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  1. Evaluating the Effectiveness of Clinical Ethics Committees: A Systematic Review.Chiara Crico, Virginia Sanchini, Paolo Giovanni Casali & Gabriella Pravettoni - 2021 - Medicine, Health Care and Philosophy 24 (1):135-151.
    Clinical Ethics Committees, as distinct from Research Ethics Committees, were originally established with the aim of supporting healthcare professionals in managing controversial clinical ethical issues. However, it is still unclear whether they manage to accomplish this task and what is their impact on clinical practice. This systematic review aims to collect available assessments of CECs’ performance as reported in literature, in order to evaluate CECs’ effectiveness. We retrieved all literature published up to November 2019 in six databases, following PRISMA guidelines. (...)
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  • Relational Autonomy in the Care of the Vulnerable: Health Care Professionals’ Reasoning in Moral Case Deliberation.Kaja Heidenreich, Anders Bremer, Lars Johan Materstvedt, Ulf Tidefelt & Mia Svantesson - 2018 - Medicine, Health Care and Philosophy 21 (4):467-477.
    In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The (...)
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  • The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care.Reidun Norvoll, Marit Helene Hem & Reidar Pedersen - 2017 - HEC Forum 29 (1):59-74.
    Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with (...)
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  • Field-Testing the Euro-MCD Instrument: Important Outcomes According to Participants Before and After Moral Case Deliberation.J. C. De Snoo-Trimp, A. C. Molewijk, M. Svantesson, G. A. M. Widdershoven & H. C. W. De Vet - forthcoming - HEC Forum:1-24.
    Ethics support services like Moral Case Deliberation 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 describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. Swedish, (...)
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  • Managing Ethical Difficulties in Healthcare: Communicating in Inter-Professional Clinical Ethics Support Sessions.Catarina Fischer Grönlund, Vera Dahlqvist, Karin Zingmark, Mikael Sandlund & Anna Söderberg - 2016 - HEC Forum 28 (4):321-338.
    Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support 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 (...)
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  • Framework for Evaluation Research on Clinical Ethical Case Interventions: The Role of Ethics Consultants.Joschka Haltaufderheide, Stephan Nadolny, Jochen Vollmann & Jan Schildmann - forthcoming - Journal of Medical Ethics:medethics-2020-107129.
    Evaluation of clinical ethical case consultations has been discussed as an important research task in recent decades. A rigid framework of evaluation is essential to improve quality of consultations and, thus, quality of patient care. Different approaches to evaluate those services appropriately and to determine adequate empirical endpoints have been proposed. A key challenge is to provide an answer to the question as to which empirical endpoints—and for what reasons—should be considered when evaluating the quality of a service. In this (...)
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  • The Significance of Ethics Reflection Groups in Mental Health Care: A Focus Group Study Among Health Care Professionals.Marit Helene Hem, Bert Molewijk, Elisabeth Gjerberg, Lillian Lillemoen & Reidar Pedersen - 2018 - BMC Medical Ethics 19 (1):54.
    Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...)
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  • Two Years of Moral Case Deliberations on the Use of Coercion in Mental Health Care: Which Ethical Challenges Are Being Discussed by Health Care Professionals?Bert Molewijk, Ingvild Stokke Engerdahl & Reidar Pedersen - 2016 - Clinical Ethics 11 (2-3):87-96.
    Background Seven wards from three Norwegian mental health care institutions participated in a study in which regular ethics reflection groups focusing on coercion had been implemented and evaluated. This article presents a thematic overview of the ethical challenges identified based on a systematic qualitative analyses of 161 ethics reflection groups and some general observations on these ethical challenges. Results The ethical challenges are divided into four main thematic categories: formal coercion, informal coercion, uncertainty related to the Norwegian legislation on coercion (...)
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  • Hospital Ethics Reflection Groups: A Learning and Development Resource for Clinical Practice.Henriette Bruun, Reidar Pedersen, Elsebeth Stenager, Christian Backer Mogensen & Lotte Huniche - 2019 - BMC Medical Ethics 20 (1):1-16.
    Background An ethics reflection group is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also (...)
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  • Hospital Ethics Reflection Groups: A Learning and Development Resource for Clinical Practice.Henriette Bruun, Reidar Pedersen, Elsebeth Stenager, Christian Backer Mogensen & Lotte Huniche - 2019 - BMC Medical Ethics 20 (1):1-16.
    An ethics reflection group is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the (...)
