| 1. |
- Ahlin, Jesper
(author)
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What Justifies Judgments of Inauthenticity?
- 2018
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In: HEC Forum. - : Springer. - 0956-2737 .- 1572-8498.
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Journal article (peer-reviewed)abstract
- The notion of authenticity, i.e., being “genuine,” “real,” or “true to oneself,” is sometimes held as critical to a person’s autonomy, so that inauthenticity prevents the person from making autonomous decisions or leading an autonomous life. It has been pointed out that authenticity is difficult to observe in others. Therefore, judgments of inauthenticity have been found inadequate to underpin paternalistic interventions, among other things. This article delineates what justifies judgments of inauthenticity. It is argued that for persons who wish to live according to the prevailing social and moral standards and desires that are seriously undesirable according to those standards, it is justified to judge that a desire is inauthentic to the extent that it is due to causal factors that are alien to the person and to the extent that it deviates from the person’s practical identity. The article contributes to a tradition of thinking about authenticity which is known mainly from Frankfurt and Dworkin, and bridges the gap between theoretical ideals of authenticity and real authenticity-related problems in practical biomedical settings.
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| 2. |
- de Snoo-Trimp, J. C., et al.
(author)
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Field-Testing the Euro-MCD Instrument : Important Outcomes According to Participants Before and After Moral Case Deliberation
- 2022
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In: HEC Forum. - : Springer Netherlands. - 0956-2737 .- 1572-8498. ; 34:1, s. 1-24
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Journal article (peer-reviewed)abstract
- Ethics support services like Moral Case Deliberation (MCD) 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 (1) describe how participants' perceive the importance of MCD outcomes after MCD; (2) compare these perceptions with those before MCD participation; and (3) test the factor structure of these outcomes. Swedish, Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as 'quite' or 'very' important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections.
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| 3. |
- Fischer Grönlund, Catarina, et al.
(author)
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Managing Ethical Difficulties in Healthcare : Communicating in Inter-professional Clinical Ethics Support Sessions
- 2016
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In: HEC Forum. - : Springer Science and Business Media LLC. - 0956-2737 .- 1572-8498. ; 28:4, s. 321-338
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Journal article (peer-reviewed)abstract
- Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) 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 study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved.
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| 4. |
- Jakobsen, Lena M., et al.
(author)
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What is a High-Quality Moral Case Deliberation? Facilitators' Perspectives in the Euro-MCD Project
- 2024
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In: HEC Forum. - : Springer. - 0956-2737 .- 1572-8498.
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Journal article (peer-reviewed)abstract
- The evaluation of the European Moral Case Deliberation Outcomes project (Euro-MCD) has resulted in a revised evaluation instrument, knowledge about the content of MCD (moral case deliberation), and the perspectives of those involved. In this paper, we report on a perspective that has been overlooked, the facilitators'. We aim to describe facilitators' perceptions of high-quality moral case deliberation and their Euro-MCD sessions. The research took place in Norway, Sweden, and the Netherlands using a survey combined with interviews with 41 facilitators. Facilitators' perceived that attaining a high-quality MCD implies fostering a safe and respectful atmosphere, creating a wondering mode, being an attentive authority, developing moral reflective skills, reaching a common understanding, and ensuring organisational prerequisites for the MCD sessions. Our central conclusion is that efforts at three levels are required to attain a high-quality MCD: trained and virtuous facilitator; committed, respectful participants; and organizational space. Furthermore, managers have a responsibility to prepare MCD participants for what it means to take part in MCD.
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| 5. |
- Lützén, Kim, et al.
(author)
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Moral Distress : A Comparative Analysis of Theoretical Understandings and Inter-Related Concepts
- 2012
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In: HEC Forum. - : Springer Science+Business Media B.V.. - 0956-2737 .- 1572-8498. ; 24:1, s. 13-25
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Journal article (peer-reviewed)abstract
- Research on ethical dilemmas in health care has become increasingly salient during the last two decades resulting in confusion about the concept of moral distress. The aim of the present paper is to provide an overview and a comparative analysis of the theoretical understandings of moral distress and related concepts. The focus is on five concepts: moral distress, moral stress, stress of conscience, moral sensitivity and ethical climate. It is suggested that moral distress connects mainly to a psychological perspective; stress of conscience more to a theological–philosophical standpoint; and moral stress mostly to a physiological perspective. Further analysis indicates that these thoughts can be linked to the concepts of moral sensitivity and ethical climate through a relationship to moral agency. Moral agency comprises a moral awareness of moral problems and moral responsibility for others. It is suggested that moral distress may serve as a positive catalyst in exercising moral agency. An interdisciplinary approach in research and practice broadens our understanding of moral distress and its impact on health care personnel and patient care.
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| 6. |
- Rasoal, Dara, 1980-, et al.
(author)
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Clinical Ethics Support for Healthcare Personnel : An Integrative Literature Review
- 2017
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In: HEC Forum. - Dordrecht, Netherlands : Springer. - 0956-2737 .- 1572-8498. ; 29:4, s. 313-346
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Research review (peer-reviewed)abstract
- This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different coun-tries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a ‘‘bot-tom-up’’ perspective might give healthcare personnel opportunities to think and reflect more than a ‘‘top-down’’ perspective. A ‘‘bottom-up’’ approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a ‘‘top-down’’ approach risks removing such moral responsibility.
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