• ethics- medical

We are grateful for the thoughtful replies to our article.1 We are especially encouraged that all respondents agree that it is of value to develop a theoretical framework which helps to study how clinical ethics support services (CESS) induce individual and organisational learning. We have focused on the relations between moral case deliberation (MCD), organisational learning and quality improvement from a predominantly sociological perspective. The goal of our theoretical framework was to establish hypotheses which allow for empirical evaluation of the relation between CESS and quality of care.

Two major concerns seem to underly the commentaries: the framework (1) lacks a normative standard which allows for ethical justification of the outcome of repeated MCD,2 and (2) the focus on morisprudence does not sufficiently emphasise the need for ‘structured, consistent, and facilitated processes for fair and robust moral case deliberation’.3 In other words, it is not the content of MCDs, recorded in a corpus of cases, that is crucial to organisational quality improvement but the presence of a moral space and/or an ethical culture which constantly promotes ethical reflection.3 4 We will attempt to address both concerns, starting with the latter.

We certainly agree that the creation of a moral …