And some had, in retrospect, felt that the situation had been difficult, painful, and had felt very pressured. Is it possible not to deal with ethical challenges, e.g. © 2020 BioMed Central Ltd unless otherwise stated. For example, when health care professionals are using forced medication against the will of a patient, we acknowledge that this can without doubt be a very stressful and challenging situation for the involved health care professionals. In one focus group interview, they talked about four consecutive meetings with different participants. Ethical concerns associated with the planning, preparedness and responses to future pandemics are important to consider, ensuring that response efforts are not hindered in the event of a pandemic. For example, some participants said they deal with ethical challenges every day: ‘Yes, as a matter of fact, I think we discuss ethics every day. Because we were sort of challenged to continue the dialogue, and not remain opposed to each other.’, One health care professional even felt as if they mistrusted or were suspicious of him for what he had done. If you really think what the team has agreed upon is wrong, and there is an implicit or explicit rule that everybody should do the same, then a dilemma related to loyalty seems inescapable. (ed.) Quite a few respondents also reported that ethical challenges are often not discussed, left to the individual, or that their opinion has little importance. She referred to the fact that those who have to work with coercion on the shop floor on a daily basis (e.g. That does something to them [social workers, authors]. Situation ethics response to the right to life-the most loving thing in any circumstance. … and that the alternative is not better.’ It becomes difficult when one does not feel confident that the coercive act is good for the patient. It takes effort to keep a company ethical, but it's worth it. for a certain treatment policy) was interpreted by others as a sign of something else then asking for a justification. 10.1136/jme.2007.021402, Hunink G, Van Leeuwen R, Jansen M, Jochemsen H: Moral issues in mentoring sessions.Nurs Ethics 2009,16(4):487–98. Edited by: Denzin NK, Lincoln YS, Denzin NK, Lincoln YS. However, some participants stressed that struggling with ethical challenges is a necessity in order to make sure that the patients receive good treatment. 119 0 obj<>stream 0000044602 00000 n Springer Nature. Implementing moral case deliberation in a mental health care institution. Your organization sets a goal—it could be a monthly sales figure … Filinnials and Millennials MILLENNIALS and FILINNIALS MILLENNIALS and FILINNIALS. Furthermore, future empirical research could enlighten if, and in which way, specific ethics arenas such as ethics reflection groups or moral case deliberation, can actually be of additional help when dealing with ethical challenges and value disagreements. We purposely only generally described ‘ethical challenge’ by using words like ‘ethical dilemmas’, ‘ethical problems’, ‘ethical issues’, ‘situations that caused a discussion or disagreement within the team or where you were concerned or uncertain about the right use of coercion’ or ‘difficult situations’. Our research question was: How do health care professionals in mental health care deal with ethical challenges related to the use of coercion? He describes a situation in which he dealt with a patient in a different way than most of the team thought was right. Do the team members interpret the question as factual and neutral, in other words: literally, just as it is? Molewijk, B., Hem, M.H. The analysis of the transcribed interviews went through four phases. Quite a few participants described how disagreement about the use of coercive measures had been a true burden to individuals and whole teams, sometimes resulting in teams that split up and teams or individuals that feel personally criticized. (II)‘And so I have had several conversations with her [that nurse, authors] afterwards where I have discussed this particular situation, gone through what could of been done differently, whether there was another way we could have solved it, what she thinks about future situations’. Knowing how health care professionals deal with ethical challenges in mental health care when not making use of an ethics support service is important. 0000001881 00000 n New York: Oxford University Press; 2008. Ethics in Clicinal Practice – an Interprofessional Approach. Participants struggled with what makes a challenge an ethical challenge and whether it differs from a professional challenge. After reviewing this chapter readers should be able to: ... changes, responses to public comments, and the final revision will be available on the website of the Office Human Research Protections. Ethical dilemmas are problems which arise when an action breaks multiple ethical codes. 3. This fragment seems to refer to an important aspect of how team members interpret the question, the questioner and the process of questioning when dealing with ethical challenges due to disagreement. For example, if a … This information was given again when the interview began. ‘And we have discussed it a lot, and I guess we have disagreed too, about what to think and what to do… But that is because we focus on the patient, and therefore we have good discussions too, even professional discussions, about what we actually believe and think about the patients and their treatment, and that is useful. All participants in the focus group interviews received an information letter beforehand in which we emphasized the voluntariness of their participation, their possibility to withdraw from the interview without giving reasons, the anonymity of the data, and the way we will archive and eventually destroy the research data. Cookies policy. Oxford: Oxford University Press; 2007. The study also revealed nine different categories of what health care professionals implicitly or explicitly conceive as ‘ethical challenges’. statement and 10.1136/jme.2010.036574. I think that is where the most cases of crying social workers in my office have come from. Correspondence to ‘Executing coercion when in some way you do not feel wholly convinced that it clearly contributes to patient’s beneficence, that is not a situation that’s always easy to be in.’ ‘It gets into people’s bodies over the years.’, Not understanding why one has to execute a coercive measure can become very burdensome. Landeweer E PhD thesis. Who are the individuals, organisations and key stakeholders affected? Through an initial open reading of the interviews each author presented separately and independently some preliminary topics. And there was talk on other units about how we, on our unit, worked with patients. 0000093545 00000 n Furthermore, some participants plead for more attention for underlying intentions and justifications of treatment decisions. ‘I think that ethical reflection…and I think that the formal, now we are sitting down to discuss, is in many ways one thing, but I think that everyone has some ethical reflection in between other tasks in the course of a day… even if we don’t sit down and think in bullet points or anything. I often think it’s like that.’. Because I think that in itself is a dilemma: that the day we no longer react to it, we are in dangerous waters, because it is such a major intervention, so just remaining in that discomfort ensures that you don’t just trust blindly, or that you do not mechanically do it. Other teams experienced less constructive ways of dealing with disagreement, for example by means of privatizing existing disagreements, or criticizing persons or teams instead of opinions or viewpoints. This subproject was part of a larger project on ethics in mental health care. 10.1177/104973200129118453. Others mentioned stressful ethical challenges due to for example the high risks that are connected to their behaviour and decisions (e.g. Another participant also stressed that dealing with ethical challenges based on disagreements can be useful in itself, as long as they are professional discussions, and as long as they focus on the patients. Or do they see the question as a sign of something else, for example as distrust or as over-identification with the patient? Part of ‘I guess it was the kind of situation where the people who came afterwards weren’t able to see that this [the use of coercion, authors] was necessary, and therefore there were some reactions.’, ‘I think that what became difficult after the situation had occurred, was that those who came later were very critical and puzzled about the doctor’s decisions and our handling of the situation that they were not part of. At the same time, most participants reported that they do not use a specific method. In another paper based on these focus group interviews, in which we describe the content of the actual ethical challenges related to the use of coercion, we elaborate more on the values that were at stake within these ethical challenges [22]. Philosophy of Mental Health Care. Solving Ethical Issues Involving Minors Consider the setting. Responses to epidemics, emergencies and disasters raise many ethical issues for the people involved, including public health specialists and policy makers. At this moment, we distinguish the following six categories of ethical challenges as experienced by health care professionals: a) sincerely asking oneself whether one does the right or good thing; b) not knowing what is the right thing to do; c) being uncertain or in doubt about what is the right or good thing to do; d) disagree about what is morally right or good to do; e) knowing what is right or good to do but not being able or allowed to do that; and f) feeling obligated or forced to do something which you think is morally wrong or bad. Sadler JZ: Values and psychiatric diagnosis. : Ethical difficulties in clinical practice: experiences of European doctors.J Med Ethics 2007,33(1):51–7. He mentioned that they sometimes identified basic principles and that they tried to weigh different principles against one another. As mentioned in the first section (‘Identification and prevalence of dealing with ethical challenges’), some participants said they deal with ethical challenges every day; it is a regular thing that is inherently attached to working as a professional in mental health care. What is at stake when being confronted with an ethical challenge? With implicit we mean two things: a) they did not frame the issues explicitly as being an ethical or moral issue, and b) they do not use specific meetings or methods with an explicit focus on ethics. One participant talked about arranging special meetings: ‘So, one of the things we do is to arrange ad hoc meetings, usually, so that the discussion is concentrated in what we actually call reflection meetings, which are being used quite actively for the difficult issues which move us emotionally.’. In the last sentence of the above citation, it looks as if another possible dimension of the disagreement in this situation arises. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated. It is essential to reflect on ethical issues instead of only following the rules. 0000061387 00000 n,,, All authors read and approved the final manuscript. The analysis of the answers to the first research question are presented elsewhere [22]. xref 10.1111/j.1365-2648.2011.05927.x, Molewijk B, Verkerk M, Milius H, Widdershoven G: Implementing moral case deliberation in a psychiatric hospital: process and outcome.Med Health Care and Philosophy 2008, 11:43–56. 0000003193 00000 n Ethical challenges and responses in harm reduction research: promoting applied communitarian ethics. Radden J: The virtuous psychiatrist: character ethics in psychiatric practice. Working … It also might reveal expressed and non-expressed needs for ethics education, ethics training or ethics support. Yes.’