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  1. Ethics rounds.Marit Silén, Mia Ramklint, Mats G. Hansson & Kristina Haglund - 2016 - Nursing Ethics 23 (2):203-213.
    Background: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection. Aim: The aim of this study was to gain a deeper understanding of how (...)
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  • Ethical challenges in everyday work with adults with learning disabilities.Betty-Ann Solvoll, Elisabeth O. C. Hall & Berit Støre Brinchmann - 2015 - Nursing Ethics 22 (4):417-427.
    Background: Healthcare providers caring for learning-disabled individuals in institutions face challenges of what is right or wrong in their daily work. Serving this group, it is of utmost importance for the healthcare staff to raise awareness and to understand how ethical values are at stake. Research question: What ethical challenges are discussed among healthcare providers working with adults with learning disabilities? Research design: The study had a qualitative and investigative design. Participants and research context: The study was conducted in a (...)
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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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  • 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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  • Hospital ethics reflection groups: a learning and development resource for clinical practice.H. Bruun, L. Huniche, E. Stenager, C. B. Mogensen & R. Pedersen - 2019 - BMC Medical Ethics 20 (1):1-16.
    BackgroundAn ethics reflection group is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark.MethodsThis is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis (...)
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  • How to succeed with ethics reflection groups in community healthcare? Professionals’ perceptions.Heidi Karlsen, Lillian Lillemoen, Morten Magelssen, Reidun Førde, Reidar Pedersen & Elisabeth Gjerberg - 2019 - Nursing Ethics 26 (4):1243-1255.
    Background: Healthcare personnel in the municipal healthcare systems experience many ethical challenges in their everyday work. In Norway, 243 municipalities participated in a national ethics project, aimed to increase ethical competence in municipal healthcare services. In this study, we wanted to map out what participants in ethics reflection groups experienced as promoters or as barriers to successful reflection. Objectives: To examine what the staff experience as promoters or as barriers to successful ethics reflection. Research design: The study has a qualitative (...)
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  • Ethics case reflection sessions: Enablers and barriers.Cecilia Bartholdson, Bert Molewijk, Kim Lützén, Klas Blomgren & Pernilla Pergert - 2018 - Nursing Ethics 25 (2):199-211.
    Background: In previous research on ethics case reflection (ECR) sessions about specific cases, healthcare professionals in childhood cancer care were clarifying their perspectives on the ethical issue to resolve their main concern of consolidating care. When perspectives were clarified, consequences in the team included ‘increased understanding’, ‘group strengthening’ and ‘decision grounding’. Additional analysis of the data was needed on conditions that could contribute to the quality of ECR sessions. Objective: The aim of this study was to explore conditions for clarifying (...)
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  • Tragedy in moral case deliberation.Benita Spronk, Margreet Stolper & Guy Widdershoven - 2017 - Medicine, Health Care and Philosophy 20 (3):321-333.
    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 (...)
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  • Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation.Margreet Stolper, Bert Molewijk & Guy Widdershoven - 2016 - BMC Medical Ethics 17 (1):45.
    BackgroundMoral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice.MethodsIn this paper we present a case-study of a Moral Case Deliberation with (...)
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  • Ethical concerns and dilemmas of Finnish and Dutch health professionals.Hanna Hopia, Ilsa Lottes & Mariël Kanne - 2016 - Nursing Ethics 23 (6):659-673.
    Background: Healthcare professionals encounter ethical dilemmas and concerns in their practice. More research is needed to understand these ethical problems and to know how to educate professionals to respond to them. Research objective: To describe ethical dilemmas and concerns at work from the perspectives of Finnish and Dutch healthcare professionals studying at the master’s level. Research design: Exploratory, qualitative study that used the text of student online discussions of ethical dilemmas at work as data. Method: Participants’ online discussions were analyzed (...)
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  • Beyond Recommendation and Mediation: Moral Case Deliberation as Moral Learning in Dialogue.Suzanne Metselaar, Bert Molewijk & Guy Widdershoven - 2015 - American Journal of Bioethics 15 (1):50-51.
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  • Can moral case deliberation in research groups help to navigate research integrity dilemmas? A pilot study.Tamarinde L. Haven, Bert Molewijk, Lex Bouter, Guy Widdershoven, Fenneke Blom & Joeri Tijdink - 2024 - Research Ethics 20 (2):219-238.
