In healthcare practice, care providers are confronted with tragic situations, in which they are expected to make choices and decisions that can have far-reaching consequences. This article investigates the role of moral case deliberation in dealing with tragic situations. It focuses on experiences of care givers involved in the treatment of a pregnant woman with a brain tumour, and their evaluation of a series of MCD meetings in which the dilemmas around care were discussed. The study was qualitative, focusing on (...) the views and experiences of the participants. A case study design is used by conducting semi-structured interviews with health care professionals who both played a role in the treatment of the patient and attended the MCD. The results show that MCD helps people to deal with tragic situations. An important element of MCD in this respect is making explicit the dilemma and the damage, demonstrating that there is no simple solution. MCD prompts participants to formulate and share personal experiences with one another and thus helps to create a shared perception of the situation as tragic. The article concludes that MCD contributes to the sharing of tragic experiences, and fosters mutual interaction during a tragedy. Its value could be increased through explicit reflection on the aspect of contingency that characterises tragedy. (shrink)

Midwives, like other health professionals, are confronted with ethical issues on a daily basis and acting ethically is a core competence within professional conduct. In midwifery in particular, the complexity of ethical problems is increasing e.g., due to new medical options in diagnostics and reproductive medicine, the increasing diversity of life styles or the high number of preterm births. The main purpose of the current project was to develop effective interventions to increase midwives’ ethical competence in educational and practical settings. (...) To reach this goal, we conducted 43 individual semi-structured and 6 focus group interviews with midwives, lecturers and midwifery students to explore their views on ethics education and the support needed in practice to develop ethical competence. Based on the analysis of these interviews, a set of 15 interventions was designed and piloted in educational and clinical settings. The piloted interventions were then evaluated with an online questionnaire. Results from the interviews, the online questionnaire as well as the lessons learnt from piloting the interventions and the current literature on ethics education were integrated in a spiral curricular model for increasing midwives’ ethical competence. This model, called MidEthics, covers essential competences for midwives to be obtained in training and in clinical practice, and should inform curriculum development and policy makers. (shrink)

Background:This article combines foundational and empirical aspects of healthcare education and develops a framework for teaching ethical theories inspired by pragmatist learning theory and recent work on the concept of moral resilience. It describes an exemplary implementation and presents data from student evaluation.Objectives:After a pilot implementation in a regular ethics module, the feasibility and acceptance of the novel framework by students were evaluated.Research design:In addition to the regular online module evaluation, specific questions referring to the teaching of ethical theories were (...) added using simple (yes/no) and Likert rating answer formats.Participants and research context:At the Bern University of Applied Sciences, a total of 93 students from 2 parallel sub-cohorts of the bachelor’s program in nursing science were sent the online survey link after having been exposed to the same modular contents. A total of 62% of all students participated in the survey.Ethical considerations:The survey was voluntary and anonymous. Students were free to write their name and additional comments.Findings:Students consider ethical theories—as taught within the proposed framework—as practically applicable, useful, and transferable into practice.Discussion:Teaching ethical theories within the proposed framework overcomes the shortcomings described by current research. Students do not consider the mutually exclusive character of ethical theories as an insurmountable problem.Conclusion:The proposed framework is likely to promote the effectiveness of healthcare ethics education. Inspired by pragmatist learning theory, it enables students to consider ethical theories as educative playgrounds that help them to “frame” and “name” the ethical issues they encounter in daily practice, which is seen as an expression of moral resilience. Since it does not advocate a single ethical theory, but is open to the diversity of traditions that shape ethical thinking, it promotes a culturally sensitive, ethically reflected healthcare practice. (shrink)

The importance of graduating ethical health professionals is indisputable. Yet evaluating the quality of ethics education programs remains problematic for educators. A divide between learning and integrating ethics in everyday professional practice lies at the heart of this issue. The Ethics in Professional Practice (EPP) project addresses health professions' students’ self-efficacy for ethical practice. Students are cast as central characters in authentic vignettes and complete guided learning activities to facilitate their ethical reasoning skills. A design-based research approach was utilised to (...) create EPP resources and this study focuses on the analysis phase of the design process. The aim was to investigate EPP learning outcomes by developing innovative measures based upon Kirkpatrick’s ( 2006 ) evaluation model: namely, reaction, learning, behaviour and effects. Health professions students from Exercise and Sports Science, Rehabilitation Counselling and Speech Pathology (n = 58) participated in the EPP. Qualitative content analysis of reflective statements demonstrated their ethical sensitivity in four categories: Expectations and Empathy in Quality Care; Managing Overwhelming Demands; Informed, Engaged and Empowered; Access to Flexible Models of Service Delivery. Findings from the Rehabilitation Counselling cohort (n = 16) were explored in-depth using Semantic Differential Scales and demonstrated positive ethical reasoning outcomes. Participants also developed individual, ethical practice goals for professional practica. Qualitative content analysis of these goals demonstrated clear ethical reasoning learning effects. Participants integrated concepts of becoming an ethical professional with effective communication, collaboration, empowerment and quality care. Study outcome measures are critiqued and findings may inform redesign of future ethics education resources. (shrink)

In this paper, I bring together Jewish and Buddhist philosophical resources to develop a notion of radical responsibility that can confront a complicity within nursing and health care between empathy and (neo)liberal white supremacist hegemony. My inspiration comes from Angela Davis's call for building coalitions to advance struggles for peace and justice. I proceed as follows. First, I note ways phenomenology clarifies empathy's seeming foundational role in nursing care, and how such a formulation can be complicit with assumptions about private (...) individualism. Second, I turn to the Jewish philosophies of Martin Buber and Emmanuel Levinas, and their advocacy for a kind of responsibility that precedes the constitution of individuality as this can provide a resource for action and practice circumventing liberal influenced empathy. I note critical reservations about direct and practical application of Levinasian ethics in nursing care, and turn to engaged Buddhist philosophies of interdependence—such as in Thich Nhat Hanh and the Dalai Lama—as a corrective. Third, I conclude by indicating ways interreligious radical responsibility can reorient us toward housekeeping habits of character and away from exceptional crisis management, noting specific examples and actions in health care, nursing education and nursing scholarship. (shrink)

“Encuentros sobre ética clínica en la medicina paliativa” es un proyecto de formación ética y clínica en el ámbito de los cuidados paliativos. Hace parte de un programa clínico y de investigación más amplio que pertenece a la línea de recuperación de las raíces antropológicas y éticas en la práctica clínica de los cuidados paliativos. Está dirigido a profesionales e investigadores en cuidados paliativos, y contempla el desarrollo de reuniones informales, donde se analizan los valores humanos y profesionales involucrados en (...) casos clínicos reales. En este programa de formación ética y clínica, se consideran esenciales la antropología, la ética general, la epistemología médica y la filosofía de la medicina, además es valiosa la información proporcionada por las humanidades. El objetivo específico no es solo proporcionar una lista de principios éticos, sino también promover una disposición ética de parte de la persona que actúa. DOI: 10.5294/pebi.2016.20.1.4. (shrink)