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  1. Need for Ethics Support in Healthcare Institutions: Views of Dutch Board Members and Ethics Support Staff.L. Dauwerse, T. Abma, B. Molewijk & G. Widdershoven - 2011 - Journal of Medical Ethics 37 (8):456-460.
    Next SectionObjective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings Most respondents see a (...)
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  • Important Outcomes of Moral Case Deliberation: A Euro-MCD Field Survey of Healthcare Professionals’ Priorities.Mia Svantesson, Janine C. De Snoo-Trimp, Göril Ursin, Henrica C. W. de Vet, Berit S. Brinchmann & Bert Molewijk - 2019 - Journal of Medical Ethics 45 (9):608-616.
    BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation. Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European field survey (...)
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  • A Pragmatist Approach to Clinical Ethics Support: Overcoming the Perils of Ethical Pluralism.Giulia Inguaggiato, Suzanne Metselaar, Rouven Porz & Guy Widdershoven - 2019 - Medicine, Health Care and Philosophy 22 (3):427-438.
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  • Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned.Laura Hartman, Guy Widdershoven, Annelou de Vries, Annelijn Wensing-Kruger, Martin den Heijer, Thomas Steensma & Bert Molewijk - 2019 - HEC Forum 31 (3):241-260.
    Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...)
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  • Evaluation of Clinical Ethics Support Services and its Normativity.Jan Schildmann, Bert Molewijk, Lazare Benaroyo, Reidun Forde & Gerald Neitzke - 2013 - Journal of Medical Ethics 39 (11):681-685.
    Evaluation of clinical ethics support services (CESS) has attracted considerable interest in recent decades. However, few evaluation studies are explicit about normative presuppositions which underlie the goals and the research design of CESS evaluation. In this paper, we provide an account of normative premises of different approaches to CESS evaluation and argue that normativity should be a focus of considerations when designing and conducting evaluation research of CESS. In a first step, we present three different approaches to CESS evaluation from (...)
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  • Moral Distress Related to Ethical Dilemmas Among Spanish Podiatrists.M. E. Losa Iglesias, R. Becerro De Bengoa Vallejo & P. Salvadores Fuentes - 2010 - Journal of Medical Ethics 36 (5):310-314.
    Objectives To describe the distress experienced by Spanish podiatrists related to ethical dilemmas, organisational matters, and lack of resources. Design A 2008 email survey of a representative sample of 485 Spanish podiatrists presenting statements about different ethical dilemmas, values and goals at the workplace. Results The response rate was 44.8%. Of all the respondents, 57% described sometimes having to act against their own conscience as distressing. Time constraints is the main cause of moral distress (67%) and 58% of respondents said (...)
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  • “Here's My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care.S. Dam, T. A. Abma, M. J. M. Kardol & G. A. M. Widdershoven - 2012 - Health Care Analysis 20 (3):250-267.
    Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...)
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  • Balancing Risk Prevention and Health Promotion: Towards a Harmonizing Approach in Care for Older People in the Community.Bienke M. Janssen, Tine Van Regenmortel & Tineke A. Abma - 2014 - Health Care Analysis 22 (1):1-21.
    Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways that (...)
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  • Inspectors’ Ethical Challenges in Health Care Regulation: A Pilot Study.W. Seekles, G. Widdershoven, P. Robben, G. van Dalfsen & B. Molewijk - 2017 - Medicine, Health Care and Philosophy 20 (3):311-320.
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  • “Here’s My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care.S. van der Dam, T. A. Abma, M. J. M. Kardol & G. A. M. Widdershoven - 2012 - Health Care Analysis 20 (3):250-267.
    Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...)
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  • Moral Distress Related to Ethical Dilemmas Among Spanish Podiatrists.Marta Elena Losa Iglesias, Ricardo Becerro de Bengoa Vallejo & Paloma Salvadores Fuentes - 2010 - Journal of Medical Ethics 36 (5):310-314.
  • Moral Dilemmas in a Military Context. A Case Study of a Train the Trainer Course on Military Ethics.Eva van Baarle, Jolanda Bosch, Guy Widdershoven, Desiree Verweij & Bert Molewijk - 2015 - Journal of Moral Education 44 (4):457-478.
    Moral competence is important for soldiers who have to deal with complex moral dilemmas in practice. However, openly dealing with moral dilemmas and showing moral competence is not always easy within the culture of a military organization. In this article, based on analysis of experiences during a train the trainer course on military ethics, we will describe the tensions between military and personal values on the one hand and the challenges related to showing moral competence on the other hand. We (...)
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  • Emotions and Clinical Ethics Support. A Moral Inquiry Into Emotions in Moral Case Deliberation.Bert Molewijk, Dick Kleinlugtenbelt, Scott M. Pugh & Guy Widdershoven - 2011 - HEC Forum 23 (4):257-268.
    Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In (...)
