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 (...) questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. (shrink)

The paper examines the contribution of the French philosopher Michel Foucault to the subject of ethics in organizations. The paper combines an analysis of Foucault’s work on discipline and control, with an examination of his later work on the ethical subject and technologies of the self. Our paper argues that the work of the later Foucault provides an important contribution to business ethics theory, practice and pedagogy. We discuss how it offers an alternative avenue to traditional normative ethical theory that (...) both converges and diverges with other extant alternatives. By situating ethics as practices of the self, and by demonstrating the conditions under which freedom in organizations can be exercised, Foucault’s ethics attempt to connect an understanding and critique of power with a personal project of self. He therefore provides a theory of subjectivity that potentially informs a reshaping of contemporary virtue ethics theory, value-based management, and business ethics teaching. (shrink)

Increasingly the business environment is tending toward a global economy. The current study compares the results of the Attitudes Towards Business Ethics Questionnaire (ATBEQ) reported in the literature for samples from the United States of America, Israel, Western Australia, and South Africa to a new sample (n = 125) from Turkey. The results indicate that while there are some shared views towards business ethics across countries, significant differences do exist between Turkey and each of the other countries in the study. (...) Similarities and differences are discussed in terms of the countries' ratings on the Corruption Perceptions Index (as reported by the Internet Center for Corruption Research) and Hofstede's Theory of International Cultures. Recommendations for managers interacting with employees from differing countries are provided. (shrink)

If one of the most important aims of education on military ethics is to strengthen moral competence, we argue that it is important to base ethics education on virtue ethics, the Socratic attitude and the process of ?living learning?. This article illustrates this position by means of the example of a ?train the trainer? course on military ethics for Non-Commissioned Officers (NCOs), which is developed at the Netherlands Defence Academy, and uses a number of examples both from its structure and (...) from experiences from its actual use. (shrink)

Although education in the responsible conduct of research is considered necessary, evidence bearing on the effectiveness of these programs in improving research ethics has indicated that, although some programs are successful, many fail. Accordingly, there is a need for systematic evaluation of ethics education programs. In the present effort, we examine procedures for evaluation of ethics education programs from a multilevel perspective: examining both within-program evaluation and cross-program evaluation. With regard to within-program evaluation, we note requisite designs and measures for (...) conducting systematic program evaluation have been developed and multiple measures should be applied in program evaluation. With regard to cross-program evaluation, we argue that a meta-analytic framework should be employed where analyses are used to identify best practices in ethics education. The implications of this multilevel approach for improving responsible conduct of research educational programs are discussed. (shrink)

In this essay I will discuss the therapeutic application of philosophy in treating what I term “the moral casualties of war.” In doing so, I will develop an etiology of moral injury and focus upon the philosophical reasoning and insights that may be applied in an individual or group setting to foster an understanding of the warexperience as the first treatment step in a long and complex journey to healing.

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 (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

Background Clinical moral case deliberation consists of the systematic reflection on a concrete moral case␣by health care professionals. This paper presents the study of a 4-year moral deliberation project.Objectives The objectives of this paper are to: (a) describe the practice and the theoretical background of moral deliberation, (b) describe the moral deliberation project, (c) present the outcomes of␣the evaluation of the moral case deliberation sessions, and (d) present the implementation process.Methods The implementation process is both monitored and supported by an (...) interactive responsive evaluation design with: (a) in-depth interviews, (b) Maastricht evaluation questionnaires, (c) evaluation survey, and (d) ethnographic participant observation. In accordance with the theory of responsive evaluation, researchers acted both as evaluators and moderators (i.e. ethicists).Results Both qualitative and quantitative results showed that the moral case deliberations, the role of the ethics facilitator, and the train-the-facilitator program were regarded as useful and were evaluated as (very) positive. Health care professionals reported that they improved their moral competencies (i.e. knowledge, attitude and skills). However, the new trained facilitators lacked a clear organisational structure and felt overburdened with the implementation process. The paper ends with both practical and research suggestions for future moral deliberation projects. (shrink)

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...) whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity. (shrink)

The paper begins by exploring whether a “tendency to avarice” exists in most capitalist business organisations. It concludes that it does and that this is problematic. The problem centres on the potential threat to the integrity of human character and the disablement of community.What, then, can be done about it? Building on previous work (Moore, 2002) in which MacIntyre’s notions of practice and institution were explored (MacIntyre, 1985), the paper offers a philosophically based argument in favour of the rediscovery of (...) craftsmanship by those who work in business organisations, and the exercise of craftsmanship in community.The practical implications for individuals of this way of conceptualising business, and the virtues which must then come to the fore, are discussed. (shrink)

Residency training in the Netherlands is to be restructured over the coming years. To this end a general competence profile for medical specialists has been introduced. This profile is nearly the same as the Canadian CanMEDS 2000 model, which describes seven general areas of medical specialist competence, one of which is professionalism. In order to establish a training programme for residents and their instructors based on this competence, it is necessary to develop a vision that does justice to everyday medical (...) practice. The two most prevailing views of professionalism—as personal, or as a behavioural characteristic—fall short of this. Only when professionalism is understood as reflective professionalism does it encompass the fundamental contextuality of medical treatment. This means that the focus of training and assessment must be shifted to accountability for treatment. (shrink)

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 (...) offending, b) agreed with the viewpoint that coercion is needed for care and security, and c) slightly disagreed that coercion could be seen as treatment. Staff did not report high rates of moral doubt related to the use of coercion, although most of them agreed there will never be a single answer to the question ‘What is the right thing to do?’. Bivariate analyses showed that the more they experienced general moral doubt and relative doubt, the more one thought that coercion is offending. Especially psychologists were critical towards coercion. We found significant differences among ward types. Respondents with decisional responsibility for coercion and leadership responsibility saw coercion less as treatment. Frequent experience with coercion was related to seeing coercion more as care and security. This study showed that experiencing moral doubt is related to some one’s normative attitude towards coercion. Future research could investigate whether moral case deliberation increases professionals’ experience of moral doubt and whether this will evoke more critical thinking and increase staff’s curiosity for alternatives to coercion. (shrink)

Ethics training has undergone dramatic changes in the past decade. Global business growth and increased technological change have played a role in the increasing sophistication and development of ethics programs and communication devices. These training initiatives are based on organizational ethical decision making theories and empirical research indicating the benefits of training in developing an ethical organizational culture. In this article, we discuss the issues important in developing effective ethics training, examine the goals and methods currently used in training, introduce (...) an ethics training behavioral simulation, and discuss its implementation and evaluation. (shrink)

Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (...) (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses’ empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members. (shrink)