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Ethical Deliberation in Multiprofessional Health Care Teams

Edited by Hubert Doucet, Jean-Marc Larouche and Kenneth R. Melchin

Publication Year: 2001

This study analyzes both pragmatic and theoretical perspectives of ethical deliberation, as well as the professional and philosophical backgrounds for the ethical deliberation of social workers, nurses and doctors working in the field of chronic illness. In doing so, this volume expands the scope of current research through an analysis of the process and its dynamics.

Published by: University of Ottawa Press

Table of Contents

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pp. 7-8

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pp. 9-12

Technological changes have had a dramatic impact upon the financing, organization and delivery of health care services in Canada. Professionals and health care decision makers now wrestle with increasingly complex sets of challenges that must involve various types of professionals in programs of care. The result is that administrators, nurses, physicians, ...

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Chapter 1. Historical Context: Deliberation and Methodology in Bioethics

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pp. 13-27

The revival of interest in ethical issues concerning biomedicine and health care in the mid-sixties was undoubtedly a search for meaning. Not only was it a protest against certain types of experimentation on human subjects, it also represented a desire to make medicine a more humane enterprise. Whatever interpretation the ethical project of the time took— for example, Van...

Part 1. Implicit Ethics of Professionals in the Field of Pediatric Chronic Care

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Introduction to Part 1

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pp. 31-34

One of the overall objectives of this study is to investigate how professionals involved in long-term care units in pediatric chronic care experience value conflicts and make decisions on ethical issues.1 Therefore, we are interested in professionals as moral agents. Are they experiencing these value conflicts and making their ethical decisions as moral...

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Chapter 2. The Nurse as Moral Agent

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pp. 35-56

This chapter considers the profession of nursing as it is exercised in the field of pediatric chronic illness. We begin with a general sociohistorical sketch from which we observe the emergence of indicators that form the dimensions of the "implicit ethics" of three ideal types of nurses. This is followed by an illustration of how each of the ideal types addresses the...

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Chapter 3. The Physician as Moral Agent

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pp. 57-76

We present here a parallel to the chapter on nursing, keeping in mind that there will not be the repetition of much of the historical and social data that provide the context for our discussion. This chapter considers the physician and the exercise of this profession in the field of pediatric chronic illness. A brief historical sketch provides the background from...

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Chapter 4. The Social Worker as Moral Agent

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pp. 77-87

In the course of the literature search on nurses and physicians, the indicators drawn from professional journals and texts were collected into dimensions that gave us three ideal types of each profession with distinct approaches to ethical issues due to their distinct implicit ethics. In the course of the documentary analysis on the social worker, having used a...

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Chapter 5. Synthesis of Part 1

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pp. 89-92

The objective of this part of the study was to use the tools of ideal type, a "portrait," to provide the background to examine both the ways in which conflicts of values are lived and the ways in which ethical decisions are made in long-term care units of pediatric hospitals. The most fruitful result of this documentary research has come as insights into the...

Part 2. Ethical Deliberation: Theoretical Perspectives from the Fields of Ethics and Conflict Studies

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Introduction to Part 2

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pp. 95-96

Currently, health care practitioners who must wrestle with ethical issues in their daily work experience are confronted with a diversity of theories and principles in the field of ethics. Professionals do not have a standardized set of ethical tools and methods for deliberating and deciding on issues. Rather, they must choose among diverse sets of such tools. ...

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Chapter 6. Theories of Discourse Ethics

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pp. 97-112

One of the fundamental assumptions of the liberal tradition of democracy, and so of the institutions nourished explicitly or implicitly by that tradition, is that there are a plurality of values that can conflict with one another and that are not reducible to one another. Consequently, it is widely accepted that value conflicts will not be eliminated. We do not...

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Chapter 7. The Cognitional Theory of Bernard Lonergan and the Structure of Ethical Deliberation

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pp. 113-128

The preceding chapter by James Sauer presents a brief overview and analysis of some of the principal contributors to the theoretical literature in discourse ethics. Sauer identifies two main approaches in this literature, the contextualists and the proceduralists. The focus of the proceduralists (e.g., Habermas, Rawls, Ackerman) is on the structure of ethical discourse and/or the political contracts and...

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Chapter 8. Value Conflicts in Health Care Teams

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pp. 129-161

Conflicts among professionals in health care teams often involve differences over values. As was observed in part 1, these value differences are often implicit and are often related to the diverse ways in which professionals of different types understand themselves and their work. The field of conflict resolution has developed a range of insights into the dynamics...

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Conclusion to Part 2

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pp. 163-165

Part 2 of this project began with a survey of literature in the field of discourse ethics. Chapter 6, by James Sauer, identified two main lines of theory in this field—the proceduralists and the contextualists—and provided preliminary arguments for the complementarity of the two. Chapter 7, by Kenneth R. Melchin, introduced the cognitional theory of...

Part 3. Action Research: Ethical Deliberation in Multiprofessional Health Care Teams

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Introduction to Part 3

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pp. 169-170

Part 3 of this study takes the results of parts 1 and 2 and applies them to a case-study, action-research context. Two teams of health care professionals from Anglophone and Francophone pediatric chronic care institutional settings volunteered to participate in videotaped discussions of case studies involving ethical issues typically encountered in their work. These...

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Chapter 9. Action Research on Ethical Deliberation

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pp. 171-186

The goals of this action-research stage of the project were twofold: (1) to determine, on the basis of an anecdotal study of the videos, if evidence of the features of ethical deliberation in multiprofessional teams gleaned from the analyses of parts 1 and 2 could be observed in the case conferences; (2) to use insights from the literature and observations from...

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Chapter 10. Guide for Ethical Deliberation

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pp. 187-198

The Guide for Ethical Deliberation recognizes that the majority of ethical decisions made in health care settings are the result of deliberations among diverse professionals in health care teams. While hospital ethics committees are often conspicuously identified with ethical issues, the full range of issues involved in patient care involves a wide range of...

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Chapter 11. Thinking About Ethical Deliberation

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pp. 199-214

The goal of this chapter is to stand back and reflect on the whole project, to ask about the overall framework that guided the research and developed through the project and to examine how this framework unified the various parts of the project. While the theoretical literature in ethics is massive and diverse, three central concerns guided the development...

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Concluding Reflections

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pp. 215-219

The changing face of health care has made the task of patient care much more complex than in past decades. This is especially the case in the field of chronic care. Professionals who care for patients, particular young children, face a bewildering array of challenges for which they often feel ill-prepared. These challenges come from the rapid pace of...

Appendix A: Database for Documentary Analysis of Part 1

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pp. 221-222

Appendix B: Analytical Grid for the Action Research of Part 3

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pp. 223-226

Appendix C: Case Studies for the Action Research of Part 3

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pp. 227-241


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pp. 243-290

E-ISBN-13: 9780776615882
E-ISBN-10: 0776615882
Print-ISBN-13: 9780776605258
Print-ISBN-10: 0776605259

Page Count: 336
Publication Year: 2001