    There is an increased focus on fostering integrity in research by through creating an open culture where research integrity dilemmas can be discussed. We describe a pilot intervention study that used Moral Case Deliberation (MCD), a method that originated in clinical ethics support, to discuss research integrity dilemmas with researchers. Our research question was: can moral case deliberation in research groups help to navigate research integrity dilemmas? We performed 10 MCDs with 19 researchers who worked in three different research groups (...)
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  • Bulgaria at the onset of clinical ethics consultation.Silviya Aleksandrova-Yankulovska - 2022 - Monash Bioethics Review 40 (Suppl 1):6-27.
    BackgroundOver the years, Bulgarian bioethics has been mainly an academic enterprise and fallen short of providing health professionals with skills for ethical decision-making. Clinical ethics support (CES) was piloted by the author through two bottom-up models – METAP (Modular, Ethical, Treatment, Allocation of resources, Process) and MCD (Moral Case Deliberation).AimsThis paper aims to present and analyse developments in the area of clinical ethics and the first experiences in CES in Bulgaria.MethodologyThe project reported here included a review of relevant literature on (...)
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  • Nurses’, nursing students’, and nursing instructors’ perceptions of professional values: A comparative study.Mostafa Bijani, Banafsheh Tehranineshat & Camellia Torabizadeh - 2019 - Nursing Ethics 26 (3):870-883.
    Background: In order to prove their commitment to the nursing profession, nurses need to base their professional activities on certain acknowledged values. Although a large number of studies have addressed professional values in nursing, only a few studies are available on the identification and comparison of nurses’, nursing students’, and nursing instructors’ understanding of such values. Objective: The study aims to compare nurses’, nursing students’, and nursing instructors’ perception of nursing professional values. Research design: In this descriptive-comparative study, data were (...)
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  • Descriptions of long-term impact from inter-professional ethics communication in groups.Britt-Marie Wälivaara, Karin Zingmark & Catarina Fischer-Grönlund - 2023 - Nursing Ethics 30 (4):614-625.
    Background On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature. Research aim The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas’ theory of (...)
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  • The Ethical Impact of a Training Programme on Ethical Agency for Social Professionals.Ed de Jonge, Sabrina Keinemans & Mariël Kanne - 2020 - Ethics and Social Welfare 14 (3):282-297.
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  • A pragmatist approach to clinical ethics support: overcoming the perils of ethical pluralism.Giulia Inguaggiato, Suzanne Metselaar, Rouven Porz & Guy Widdershoven - 2019 - Medicine, Health Care and Philosophy 22 (3):427-438.
    In today’s pluralistic society, clinical ethics consultation cannot count on a pre-given set of rules and principles to be applied to a specific situation, because such an approach would deny the existence of different and divergent backgrounds by imposing a dogmatic and transcultural morality. Clinical ethics support (CES) needs to overcome this lack of foundations and conjugate the respect for the difference at stake with the necessity to find shared and workable solutions for ethical issues encountered in clinical practice. We (...)
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  • Dealing with ethical challenges: a focus group study with professionals in mental health care.Bert Molewijk, Marit Helene Hem & Reidar Pedersen - 2015 - BMC Medical Ethics 16 (1):4.
    Little is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.
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  • Addressing harm in moral case deliberation: the views and experiences of facilitators.Benita Spronk, Guy Widdershoven & Hans Alma - 2020 - BMC Medical Ethics 21 (1):1-11.
    In healthcare practice, care providers are confronted with decisions they have to make, directly affecting patients and inevitably harmful. These decisions are tragic by nature. This study investigates the role of Moral Case Deliberation in dealing with tragic situations. In MCD, caregivers reflect on real-life dilemmas, involving a choice between two ethical claims, both resulting in moral damage and harm. One element of the reflection process is making explicit the harm involved in the choice. How harmful are our decisions? We (...)
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  • Implementing ethics reflection groups in hospitals: an action research study evaluating barriers and promotors.Henriette Bruun, Reidar Pedersen, Elsebeth Stenager, Christian Backer Mogensen & Lotte Huniche - 2019 - BMC Medical Ethics 20 (1):49.
    An ethics reflection group is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of (...)
