping²,

Nauck

et al. 2019

Nurs Ethics

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Background: Clinical ethics committees have been broadly implemented in university hospitals, general hospitals and nursing homes. To ensure the quality of ethics consultations, evaluation should be mandatory. Research question/aim: The aim of this article is to evaluate the perspectives of all people involved and the process of implementation on the wards. Research design and participants: The data were collected in two steps: by means of non-participating observation of four ethics case consultations and by open-guided interviews with 28 participants. Data analysis was performed according to grounded theory. Ethical considerations: The study received approval from the local Ethics Commission (registration no.: 32/11/10). Findings: ‘Communication problems’ and ‘hierarchical team conflicts’ proved to be the main aspects that led to ethics consultation, involving two factors: unresolvable differences arise in the context of team conflicts on the ward and unresolvable differences prevent a solution being found. Hierarchical asymmetries, which are common in the medical field, support this vicious circle. Based on this, minor or major disagreements regarding clinical decisions might be seen as ethical conflicts. The expectation on the clinical ethics committee is to solve this (communication) problem, but the participants experienced that hierarchy is maintained by the clinical ethics committee members. Discussion: The asymmetrical structures of the clinical ethics committee reflect the institutional hierarchical nature. They endure, despite the fact that the clinical ethics committee should be able to detect and overcome them. Disagreements among care givers are described as one of the most difficult ethically relevant situations and should be recognised by the clinical ethics committee. On the contrary, discussion of team conflicts and clinical ethical issues should not be combined, since the first is a mandate for team supervision. Conclusion: To avoid dominance by physicians and an excessively factual character of the presentation, the case or conflict could be presented by both physicians and nurses, a strategy that strengthens the interpersonal and emotional aspects and also integrates both professional perspectives.

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“…The services often experience challenging situations where different values and arguments are emphasized. Some studies have demonstrated that ethics reflection has a positive role in supporting the staff in difficult decision-making processes (8)(9)(10)(11).…”

Section: Professionals' Perceptions Introductionmentioning

confidence: 99%

“…In this study we use the term ERG because in our view, the ERG can also involve the discussion of other topics, such as clinical-ethical values or other general topics. Other authors use terms like ethics case reflection (ECR) (12) or Moral case deliberation (MCD) (10,11,13). A study of doctors who had brought a case to a hospital Clinical ethics committees, showed that clinicians found it useful to discuss ethical problems, and that they appreciated the depth of the discussion (14).…”

Section: Professionals' Perceptions Introductionmentioning

confidence: 99%