TY - JOUR
T1 - Theory and practice of integrative clinical ethics support
T2 - A joint experience within gender affirmative care
AU - Hartman, Laura
AU - Inguaggiato, Giulia
AU - Widdershoven, Guy
AU - Wensing-Kruger, Annelijn
AU - Molewijk, Bert
PY - 2020/8/26
Y1 - 2020/8/26
N2 - 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.
AB - 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.
KW - Clinical ethics support
KW - Gender affirmative care
KW - Hermeneutics
KW - Integrative
KW - Pragmatism
KW - Responsive evaluation
KW - Theory
UR - http://www.scopus.com/inward/record.url?scp=85089971541&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12910-020-00520-3
DO - https://doi.org/10.1186/s12910-020-00520-3
M3 - Article
C2 - 32847572
SN - 1472-6939
VL - 21
JO - BMC medical ethics
JF - BMC medical ethics
IS - 1
M1 - 79
ER -