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  • Relational autonomy in the care of the vulnerable: health care professionals’ reasoning in Moral Case Deliberation.Kaja Heidenreich, Anders Bremer, Lars Johan Materstvedt, Ulf Tidefelt & Mia Svantesson - 2018 - Medicine, Health Care and Philosophy 21 (4):467-477.
    In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...)
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  • (1 other version)Staff’s normative attitudes towards coercion: the role of moral doubt and professional context—a cross-sectional survey study.Bert Molewijk, Almar Kok, Tonje Husum, Reidar Pedersen & Olaf Aasland - 2017 - BMC Medical Ethics 18 (1):37.
    The use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified is related to professionals’ normative attitudes regarding the use of coercion. This paper describes an explorative statistical analysis based on a cross-sectional survey across seven wards in three Norwegian mental health care institutions. Descriptive analyses showed that in general the 379 respondents a) were not so sure whether coercion should be seen as (...)
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  • The Contribution of Moral Case Deliberation to Teaching RCR to PhD Students.Giulia Inguaggiato, Krishma Labib, Natalie Evans, Fenneke Blom, Lex Bouter & Guy Widdershoven - 2023 - Science and Engineering Ethics 29 (2):1-18.
    Teaching responsible conduct of research (RCR) to PhD students is crucial for fostering responsible research practice. In this paper, we show how the use of Moral Case Deliberation—a case reflection method used in the Amsterdam UMC RCR PhD course—is particularity valuable to address three goals of RCR education: (1) making students aware of, and internalize, RCR principles and values, (2) supporting reflection on good conduct in personal daily practice, and (3) developing students’ dialogical attitude and skills so that they can (...)
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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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  • What outcomes of moral case deliberations are perceived important for healthcare professionals to handle moral challenges? A national cross-sectional study in paediatric oncology.Pernilla Pergert, Bert Molewijk, Isabelle Billstein & Cecilia Bartholdson - 2022 - BMC Medical Ethics 23 (1):1-11.
    BackgroundIn paediatric oncology, healthcare professionals face moral challenges. Clinical ethics support services, such as moral case deliberation, aim to assist them in dealing with these challenges. Yet, healthcare professionals can have different expectations and goals related to clinical ethics support services.MethodsIn this study, the perceptions held by healthcare professionals regarding the importance of possible outcomes of MCDs, prior to implementation of MCDs, were investigated. A multisite, cross-sectional, quantitative study was performed at all six Paediatric Oncology Centres in Sweden. Healthcare professionals (...)
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  • Defining and categorizing outcomes of Moral Case Deliberation (MCD): concept mapping with experienced MCD participants.Janine C. de Snoo-Trimp, Bert Molewijk & Henrica C. W. de Vet - 2018 - BMC Medical Ethics 19 (1):1-14.
    To support healthcare professionals in dealing with ethically difficult situations, Clinical Ethics Support (CES) services like Moral Case Deliberation (MCD) are increasingly implemented. To assess the impact of CES, it is important to evaluate outcomes. Despite general claims about outcomes from MCD experts and some qualitative research, there exists no conceptual analysis of outcomes yet. Therefore, the aim of this study was to systematically define and categorize MCD outcomes. An additional aim was to compare these outcomes with the outcomes in (...)
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  • Prevalence and characteristics of moral case deliberation in Dutch health care.Linda Dauwerse, Margreet Stolper, Guy Widdershoven & Bert Molewijk - 2014 - Medicine, Health Care and Philosophy 17 (3):365-375.
    The attention for Moral case deliberation has increased over the past years. Previous research on MCD is often written from the perspective of MCD experts or MCD participants and we lack a more distant view to the role of MCD in Dutch health care institutions in general. The purpose of this paper is to provide an overview of the state of the art concerning MCD in the Netherlands. As part of a larger national study on clinical ethics support in the (...)
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  • Moral Issues in Soldier Enhancement: Military Physicians’ Perspectives.Eva M. van Baarle, Carlijn Damsté, Sanne A. J. de Bruijn & Gwendolyn C. H. Bakx - 2022 - Journal of Military Ethics 21 (3):198-209.
