Systematisk etikkrefleksjon gjør en forskjell. Et ressurshefte for etikkrefleksjonsgrupper i psykisk helsevern

Dette ressursheftet er utviklet av forskere ved Senter for medisinsk etikk (SME) ved Universitetet i Oslo. SME har gjennom en årrekke arbeidet med etikk i helsetjenesten. To viktige satsinger har vært utviklingen av Kliniske etikk-komitéer (KEK) som nå alle helseforetak er pålagt å ha,1 samt Etikk i kommunehelsetjenesten (EIK).2 På bakgrunn av at vi så behovet for en etikksatsing i psykisk helsevern, fikk vi – takket være økonomisk støtte fra Helsedirektoratet i en lengre periode (2011-2016) – muligheten til å sette fokus på etiske problemstillinger i de psykiske helsetjenestene. Prosjektet fikk navnet Psykiske helsetjenester, etikk og tvang (PET), og det har blitt ledet av Reidar Pedersen. Øvrige medarbeidere i prosjektet har vært Reidun Norvoll, Bert Molewijk, Marit Helene Hem, Tonje Lossius Husum, Reidun Førde, Olaf Gjerløw Aasland, Elisabeth Gjerberg, Lillian Lillemoen, Elin Håkonsen Martinsen, Bente Weimand, Irene Syse og Anders Tvedt

Setting standards for empirical bioethics research:A response to Carter and Cribb

Abstract This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of ‘integrating’ empirical methods and ethical argument as a standard for research practice within empirical bioethics

Good Care in Ongoing Dialogue. Improving the Quality of Care Through Moral Deliberation and Responsive Evaluation

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry

Dealing with ethical challenges: a focus group study with professionals in mental health care

Background 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. Methods Within a project on ethics, coercion and psychiatry, we executed a focus group interview study at seven departments with 65 health care professionals and managers. We performed a systematic and open qualitative analysis focusing on the question: ‘How do health care professionals deal with ethical challenges?’ We deliberately did not present a fixed definition or theory of ethical challenge. Results We categorized relevant topics into three subthemes: 1) Identification and presence of ethical challenges; 2) What do the participants actually do when dealing with an ethical challenge?; and 3) The significance of facing ethical challenges. Results varied from dealing with ethical challenges every day and appreciating it as a positive part of working in mental health care, to experiencing ethical challenges as paralyzing burdens that cause a lot of stress and hinder constructive team cooperation. Some participants reported that they do not have the time and that they lack a specific methodology. Quite often, informal and retrospective ad-hoc meetings in small teams were organized. Participants struggled with what makes a challenge an ethical challenge and whether it differs from a professional challenge. When dealing with ethical challenges, a number of participants experienced difficulties handling disagreement in a constructive way. Furthermore, some participants plead for more attention for underlying intentions and justifications of treatment decisions. Conclusions The interviewed health care professionals dealt with ethical challenges in many different ways, often in an informal, implicit and reactive manner. This study revealed nine different categories of what health care professionals implicitly or explicitly conceive as ‘ethical challenges’. Future research should focus on how ethics support services, such as ethics reflection groups or moral case deliberation, can be of help with respect to dealing with ethical challenges and value disagreements in a constructive way