Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care.
Clinical ethics support
Gender affirmative care
Hermeneutics
Integrative
Pragmatism
Responsive evaluation
Theory
Journal
BMC medical ethics
ISSN: 1472-6939
Titre abrégé: BMC Med Ethics
Pays: England
ID NLM: 101088680
Informations de publication
Date de publication:
26 08 2020
26 08 2020
Historique:
received:
11
11
2019
accepted:
13
08
2020
entrez:
28
8
2020
pubmed:
28
8
2020
medline:
29
7
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32847572
doi: 10.1186/s12910-020-00520-3
pii: 10.1186/s12910-020-00520-3
pmc: PMC7448443
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
79Références
Arch Sex Behav. 2020 Oct;49(7):2619-2634
pubmed: 32592076
J R Soc Med. 1989 May;82(5):260-3
pubmed: 2754680
Bioethics. 2010 Jun;24(5):242-55
pubmed: 20500761
Hospitals. 1988 Jan 5;62(1):72
pubmed: 3422068
HEC Forum. 2019 Sep;31(3):241-260
pubmed: 31098934
Camb Q Healthc Ethics. 2002 Winter;11(1):87-93
pubmed: 11868423
AMA J Ethics. 2016 May 01;18(5):528-33
pubmed: 27213884
Health Care Anal. 2009 Sep;17(3):217-35
pubmed: 19139992
Bioethics. 2019 Nov;33(9):1012-1021
pubmed: 31339182
BMC Med Ethics. 2016 Jul 22;17(1):45
pubmed: 27448597
BMC Med Ethics. 2015 Apr 04;16:20
pubmed: 25889221
Med Health Care Philos. 1998;1(1):65-70
pubmed: 11081285
Sci Technol Human Values. 2004 Winter;29(1):3-29
pubmed: 16013108
J Med Philos. 2003 Oct-Dec;28(5-6):635-53
pubmed: 14972765
Postgrad Med J. 2009 Sep;85(1007):451-4
pubmed: 19734510
Med Health Care Philos. 2019 Sep;22(3):427-438
pubmed: 30684092
J Med Ethics. 2013 Nov;39(11):681-5
pubmed: 23328983
J Med Ethics. 2005 May;31(5):256-61
pubmed: 15863679
HEC Forum. 2011 Sep;23(3):207-24
pubmed: 21792683
Bioethics. 2009 Oct;23(8):460-9
pubmed: 18549426
Arch Sex Behav. 2018 Nov;47(8):2319-2333
pubmed: 30229517
HEC Forum. 2012 Sep;24(3):219-26
pubmed: 22886153