Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care
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RESEARCH ARTICLE
Open Access
Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care Laura Hartman1* , Giulia Inguaggiato1 , Guy Widdershoven1 , Annelijn Wensing-Kruger2,3 and Bert Molewijk1,4
Abstract Background: Clinical ethics support (CES) aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization. Methods: This integrative approach was developed in an iterative process, combining actual experiences in a case study in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences. Results: In this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design. Conclusions: In the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES. Keywords: Clinical ethics support, Theory, Pragmatism, Hermeneutics, Gender affirmative care, Integrative, Responsive evaluation
Background Clinical ethics support (CES) aims to support health care professionals in dealing with ethical issues in clinical practice. Since the seventies of the last century the prevalence of CES is gradually increasing in Europe, the US and Canada [11]. Regulatory agencies, who issue health care organizations their accreditation, also increasingly mention the importance of CES services for * Correspondence: [email protected] 1 Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universitieit Amsterda, Amsterdam, The Netherlands Full list of author information is available at the end of the article
both health care professionals and the quality of health care [23, 24]. CES is provided by different services (e.g. ethics committee, ethics consultation, moral case deliberation (MCD)) with varying aims, methods and procedures [11, 30]. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization [12, 39, 46]. Research shows, that CES providers encounter difficulties in setting up the collaboration with clinicians, in receiving cases, and in following the uptake of their advice [29, 31, 40]. Also, there is uncertainty about the role of the CES professional,
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