Theory and practice of integrative clinical ethics support: A joint experience within gender affirmative care

Laura Hartman, Giulia Inguaggiato, Guy Widdershoven, Annelijn Wensing-Kruger, Bert Molewijk

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)


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.

Original languageEnglish
Article number79
JournalBMC medical ethics
Issue number1
Publication statusPublished - 26 Aug 2020


  • Clinical ethics support
  • Gender affirmative care
  • Hermeneutics
  • Integrative
  • Pragmatism
  • Responsive evaluation
  • Theory

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