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  1. Blurred lines: Ethical challenges related to autonomy in home-based care.Cecilie Knagenhjelm Hertzberg, Anne Kari Tolo Heggestad & Morten Magelssen - forthcoming - Nursing Ethics.
    Background Home-based care workers mainly work alone in the patient’s home. They encounter a diverse patient population with complex health issues. This inevitably leads to several ethical challenges. Aim The aim is to gain insight into ethical challenges related to patient autonomy in home-based care and how home-based care staff handle such challenges. Research design The study is based on a 9-month fieldwork, including participant observation and interviews in home-based care. Data were analysed with a thematic analysis approach. Participants and (...)
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  • Effectiveness of CURA: Healthcare professionals’ moral resilience and moral competences.Malene van Schaik, H. Roeline R. W. Pasman, Guy A. M. Widdershoven, Janine De Snoo-Trimp & Suzanne Metselaar - forthcoming - Nursing Ethics.
    Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral (...)
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  • Clinical Ethics Committee in an Oncological Research Hospital: two-years Report.Marta Perin, Ludovica De Panfilis & on Behalf of the Clinical Ethics Committee of the Azienda Usl-Irccs di Reggio Emilia - 2023 - Nursing Ethics 30 (7-8):1217-1231.
    Research question and aimClinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020,...
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  • Should Artificial Intelligence be used to support clinical ethical decision-making? A systematic review of reasons.Sabine Salloch, Tim Kacprowski, Wolf-Tilo Balke, Frank Ursin & Lasse Benzinger - 2023 - BMC Medical Ethics 24 (1):1-9.
    BackgroundHealthcare providers have to make ethically complex clinical decisions which may be a source of stress. Researchers have recently introduced Artificial Intelligence (AI)-based applications to assist in clinical ethical decision-making. However, the use of such tools is controversial. This review aims to provide a comprehensive overview of the reasons given in the academic literature for and against their use.MethodsPubMed, Web of Science, Philpapers.org and Google Scholar were searched for all relevant publications. The resulting set of publications was title and abstract (...)
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  • Two years of ethics reflection groups about coercion in psychiatry. Measuring variation within employees’ normative attitudes, user involvement and the handling of disagreement.Bert Molewijk, Reidar Pedersen, Almar Kok, Reidun Førde & Olaf Aasland - 2023 - BMC Medical Ethics 24 (1):1-19.
    Background Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. Methods We used panel data in a longitudinal design study to measure (...)
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  • Contribution of moral case deliberations to the Moral Craftmanship of prison staff: A quantitative analysis.Marie Huysentruyt, A. I. Schaap, M. M. Stolper, M. Snijdewind, H. C. W. de Vet & A. C. Molewijk - 2023 - International Journal of Ethics Education 8 (2):389-405.
    This study explores the impact of participation in a series of moral case deliberations (MCD) on the moral craftsmanship (MCS) of Dutch prison staff. Between 2017–2020, ten MCDs per team were implemented in three prisons (i.e., intervention group). In three other prisons (i.e., control group) no MCDs were implemented. We compared the intervention and control group using a self-developed questionnaire, administered before (pre-measurement) and after the series of MCDs (post-measurement). Results After the MCDs, participants scored significantly higher on 7 of (...)
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  • Ethik-Fortbildungen als Element der Klinischen Ethikarbeit: Ein Überblick über Formate und weitere strukturierende Elemente.Anna-Henrikje Seidlein, Florian Rave, Annette Rogge, Katharina Woellert & Caroline Hack - 2023 - Ethik in der Medizin 35 (3):341-356.
    Zusammenfassung Ausgehend von den Erfahrungswerten sechs Klinischer Ethiker*innen an Universitätsklinika in Deutschland wurde eine strukturierte Auseinandersetzung mit dem Arbeitsfeld der Fortbildungen im Rahmen der Klinischen Ethikarbeit vorgenommen. Die Zusammenarbeit wurde von der Fragestellung geleitet, was bei der Konzeption einer Ethik-Fortbildung innerhalb einer Einrichtung zu berücksichtigen ist. Der methodische Zugang zur Beantwortung der explorativen Fragestellung bestand in einem mehrstufigen, deskriptiven Verfahren, das alternierend in gemeinsamen Arbeitssitzungen und individueller Arbeit zwischen den Sitzungen umgesetzt wurde. Als Resultat zeigt der Aufsatz eine Übersicht über (...)
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  • Outcomes of clinical ethics support near the end of life: A systematic review.Joschka Haltaufderheide, Stephan Nadolny, Marjolein Gysels, Claudia Bausewein, Jochen Vollmann & Jan Schildmann - 2020 - Nursing Ethics 27 (3):838-854.
