Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care

Abstract

Background: Clinical ethics support (CES) aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization. Methods: This integrative approach was developed in an iterative process, combining actual experiences in a case study in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences. Results: In this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design. Conclusions: In the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES.

Conceptualizing and Fostering the Quality of CES Through a Dutch National Network on CES (NEON)

“…A responsive evaluation methodology shares key presuppositions with our approach to CES (Hartman et. al 2020).…”

“…A responsive evaluation methodology shares key presuppositions with our approach to CES (Hartman et. al 2020 ). A responsive evaluation methodology focuses on a joint reflection process with the involved stakeholders about both quality improvement of a certain practice and the criteria one uses to conceptualize and evaluate this quality (Abma et al 2009 ).…”

“…Various perspectives on a situation, entailing both practical experience and theoretical understanding, offer a relevant and potentially valid interpretation of the situation. CES should be focused on engaging these perspectives in a dialogue, fostering awareness of one’s own moral presuppositions and the differences with those of others leading to broadening of one’s horizon, and an enriched, more nuanced and shared understanding of a moral issue (Porz et al 2011 ; Hartman et al 2020 ).…”

Quality Characteristics for Clinical Ethics Support in the Netherlands

“…By means of a joint reflection process with involved stakeholders, allowing space for different perspectives, the objective is to achieve shared understanding and commitment to actions. Experiential knowledge is taken as a primary source of knowledge in this process, combined and refined by theoretical understanding (Hartman et al 2020). Within a responsive evaluation methodology, stakeholders are encouraged to steer both the direction and the form of the evaluation process itself (Abma 2001;Abma, Nierse, and Widdershoven 2009).…”

Clinical Ethics Consultations in the Opinion of Polish Physicians

“…Newer forms of ethics support exist as well e.g. Moral Case Deliberation (Stolper et al 2016 ) or Ethics Reflection Groups (Lillemoen and Pedersen 2015 ), as well as others (Hartman et al 2020 ). However, there is no evidence of such methods being applied in Poland.…”