    Dealing with soldier enhancement can be challenging for military physicians. As research on the ethics of soldier enhancement is mostly theoretical, this study aims to gain insights into the actual moral issues military physicians encounter, or expect to encounter. To that end, we carried out a qualitative study involving six focus groups of Dutch military physicians (n = 28) in operational roles. The participants voiced their concerns about moral issues concerning soldier enhancement. Based on the group discussions, and using inductive (...)
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  • Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions.Catarina Fischer Grönlund, Vera Dahlqvist, Karin Zingmark, Mikael Sandlund & Anna Söderberg - 2016 - HEC Forum 28 (4):321-338.
    Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support inspired by Habermas’ theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this (...)
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  • Implicit and Explicit Clinical Ethics Support in The Netherlands: A Mixed Methods Overview Study. [REVIEW]Linda Dauwerse, Froukje Weidema, Tineke Abma, Bert Molewijk & Guy Widdershoven - 2014 - HEC Forum 26 (2):95-109.
    Internationally, the prevalence of clinical ethics support (CES) in health care has increased over the years. Previous research on CES focused primarily on ethics committees and ethics consultation, mostly within the context of hospital care. The purpose of this article is to investigate the prevalence of different kinds of CES in various Dutch health care domains, including hospital care, mental health care, elderly care and care for people with an intellectual disability. A mixed methods design was used including two survey (...)
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  • Lessons learned from implementing a responsive quality assessment of clinical ethics support.Eva M. Van Baarle, Marieke C. Potma, Maria E. C. van Hoek, Laura A. Hartman, Bert A. C. Molewijk & Jelle L. P. van Gurp - 2019 - BMC Medical Ethics 20 (1):1-11.
    BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...)
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  • Organisational and individual support for nurses’ ethical competence: A cross-sectional survey.Tarja Poikkeus, Riitta Suhonen, Jouko Katajisto & Helena Leino-Kilpi - 2018 - Nursing Ethics 25 (3):376-392.
    Background: Nurses’ ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses’ ethical competence is needed. Research questions: This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses’ and nurse leaders’ ethical competence, perceptions of support for nurses’ ethical competence at the organisational and individual levels and background factors associated with this support. Research design: (...)
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  • (1 other version)A Qualitative Study on Experiences and Perspectives of Members of a Dutch Medical Research Ethics Committee.Rien M. J. P. A. Janssens, Wieke E. van der Borg, Maartje Ridder, Mariëlle Diepeveen, Benjamin Drukarch & Guy A. M. Widdershoven - 2020 - HEC Forum 32 (1):63-75.
    The aim of this research was to gain insight into the experiences and perspectives of individual members of a Medical Research Ethics Committee regarding their individual roles and possible tensions within and between these roles. We conducted a qualitative interview study among members of a large MREC, supplemented by a focus group meeting. Respondents distinguish five roles: protector, facilitator, educator, advisor and assessor. Central to the role of protector is securing valid informed consent and a proper risk-benefit analysis. The role (...)
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  • (1 other version)Evaluation of moral case deliberation at the Dutch Health Care Inspectorate: a pilot study.Wike Seekles, Guy Widdershoven, Paul Robben, Gonny van Dalfsen & Bert Molewijk - 2016 - BMC Medical Ethics 17 (1):31.
    BackgroundMoral case deliberation as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate.The objective of this pilot study is to investigate: 1) the current way of dealing with (...)
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  • Need for ethics support in healthcare institutions: views of Dutch board members and ethics support staff.L. Dauwerse, T. Abma, B. Molewijk & G. Widdershoven - 2011 - Journal of Medical Ethics 37 (8):456-460.
    Next SectionObjective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings Most respondents see a (...)
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  • Safe and competent nursing care: An argument for a minimum standard?Siri Tønnessen, Anne Scott & Per Nortvedt - 2020 - Nursing Ethics 27 (6):1396-1407.
    There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient’s actual situation is unclear. Thus, (...)
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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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  • Refleksjonsgrupper i etikk: «Pusterom» eller læringsarena?Siri Tønnessen, Lillian Lillemoen & Elisabeth Gjerberg - 2016 - Etikk I Praksis - Nordic Journal of Applied Ethics 1 (1):75-90.