    Background: Clinical ethics support services have been advocated in recent decades. In clinical practice, clinical ethics support services are often requested for difficult decisions near the end of life. However, their contribution to improving healthcare has been questioned and demands for evaluation have been put forward. Research indicates that there are considerable challenges associated with defining adequate outcomes for clinical ethics support services. In this systematic review, we report findings of qualitative studies and surveys, which have been conducted to evaluate (...)
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  • Relevance of a normative framework for evaluating the impact of clinical ethics support services in healthcare.Oliver Rauprich, Georg Marckmann & Jan Schildmann - 2022 - Journal of Medical Ethics 48 (12):987-988.
    Evaluating the impact of clinical ethics support services remains a challenging task. 1 Against this background, we applaud the authors for developing a theoretical framework that aims to explain how repeated moral case deliberations may promote ‘practical wisdom’ in healthcare professionals and improve the quality of care in health facilities. 2 In our view, it is of particular value to draw attention to the learning processes that may be induced by ethics support services. Understanding such learning processes on the individual (...)
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  • Clinical ethics support services during the COVID-19 pandemic in the UK: a cross-sectional survey.Mariana Dittborn, Emma Cave & David Archard - 2022 - Journal of Medical Ethics 48 (10):695-701.
    Background Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder. Objectives To validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and investigate characteristics for adherence to medication measured via smartphones. Methods Patients with BD evaluated adherence to medication daily for 6–9 months via smartphones. The Medication Adherence Rating Scale and the Rogers’ Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional (...)
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  • Clinical ethics consultations: a scoping review of reported outcomes.Ann M. Heesters, Ruby R. Shanker, Kevin Rodrigues, Daniel Z. Buchman, Andria Bianchi, Claudia Barned, Erica Nekolaichuk, Eryn Tong, Marina Salis & Jennifer A. H. Bell - 2022 - BMC Medical Ethics 23 (1):1-65.
    BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...)
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  • Systemic approach to clinical ethics—impact of systems thinking and practice on the design of effective ethics consultations.Katharina Woellert - 2022 - Ethik in der Medizin 34 (4):529-548.
    Definition of the problemQuality of care also includes a professional approach to ethical challenges. This involves the moral interpretation of an issue and the management of intra- and interpersonal reflection processes. Combining both is the central task of clinical ethics consultation (CEC). Despite its importance only a few studies have dealt with the appropriate methods for steering reflection processes.ArgumentsCEC requires a theory-based and methodological approach. The argumentation shows the effects that systems theory and systemic methods have on the effectiveness of (...)
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  • Klinische Ethik systemisch betrachtet – Vom Einfluss systemischer Grundannahmen und Methoden auf die Gestaltung einer effektiven Ethikberatung.Katharina Woellert - 2022 - Ethik in der Medizin 34 (4):529-548.
    Zusammenfassung Krankenhäuser müssen sich an der ethischen Qualität ihrer Versorgung messen lassen. Es geht dabei um einen Zustand, in dem allgemein anerkannte moralische Normen in der Patient:innenversorgung konsequent berücksichtigt werden. Damit sind zwei Ebenen angesprochen: die der ethisch-normativen Deutung und die der Gestaltung intra- und interpersonaler Prozesse. Die Klinische Ethik ist die Disziplin, die in der Verbindung beider ihre zentrale Aufgabe sieht. Um sie zu erfüllen, muss Ethikarbeit auf der Basis komplexer Kompetenzen erfolgen. Neben fundiertem Ethikwissen ist das Beherrschen von (...)
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  • CURA: A clinical ethics support instrument for caregivers in palliative care.Suzanne Metselaar, Malene van Schaik, Guy Widdershoven & H. Roeline Pasman - 2022 - Nursing Ethics 29 (7-8):1562-1577.
    This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case (...)
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  • Morisprudence: a theoretical framework for studying the relationship linking moral case deliberation, organisational learning and quality improvement.Niek Kok, Marieke Zegers, Hans van der Hoeven, Cornelia Hoedemaekers & Jelle van Gurp - 2022 - Journal of Medical Ethics 48 (11):868-876.
    There is a claim that clinical ethics support services (CESS) improve healthcare quality within healthcare organisations. However, there is lack of strong evidence supporting this claim. Rather, the current focus is on the quality of CESS themselves or on individual learning outcomes. In response, this article proposes a theoretical framework leading to empirical hypotheses that describe the relationship between a specific type of CESS, moral case deliberation and the quality of care at the organisational level. We combine insights from the (...)
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  • It’s About Heterogeneity! Strategies to Advance the Evaluation of Ethics Consultation.Joschka Haltaufderheide, Stephan Nadolny, Jochen Vollmann & Jan Schildmann - 2022 - American Journal of Bioethics 22 (4):56-58.
