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      Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation

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          Abstract

          Background

          Moral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice.

          Methods

          In this paper we present a case-study of a Moral Case Deliberation with the dilemma method in a health care institution for people with an intellectual disability, describing the theoretical background and the practical application of the dilemma method. The dilemma method focuses on moral experiences of participants concerning a concrete dilemma in practice. By an in-depth description of each of the steps of the deliberation process, we elucidate the educational value and didactics of this specific method.

          Results

          The didactics and methodical steps of the dilemma method both supported and structured the dialogical reflection process of the participants. The process shows that the participants learned to recognize the moral dimension of the issue at stake and were able to distinguish various perspectives and reasons in a systematic manner. The facilitator played an important role in the learning process of the participants, by assisting them in focusing on and exploring moral aspects of the case.

          Discussion

          The reflection and learning process, experienced by the participants, shows competency-based characteristics. The role of the facilitator is that of a Socratic teacher with specific knowledge and skills, fostering reflection, inquiry and dialogue.

          Conclusion

          The specific didactics of the dilemma method is well suited for teaching bioethics in clinical settings. The dilemma method follows an inductive learning approach through a dialogical moral inquiry in which participants develop not only knowledge but also skills, attitude and character. The role of a trained facilitator and a specific view on teaching and practicing ethics are essential when using the dilemma method in teaching health care professionals how to reflect on their own moral issues in practice.

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          Most cited references28

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          Case Study Research, Design and Methods

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            Teaching ethics in the clinic. The theory and practice of moral case deliberation.

            A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on (teaching) ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation.
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              Linking Theory and Practice: Changing the Pedagogy of Teacher Education

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                Author and article information

                Contributors
                0031 (0)20 444 8266 , m.stolper@vumc.nl
                a.molewijk@vumc.nl
                g.widdershoven@vumc.nl
                Journal
                BMC Med Ethics
                BMC Med Ethics
                BMC Medical Ethics
                BioMed Central (London )
                1472-6939
                22 July 2016
                22 July 2016
                2016
                : 17
                : 45
                Affiliations
                [ ]Department of Medical Humanities, EMGO+ Institute for Health and Care Research, VU University medical centre (VUmc), De Boelenlaan 1089a, 1081 HV Amsterdam, The Netherlands
                [ ]Centre of Medical Ethics, University of Oslo, Oslo, Norway
                Article
                125
                10.1186/s12910-016-0125-1
                4957934
                27448597
                b8391b8f-1b52-413e-bf5e-2fa0cc4ddaf3
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 24 September 2015
                : 17 June 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Medicine
                education,clinical setting,moral case deliberation,dilemma method,moral competence
                Medicine
                education, clinical setting, moral case deliberation, dilemma method, moral competence

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