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  • Improving Care and Ethics: A Plea for Interactive Empirical Ethics.Guy Widdershoven, Bert Molewijk & Tineke Abma - 2009 - American Journal of Bioethics 9 (6-7):99-101.
  • Don’T Solve the Issues!Bert Molewijk & Guy A. M. Widdershoven - 2012 - Cambridge Quarterly of Healthcare Ethics 21 (4):448-456.
  • Evaluation of Moral Case Deliberation at the Dutch Health Care Inspectorate: A Pilot Study.Wike Seekles, Guy Widdershoven, Paul Robben, Gonny van Dalfsen & Bert Molewijk - 2016 - BMC Medical Ethics 17 (1):31.
    BackgroundMoral case deliberation as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate.The objective of this pilot study is to investigate: 1) the current way of dealing with (...)
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  • Bioethics Education in Clinical Settings: Theory and Practice of the Dilemma Method of Moral Case Deliberation.Margreet Stolper, Bert Molewijk & Guy Widdershoven - 2016 - BMC Medical Ethics 17 (1):45.
    BackgroundMoral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice.MethodsIn this paper we present a case-study of a Moral Case Deliberation with (...)
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  • Training Healthcare Professionals as Moral Case Deliberation Facilitators: Evaluation of a Dutch Training Programme.M. Plantinga, B. Molewijk, M. de Bree, M. Moraal, M. Verkerk & G. A. M. Widdershoven - 2012 - Journal of Medical Ethics 38 (10):630-635.
    Until recently, moral case deliberation (MCD) sessions have mostly been facilitated by external experts, mainly professional ethicists. We have developed a train the facilitator programme for healthcare professionals aimed at providing them with the competences needed for being an MCD facilitator. In this paper, we present the first results of a study in which we evaluated the programme. We used a mixed methods design. One hundred and twenty trained healthcare professionals and five trainers from 16 training groups working in different (...)
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  • Enacting Ethics: Bottom-Up Involvement in Implementing Moral Case Deliberation. [REVIEW]F. C. Weidema, A. C. Molewijk, G. A. M. Widdershoven & T. A. Abma - 2012 - Health Care Analysis 20 (1):1-19.
    In moral case deliberation (MCD), healthcare professionals meet to reflect upon their moral questions supported by a structured conversation method and non-directive conversation facilitator. An increasing number of Dutch healthcare institutions work with MCD to (1) deal with moral questions, (2) improve reflection skills, interdisciplinary cooperation and decision-making, and (3) develop policy. Despite positive evaluations of MCD, organization and implementation of MCD appears difficult, depending on individuals or external experts. Studies on MCD implementation processes have not yet been published. The (...)
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  • The Safety Paradox in Ethics Training: A Case Study on Safety Dynamics Within a Military Ethics Train-the-Trainer Course.Eva van Baarle, Ineke van de Braak, Desiree Verweij, Guy Widdershoven & Bert Molewijk - 2019 - Medicine, Health Care and Philosophy 22 (1):107-117.
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  • Paradoxes in the Care of Older People in the Community: Walking a Tightrope.Bienke Janssen, Tineke A. Abma & Tine Van Regenmortel - 2014 - Ethics and Social Welfare 8 (1):39-56.
    The expansion of the older population suggests that there will be significant numbers in need of care and support in their own home environment. Yet, little is known about the kind of situations professionals are faced with and how they intervene in the living environment of older people. Qualitative data were collected over a period of 1.5 years from a multi-disciplinary community-based geriatric team in the Netherlands, and participant observations carried out. Forty-two cases discussed within the team meetings were analysed. (...)
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  • It’s Not All About Moral Reasoning: Understanding the Content of Moral Case Deliberation.Mia Svantesson, Marit Silén & Inger James - 2018 - Nursing Ethics 25 (2):212-229.
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  • Prevalence and Characteristics of Moral Case Deliberation in Dutch Health Care.Linda Dauwerse, Margreet Stolper, Guy Widdershoven & Bert Molewijk - 2014 - Medicine, Health Care and Philosophy 17 (3):365-375.
  • Working Towards Implementing Moral Case Deliberation in Mental Healthcare: Ongoing Dialogue and Shared Ownership as Strategy.Froukje Weidema, Hans van Dartel & Bert Molewijk - 2016 - Clinical Ethics 11 (2-3):54-62.
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  • Deliberative Engagement: An Inclusive Methodology for Exploring Professionalization. [REVIEW]Jeffrey Kirby & Christy Simpson - 2012 - HEC Forum 24 (3):187-201.
    Early on in the development of Practicing Healthcare Ethicists Exploring Professionalization (PHEEP), the founding members recognized the need to address and meet two important goals: (1) the creation of a dynamic, rigorous process to support the exploratory work, and (2) the establishment of the means—deliberative engagement—to generate and justify the substantive content of professionalization-related products, such as practice standards and position statements. Drawing from social justice and deliberative democracy conceptions and insights (among others), the authors identify and describe the core (...)