. London: SAGE publications; 1994. More or less, yes. 0000000936 00000 n Also thanks to Kristin Weaver for checking the translations of the Norwegian citations and edited the general English language. We probably are not very good at that.’ ‘When you have a good method, you probably hear more from more people than when you use a bad method, where you just sit and talk, and those who talk first also talk most’. In line with this, Schippers et al. Weidema F PhD thesis. Often disagreement involved a conflict between different values that are aimed for. 1. This is in line with what Hurst and colleagues report [26], p.7: ‘There has been no systematic, empirical examination of the values or the strategies actually employed by physicians to deal with the ethically problematic situations they face without help from ethics committees or consultants.’ In the study of Hurst and colleagues [26], American internists, oncologists, and intensive care specialists were asked (by means of short telephone interviews) what kinds of strategies and approaches they used when facing ‘a recent ethical dilemma’. Quite often it concerned regular meetings such as debriefing meetings in between two shifts, or the meetings in which the treatment team discusses the treatment plans of the patients. Some of them said that they should do it every day, the whole year, but that they lack the time to do so. BM also works as Associate Professor of Clinical Ethics at the Department of Medical Humanities, Free University medical centre (VUmc), EMGO+ (Quality of Care), Amsterdam, the Netherlands. Different settings might be governed … The sampling error is +/- 1.2% at the 95% confidence level. nurses) often do not take part in the treatment meetings where the rationale for the use of coercion is being discussed. We received funding from the Norwegian Directorate of Health (September 2011–February 2015). Furthermore, not paying attention to ethical challenges can be detrimental to patients, relatives, health care professionals, management; it might both challenge their cooperation and diminish the quality of the decision-making processes. startxref The Japanese Federation of Social Workers also translated one question about what ethical challenges were being faced, and 91 additional responses were received via the four Japanese associations. As moderators in the focus group interviews, we tried to stimulate an open dialogue and a safe atmosphere so that the participants could not only express their viewpoints but also could actually exchange and reflect upon their viewpoints together [33–35]. However, most citations refer to situations in which the participants, both individually and as a team, become paralyzed due to the heaviness of dealing with ethical challenges. Bring different disciplines together. The report lists defining events that shape the attitudes of each group: * Millennials: globalization of the economy, terrorism, and rise of technology, including the internet. Dickenson D: In two minds. BM, MHH & RP work respectively as Associate Professor of Clinical Ethics, Postdoc-researcher and Professor-researcher at the Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Fry CL(1), Treloar C, Maher L. Author information: (1)Turning … what ought or should be done), ethical theory (e.g. doi: 10.17226/11917. Ethical Challenges and Dilemmas in Organizations A Case Study Approach The business of the modern world, for better or worse, is business. Can you repeat one more time why it is so important to go through with this here, so that those involved [colleagues, authors] get the information?’, Chief physician: ‘It’s not always coincidental who starts to identify with patients, and finds this [the use of coercion, authors] to be impossible or difficult. What do you expect from the ethics reflection groups? A more pragmatic description comes from a recent paper from Lillemoen and Pedersen on ethical challenges in primary health care: ‘Ethical challenges may arise when we cannot do what we think ought to be done, or when there is doubt or disagreement about what is right or wrong’ [27], p. 99. Stake RE: Qualitative case studies. The Hong Kong and Japanese responses were analysed along with the 505 main survey responses, making a total of 607. Terms and Conditions, This happened when he was working at another workplace in another hospital. He thought that more written information about the intentions behind the coercive actions will make it easier to understand why the coercive actions are planned or how they should be executed. DuVal G, Sartorius L, Clarridge B, Gensler G, Danis M: What triggers requests for ethics consultations?J Med Ethics 2001,27(suppl I):i24–9. In their analysis, Donaldson and colleagues distinguished between ethical-philosophical, legal-regulatory and practical-operational aspects of the students’ cases. Furthermore, it is a necessary requirement in order to know how future ethics support services might fit the specific characteristics and needs of stakeholders and context within mental health care [17, 30, 31]. 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. As a result, health care standards may need to be modified to respond to the p… The ethical issues in business take different shapes than in schools or the home, even though they stem from the same impulses. Other participants did not refer to everyday situations or questions, but described in more detail the history of a single dramatic and often burdensome situation. Unrealistic and Conflicting Goals. One of the participants pointed out another positive meaning of the struggling. ‘The reason why I asked how often you discuss the justifications for the possible use of coercion is because I think it’s easier to take part in situations that feel ethically challenging if you understand their background’. 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