Good Care in Ongoing Dialogue. Improving the Quality of Care Through Moral Deliberation and Responsive Evaluation
Good Care in Ongoing Dialogue. Improving the Quality of Care Through Moral Deliberation and Responsive Evaluation
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DOI：
10.1007/s10728-008-0102-z
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发表时间：
2009-09-01
影响因子：
1.9
通讯作者：
Widdershoven, Guy A. M.
中科院分区：
文献类型：
--
作者：
Abma, Tineke A.;Molewijk, Bert;Widdershoven, Guy A. M.
近年来，护理机构内部的道德审议在医学伦理学中受到越来越多的关注。正在进行的关于伦理问题的对话被认为是提高卫生保健实践质量的一种手段。伦理对话方法的兴起可以被理解为反对医学伦理学的更广泛的发展，在医学伦理学中，互动和对话被视为对伦理问题进行理论或个人思考的替代方案。在其他学科中，主体间性也被视为处理实际问题的一种方式，并出现了处理实践改进的动态过程的方法论。响应性评估就是一个例子。本文探讨了道德商议与反应性评价的关系，描述了它们在对话伦理学和语用解释学中的共同基础，并探讨了两者对提高护理质量的相关性。通过一个案例说明了这两种方法之间的协同作用，在这些案例中，两种方法都发挥着截然不同的补充作用。它涉及荷兰精神病学中强制的质量标准的实施。
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.