Department of Medical Humanities, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorstraat 7, 1081 BT Amsterdam, The Netherlands.
Health Care Anal. 2012 Sep;20(3):281-96. doi: 10.1007/s10728-011-0187-7.
The traditional organizational boundaries between healthcare, social work, police and other non-profit organizations are fading and being replaced by new relational patterns among a variety of disciplines. Professionals work from their own history, role, values and relationships. It is often unclear who is responsible for what because this new network structure requires rules and procedures to be re-interpreted and re-negotiated. A new moral climate needs to be developed, particularly in the early stages of integrated services. Who should do what, with whom and why? Departing from a relational and hermeneutic perspective, this article shows that professionals in integrated service networks embark upon a moral learning process when starting to work together for the client's benefit. In this context, instrumental ways of thinking about responsibilities are actually counterproductive. Instead, professionals need to find out who they are in relation to other professionals, what core values they share and what responsibilities derive from these aspects. This article demonstrates moral learning by examining the case of an integrated social service network. The network's development and implementation were supported by responsive evaluation, enriched by insights of care ethics and hermeneutic ethics.
传统的医疗保健、社会工作、警察和其他非营利组织之间的组织界限正在消失，取而代之的是各种学科之间的新关系模式。专业人员从自己的历史、角色、价值观和关系出发开展工作。由于这种新的网络结构需要重新解释和重新协商规则和程序，因此往往不清楚谁对什么负责。需要制定新的道德风气，特别是在综合服务的早期阶段。谁应该做什么、与谁一起做以及为什么？本文从关系和解释学的角度出发，表明当专业人员为了客户的利益开始合作时，他们会在综合服务网络中开始一个道德学习过程。在这种情况下，关于责任的工具性思维方式实际上是适得其反的。相反，专业人员需要了解他们与其他专业人员的关系、他们共同拥有哪些核心价值观以及这些价值观衍生出哪些责任。本文通过考察一个综合社会服务网络的案例来展示道德学习。该网络的发展和实施得到了回应性评估的支持，丰富了关怀伦理和解释学伦理的见解。