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  • Lessons Learned From Implementing a Responsive Quality Assessment of Clinical Ethics Support.Eva M. Van Baarle, Marieke C. Potma, Maria E. C. van Hoek, Laura A. Hartman, Bert A. C. Molewijk & Jelle L. P. van Gurp - 2019 - BMC Medical Ethics 20 (1):1-11.
    Background Various forms of Clinical Ethics Support have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment project. Methods (...)
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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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  • 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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  • 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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  • The Norwegian National Project for Ethics Support in Community Health and Care Services.Morten Magelssen, Elisabeth Gjerberg, Reidar Pedersen, Reidun Førde & Lillian Lillemoen - 2016 - BMC Medical Ethics 17 (1):70.
    BackgroundInternationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project attempted to increase ethical competence in community services through facilitating the implementation of ethics support activities in 241 Norwegian municipalities. The article describes the ethics project and the ethics activities that ensued.MethodsThe article first gives an account of the Norwegian ethics project. Then the results of two online questionnaires are reported, characterizing the scope, activities and organization of the ethics activities (...)
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  • Staff’s Normative Attitudes Towards Coercion: The Role of Moral Doubt and Professional Context—a Cross-Sectional Survey Study.Bert Molewijk, Almar Kok, Tonje Husum, Reidar Pedersen & Olaf Aasland - 2017 - BMC Medical Ethics 18 (1):37.
    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 (...)
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  • “It Scares Me to Know That We Might Not Have Been There!”: A Qualitative Study Into the Experiences of Parents of Seriously Ill Children Participating in Ethical Case Discussions.Reidun Førde & Trude Linja - 2015 - BMC Medical Ethics 16 (1):1-8.
    BackgroundAll hospital trusts in Norway have clinical ethics committees. Some of them invite next of kin/patients to be present during the discussion of their case. This study looks closer at how parents of seriously ill children have experienced being involved in CEC discussions.MethodsTen next of kin of six seriously ill children were interviewed. Their cases were discussed in two CECs between April of 2011 and March of 2014. The main ethical dilemma was limitation of life-prolonging treatment. Health care personnel who (...)
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  • Dealing with Ethical Challenges: A Focus Group Study with Professionals in Mental Health Care.Bert Molewijk, Marit Helene Hem & Reidar Pedersen - 2015 - BMC Medical Ethics 16 (1):4.
    Little is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.
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  • Implementing Ethics Reflection Groups in Hospitals: An Action Research Study Evaluating Barriers and Promotors.Henriette Bruun, Reidar Pedersen, Elsebeth Stenager, Christian Backer Mogensen & Lotte Huniche - 2019 - BMC Medical Ethics 20 (1):49.
    An ethics reflection group is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of (...)
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  • What Sticks? The Evaluation of a Train-the-Trainer Course in Military Ethics and its Perceived Outcomes.Eva van Baarle, Laura Hartman, Desiree Verweij, Bert Molewijk & Guy Widdershoven - 2017 - Journal of Military Ethics 16 (1-2):56-77.
    Ethics training has become a common phenomenon in the training of military professionals at all levels. However, the perceived outcomes of this training remain open. In this article, we analyze the experiences of course participants who were interviewed 6–12 months after they had participated in a train-the-trainer course in military ethics developed by the Faculty of Military Sciences of the Netherlands Defence Academy. Through qualitative inductive analysis, it is shown how participants evaluate the training, how they perceive the development of (...)
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  • Field-Testing the Euro-MCD Instrument: Experienced Outcomes of Moral Case Deliberation.Janine C. de Snoo-Trimp, Bert Molewijk, Gøril Ursin, Berit Støre Brinchmann, Guy A. M. Widdershoven, Henrica C. W. de Vet & Mia Svantesson - forthcoming - Nursing Ethics:096973301984945.
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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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  • The Particular Relevance of Clinical Ethics Support in Psychiatry: Concepts, Research, and Experiences.Bert Molewijk & Stella Reiter-Theil - 2016 - Clinical Ethics 11 (2-3):43-44.
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  • Ethical Challenges When Using Coercion in Mental Healthcare: A Systematic Literature Review.Marit Helene Hem, Elisabeth Gjerberg, Tonje Lossius Husum & Reidar Pedersen - 2018 - Nursing Ethics 25 (1):92-110.
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  • Development, Validity and Reliability Testing the Swedish Ethical Climate Questionnaire.Catarina Fischer Grönlund, Anna Söderberg, Vera Dahlqvist, Lars Andersson & Ulf Isaksson - forthcoming - Nursing Ethics:096973301881912.
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