    Siden 2007 har HOD og KS satset store ressurser på prosjektet «Samarbeid om etisk kompetanseheving» i kommunale helse- og omsorgstjenester. Hensikten med prosjektet har vært å heve de ansattes etiske kompetanse, og ett av de iverksatte tiltakene har vært å etablere refleksjonsgrupper i etikk. Denne artikkelen er basert på en evaluering av arbeidet i refleksjonsgruppene med fokus på hvordan etikkveilederen, også kalt fasilitator, beskriver arbeidet i gruppene. Hensikten med studien var å utvikle kunnskap om hvordan arbeidet med etikk-refleksjon foregår, samt (...)
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  • The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.Marit Helene Hem, Bert Molewijk, Elisabeth Gjerberg, Lillian Lillemoen & Reidar Pedersen - 2018 - BMC Medical Ethics 19 (1):54.
    Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...)
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  • Evaluation and perceived results of moral case deliberation.R. M. Janssens, E. van Zadelhoff, G. van Loo, G. A. Widdershoven & B. A. Molewijk - 2015 - Nursing Ethics 22 (8):870-880.
    Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a (...)
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  • Evaluating clinical ethics support in mental healthcare.Marit Helene Hem, Reidar Pedersen, Reidun Norvoll & Bert Molewijk - 2015 - Nursing Ethics 22 (4):452-466.
    A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...)
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  • Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities.Mia Svantesson, Janine C. de Snoo-Trimp, Göril Ursin, Henrica C. W. de Vet, Berit S. Brinchmann & Bert Molewijk - 2019 - Journal of Medical Ethics 45 (9):608-616.
    BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European (...)
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  • Impact of moral case deliberation in healthcare settings: a literature review.Maaike M. Haan, Jelle L. P. van Gurp, Simone M. Naber & A. Stef Groenewoud - 2018 - BMC Medical Ethics 19 (1):85.
    An important and supposedly impactful form of clinical ethics support is moral case deliberation. Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings. A systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science. Both the data collection and the (...)
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  • What Sticks? The Evaluation of a Train-the-Trainer Course in Military Ethics and its Perceived Outcomes.Eva van Baarle, Laura Hartman, Desiree Verweij, Bert Molewijk & Guy Widdershoven - 2017 - Journal of Military Ethics 16 (1-2):56-77.
    Ethics training has become a common phenomenon in the training of military professionals at all levels. However, the perceived outcomes of this training remain open. In this article, we analyze the experiences of course participants who were interviewed 6–12 months after they had participated in a train-the-trainer course in military ethics developed by the Faculty of Military Sciences of the Netherlands Defence Academy. Through qualitative inductive analysis, it is shown how participants evaluate the training, how they perceive the development of (...)
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  • Working towards implementing moral case deliberation in mental healthcare: Ongoing dialogue and shared ownership as strategy.Froukje Weidema, Hans van Dartel & Bert Molewijk - 2016 - Clinical Ethics 11 (2-3):54-62.
    The design and implementation of clinical ethics support is attracting increasing attention. Often, the characteristics and aims of clinical ethics support are translated into practice in a top-down, programmatic manner. These characteristics and aims then remain a constant feature of the clinical ethics support functions within the organisation. We argue that the characteristics of clinical ethics support should be reflected in the implementation strategy. Inspired by dialogical, pragmatic and hermeneutic perspectives on clinical ethics support in general and moral case deliberation (...)
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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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  • Inspectors’ ethical challenges in health care regulation: a pilot study.W. Seekles, G. Widdershoven, P. Robben, G. van Dalfsen & B. Molewijk - 2017 - Medicine, Health Care and Philosophy 20 (3):311-320.
    There is an increasing body of research on what kind of ethical challenges health care professionals experience regarding the quality of care. In the Netherlands the Dutch Health Care Inspectorate is responsible for monitoring and regulating the quality of health care. No research exists on what kind of ethical challenges inspectors experience during the regulation process itself. In a pilot study we used moral case deliberation as method in order to reflect upon inspectors’ ethical challenges. The objective of this paper (...)
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  • Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care.Pernilla Pergert, Bert Molewijk & Cecilia Bartholdson - forthcoming - HEC Forum:1-12.
    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 (...)
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  • Development, validity and reliability testing the Swedish Ethical Climate Questionnaire.Catarina Fischer Grönlund, Anna Söderberg, Vera Dahlqvist, Lars Andersson & Ulf Isaksson - 2019 - Nursing Ethics 26 (7-8):2482-2493.
    Background: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas’ four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to (...)
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