In their paper (‘ Morisprudence: a theoretical framework for studying the relationship linking moral case deliberation, organisational learning and quality improvement ‘),1 Kok et al addresses an important topic: how to theoretically think about studying the impact of moral case deliberations and how to conceptualise organisational learning? In this article, they aim to develop a theoretical framework that provides empirically assessable hypotheses that describe the relationship between moral case deliberation and care quality at an organisational level. The authors describe care (...) quality mostly in terms of practical wisdom which they aggregate into both individual and organisational morisprudence. Morisprudence is defined as an ongoing formulation of moral judgements. However, it remains a bit unclear how the theoretical framework of Kok et al may lead to empirically assessable hypotheses. Concepts like ‘quality’, ‘quality of care’, ‘practical wisdom’ and ‘individual and organisational morisprudence’ are not described in detail, let alone operationalised in measurable terms. How should we understand morisprudence in empirical terms? What is a good morisprudence? And how should we measure or conclude whether morisprudence has been improved (or not)? The authors rightfully focus on the need for organisational learning during and through Moral Case Deliberation (MCD). Too often, MCD is only described as the discussion of one patient’s case, thereby implicitly suggesting that the learning process only takes place at the level of an individual case. Yet, based on many years of MCD evaluation research, we know from mostly …. (shrink)

Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees’ experiences of (...) implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed. (shrink)