V. Hans

The design and implementation of clinical ethics support is attracting increasing attention. Often, the characteristics and aims of clinical ethics support are translated into practice in a top-down, programmatic manner. These characteristics and aims then remain a constant feature of the clinical ethics support functions within the organisation. We argue that the characteristics of clinical ethics support should be reflected in the implementation strategy. Inspired by dialogical, pragmatic and hermeneutic perspectives on clinical ethics support in general and moral case deliberation in particular, we argue for a dialogical approach to implementing clinical ethics support, based on open, ongoing discussion with healthcare professionals about how they conceive clinical ethics support. Based on research and experience with various moral case deliberation implementation projects in mental healthcare, we present a theoretical framework for dialogical implementation and heuristic guidelines for implementing moral case deliberation in mental healthcare, which take into account the dialogical characteristics of moral case deliberation and some specific features of mental healthcare.

John Rawls offers an account of public reason that argues that comprehensive doctrines are admissible into public deliberations of fundamental political matters only when they are used to say things that can also be said on the basis of the noncomprehensive liberal political values of freedom and equality. This essay argues that elements of comprehensive doctrines ought to be allowed into public reason even when those elements cannot be translated into the terms of liberal political values. It draws on Ralph Waldo Emerson’s conception of communication among citizens and Stanley Cavell’s interpretationof Emersonian moral perfectionism to develop a conception of public reason that allows a greater range of views held by citizens to play a legitimate role in democratic deliberations. An Emersonian conception of liberal democracy differs from Rawls’s in that it more explicitly views the democratic community as actively engaged in continually revising and perfecting the liberal political values of freedom and equality.