Good care in ongoing dialogue. Improving the quality of care through moral deliberation and responsive evaluation

Health Care Anal. 2009 Sep;17(3):217-35. doi: 10.1007/s10728-008-0102-z. Epub 2009 Jan 13.


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.

MeSH terms

  • Coercion
  • Ethical Analysis*
  • Ethics, Medical
  • Humans
  • Mental Health Services / ethics
  • Mental Health Services / organization & administration
  • Morals*
  • Psychology, Medical
  • Quality of Health Care / ethics*
  • Quality of Health Care / organization & administration*