Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and methodologies have (...) emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)

A cross-sectional study explored the moral judgement competence and moral attitudes of 310 Czech and Slovak and 70 foreign national students at the Medical Faculty of Charles University in Hradec Králové, Czech Republic. Lind's Moral Judgement Test was used to evaluate moral judgement competence and moral attitudes depending on factors such as age, number of semesters of study, sex, nationality and religion. Moral judgement competence decreased significantly in the Czech and Slovak medical students as they grew older; in medical students (...) from other countries it did not significantly increase. The influence of other factors (sex, nationality and religion) on moral judgement competence was not proven in either the Czech and Slovak or the foreign national medical students. Moral attitudes do not change; the Czech and Slovak as well as the foreign students preferred the post-conventional levels of moral judgement (Kohlberg's 5th and 6th stages). The fact that the Czech and Slovak students' moral judgement competence decreased with age and number of semesters of study completed is not an optimistic sign: medical students who had undergone a lower number of semesters of study were morally more competent. (shrink)

There is evidence that medical students do not develop their moral competence as expected for university students and that medical training, via formal and hidden curricula, somehow contributes to the scenario known as dehumanization of medicine. Education in Bioethics may be an interesting strategy to change this scenario. We investigated the impact of a course in Bioethics and a method of dilemma discussion on medical students’ moral competence. We conducted an observational controlled study at a public Brazilian medical school. The (...) extended version of the Moral Competence Test was applied at first and last days of a course on Bioethics in two consecutive years. These two courses were perfectly similar, except that with the second group two discussions according to the KMDD complemented the course. 165 undergraduate students participated in this research. Competence score slightly decreased in the group who took the traditional course while it slightly increased in the group who had the course complemented by KMDD’s discussions. Though these differences were not statiscally significant, absolute effect size measurement suggests that KMDD’ s discussions had a small but positive effect on students’ moral competence. If, as suggested by empirical evidence, medical education stagnates students’ moral competence, then medicine is severely ill. Treatment may be found in a set of bioethical educative interventions, aimed at cognitive and affective aspects of moral competence. (shrink)

-/- Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. -/- Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to capture (...) how competencies may reflect an adaptation to a less than ideal work environment. -/- Research design: A critical qualitative approach was used. -/- Participants: Fifteen graduate nursing students from various practice areas participated. -/- Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. -/- Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. -/- Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. -/- Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings. (shrink)

This longitudinal study examined the development of moral judgement in 37 nursing students attending a university in Suwon, Korea. The participants completed the Korean version of the Defining Issues Test to allow analysis of their level of moral judgement. The development of moral judgement was quantified using ‘the moral development score’ at each stage (i.e. the six stages detailed by Kohlberg) and the ‘P(%) score’ (a measure of the overall moral judgement level). The results were as follows: (1) the moral (...) development score for stage 5A was consistently the highest across the four years of the students’ course, showing significant differences in some sociodemographic factors including home, birth order and monthly income; and (2) the P(%) score was higher in fourth-year (47.47 ± 11.21) than in first-year (46.13±9.73) students. There was no significant difference in the P(%) score according to sociodemographic factors. Further studies will examine in detail the correlation between curriculum and moral judgement development. We suggest that courses in ethics education should be made more relevant. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.