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  • Evaluation and Perceived Results of Moral Case Deliberation.R. M. Janssens, E. van Zadelhoff, G. van Loo, G. A. Widdershoven & B. A. Molewijk - 2015 - Nursing Ethics 22 (8):870-880.
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  • Nurturing Cultural Change in Care for Older People: Seeing the Cherry Tree Blossom.Miranda M. W. C. Snoeren, Bienke M. Janssen, Theo J. H. Niessen & Tineke A. Abma - 2016 - Health Care Analysis 24 (4):349-373.
    There is a need for person-centred approaches and empowerment of staff within the residential care for older people; a movement called ‘culture change’. There is however no single path for achieving culture change. With the aim of increasing understandings about cultural change processes and the promotion of cultural values and norms associated with person-centred practices, this article presents an action research project set on a unit in the Netherlands providing care for older people with dementia. The project is presented as (...)
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  • The Sensible Health Care Professional: A Care Ethical Perspective on the Role of Caregivers in Emotionally Turbulent Practices.Vivianne Baur, Inge van Nistelrooij & Linus Vanlaere - 2017 - Medicine, Health Care and Philosophy 20 (4):483-493.
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  • Goals of Clinical Ethics Support: Perceptions of Dutch Healthcare Institutions. [REVIEW]L. Dauwerse, T. A. Abma, B. Molewijk & G. Widdershoven - 2013 - Health Care Analysis 21 (4):323-337.
    In previous literature, ethicists mention several goals of Clinical Ethics Support (CES). It is unknown what key persons in healthcare institutions see as main–—and sub-goals of CES. This article presents the goals of CES as perceived by board members and members of ethics support staff. This is part of a Dutch national research using a mixed methods design with questionnaires, focus groups and interviews. Quantitative and qualitative data were analyzed and combined in an iterative process. Four main clusters of goals (...)
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  • Aims and Harvest of Moral Case Deliberation.Froukje C. Weidema, Bert Ac Molewijk, Frans Kamsteeg & Guy Am Widdershoven - 2013 - Nursing Ethics 20 (6):617-631.
    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 (...)
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  • Moral Learning in an Integrated Social and Healthcare Service Network.Merel Visse, Guy A. M. Widdershoven & Tineke A. Abma - 2012 - Health Care Analysis 20 (3):281-296.
    The traditional organizational boundaries between healthcare, social work, police and other non-profit organizations are fading and being replaced by new relational patterns among a variety of disciplines. Professionals work from their own history, role, values and relationships. It is often unclear who is responsible for what because this new network structure requires rules and procedures to be re-interpreted and re-negotiated. A new moral climate needs to be developed, particularly in the early stages of integrated services. Who should do what, with (...)
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  • Learning by Doing. Training Health Care Professionals to Become Facilitator of Moral Case Deliberation.Margreet Stolper, Bert Molewijk & Guy Widdershoven - 2015 - HEC Forum 27 (1):47-59.
    Moral case deliberation is a dialogue among health care professionals about moral issues in practice. A trained facilitator moderates the dialogue, using a conversation method. Often, the facilitator is an ethicist. However, because of the growing interest in MCD and the need to connect MCD to practice, healthcare professionals should also become facilitators themselves. In order to transfer the facilitating expertise to health care professionals, a training program has been developed. This program enables professionals in health care institutions to acquire (...)
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  • Fostering the Ethics of Ethics Consultants in Health Care: An Ongoing Participatory Approach.Bert Molewijk, Laura Hartman, Froukje Weidema, Yolande Voskes & Guy Widdershoven - 2015 - American Journal of Bioethics 15 (5):60-62.
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  • Clinical Ethics in Forensic Psychiatry: Fostering Reflection and Dialog on the Ward Through Moral Case Deliberation.Yolande Voskes, Frouk Weidema & Guy Widdershoven - 2016 - Clinical Ethics 11 (2-3):63-69.
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  • Client Participation in Moral Case Deliberation: A Precarious Relational Balance. [REVIEW]F. C. Weidema, T. A. Abma, G. A. M. Widdershoven & A. C. Molewijk - 2011 - HEC Forum 23 (3):207-224.
    Moral case deliberation (MCD) is a form of clinical ethics support in which the ethicist as facilitator aims at supporting professionals with a structured moral inquiry into their moral issues from practice. Cases often affect clients, however, their inclusion in MCD is not common. Client participation often raises questions concerning conditions for equal collaboration and good dialogue. Despite these questions, there is little empirical research regarding client participation in clinical ethics support in general and in MCD in particular. This article (...)
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  • Balancing Risk Prevention and Health Promotion: Towards a Harmonizing Approach in Care for Older People in the Community. [REVIEW]Bienke M. Janssen, Tine Regenmortel & Tineke A. Abma - 2012 - Health Care Analysis (1):1-21.
    Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways that (...)
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