    In their national follow-up study on ethics consultation in the U.S., Fox et al. report the worrying finding of a decline in efforts to evaluate ECs. Compared to the findings of Fox et...
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  • Evaluating interventions to improve ethical decision making in clinical practice: a review of the literature and reflections on the challenges posed. [REVIEW]Agnieszka Ignatowicz, Anne Marie Slowther, Christopher Bassford, Frances Griffiths, Samantha Johnson & Karen Rees - 2023 - Journal of Medical Ethics 49 (2):136-142.
    Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of (...)
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  • Conceptualizing the impact of moral case deliberation: a multiple-case study in a health care institution for people with intellectual disabilities.A. C. Molewijk, J. L. P. van Gurp & J. C. de Snoo-Trimp - 2022 - BMC Medical Ethics 23 (1):1-15.
    BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people with (...)
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  • CURA—An Ethics Support Instrument for Nurses in Palliative Care. Feasibility and First Perceived Outcomes.Malene Vera van Schaik, H. Roeline Pasman, Guy Widdershoven, Bert Molewijk & Suzanne Metselaar - 2021 - HEC Forum 35 (2):1-21.
    Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert scales (...)
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  • Clinical ethics case consultation in a university department of cardiology and intensive care: a descriptive evaluation of consultation protocols.Michel Noutsias, Daniel Sedding, Jochen Dutzmann, Henning Rosenau, Kim P. Linoh, Nicolas Heirich, Stephan Nadolny, Jan Schildmann & Andre Nowak - 2021 - BMC Medical Ethics 22 (1):1-12.
    BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. (...)
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  • Framework for evaluation research on clinical ethical case interventions: the role of ethics consultants.Joschka Haltaufderheide, Stephan Nadolny, Jochen Vollmann & Jan Schildmann - 2022 - Journal of Medical Ethics 48 (6):401-406.
    Evaluation of clinical ethical case consultations has been discussed as an important research task in recent decades. A rigid framework of evaluation is essential to improve quality of consultations and, thus, quality of patient care. Different approaches to evaluate those services appropriately and to determine adequate empirical endpoints have been proposed. A key challenge is to provide an answer to the question as to which empirical endpoints—and for what reasons—should be considered when evaluating the quality of a service. In this (...)
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  • Implementing clinical ethics committees as a complex intervention: presentation of a feasibility study in community care.Morten Magelssen, Heidi Karlsen, Reidar Pedersen & Lisbeth Thoresen - 2020 - BMC Medical Ethics 21 (1):1-9.
    BackgroundHow should clinical ethics support services such as clinical ethics committees (CECs) be implemented and evaluated? We argue that both the CEC itself and theimplementationof the CEC should be considered as ‘complex interventions’.Main textWe present a research project involving the implementation of CECs in community care in four Norwegian municipalities. We show that when both the CEC and its implementation are considered as complex interventions, important consequences follow – both for implementation and the study thereof. Emphasizing four such sets of (...)
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  • Field-Testing the Euro-MCD Instrument: Important Outcomes According to Participants Before and After Moral Case Deliberation.J. C. de Snoo-Trimp, A. C. Molewijk, M. Svantesson, G. A. M. Widdershoven & H. C. W. de Vet - 2020 - HEC Forum 34 (1):1-24.
    Ethics support services like Moral Case Deliberation intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. Swedish, (...)
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  • Moral competence, moral teamwork and moral action - the European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process. [REVIEW]J. C. de Snoo-Trimp, H. C. W. de Vet, G. A. M. Widdershoven, A. C. Molewijk & M. Svantesson - 2020 - BMC Medical Ethics 21 (1):1-18.
    BackgroundClinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies (...)
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  • Evaluating assessment tools of the quality of clinical ethics consultations: a systematic scoping review from 1992 to 2019.Nicholas Yue Shuen Yoon, Yun Ting Ong, Hong Wei Yap, Kuang Teck Tay, Elijah Gin Lim, Clarissa Wei Shuen Cheong, Wei Qiang Lim, Annelissa Mien Chew Chin, Ying Pin Toh, Min Chiam, Stephen Mason & Lalit Kumar Radha Krishna - 2020 - BMC Medical Ethics 21 (1):1-11.
    BackgroundAmidst expanding roles in education and policy making, questions have been raised about the ability of Clinical Ethics Committees (CEC) s to carry out effective ethics consultations (CECons). However recent reviews of CECs suggest that there is no uniformity to CECons and no effective means of assessing the quality of CECons. To address this gap a systematic scoping review of prevailing tools used to assess CECons was performed to foreground and guide the design of a tool to evaluate the quality (...)
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