Seit 2003 ist neben Medizingeschichte und -theorie Medizinethik Bestandteil des Pflichtstudiencurriculums (Querschnittsbereich GTE). Zuvor, seit Ende der 80er Jahre, hatte es an vielen medizinischen Fakultäten optionale Veranstaltungen zur Medizinethik gegeben. Die Analyse von Veröffentlichungen zur Didaktik der Medizinethik und von Unterrichtscurricula zeigt, dass einem relativ geringen Stundenkontingent anspruchsvolle kognitive, emotionale und handlungsorientierte Lehrziele gegenüberstehen. Offenbar wird von der Medizinethik praxisbezogene Problemlösungskompetenz erwartet. Zugleich zeigt sich, dass die Vorbereitung der Studierenden auf schwierige moralische Entscheidungen nach wie vor ein Desiderat darstellt. Angesichts (...) der unausweichlichen Kluft zwischen Lehrzielen und Vermittlungsergebnissen bedarf es einer erneuten Lehrziel- und Curriculumsdiskussion. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals (...) bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

Many models of (un)ethical decision making assume that people decide rationally and are in principle able to evaluate their decisions from a moral point of view. However, people might behave unethically without being aware of it. They are ethically blind. Adopting a sensemaking approach, we argue that ethical blindness results from a complex interplay between individual sensemaking activities and context factors.

The pluralism of methodologies and severe time constraints pose important challenges to pedagogy in clinical ethics. We designed a step-by-step student handbook to operate within such constraints and to respect the methodological pluralism of bioethics and clinical ethics. The handbook comprises six steps: Step 1: What are the facts of the case?; Step 2: What are your obligations to your patient?; Step 3: What are your obligations to third parties to your relationship with the patient?; Step 4: Do your obligations (...) converge or conflict?; Step 5: What is the strongest objection that could be made to the identification of convergence in step 4 or the arguments in step 4? How can this objection be effectively countered?; and Step 6: How could the ethical conflict, or perceived ethical conflict, have been prevented? (shrink)