Luppo Kuillman

Chapter 1 10 Given the Hippocratic Oath, it becomes clear that since ancient times the art of healing is something which not only includes knowledge and technical skills but constitutes a total cognition of professional behavior (Edelstein, 1943). Although dating back to about 400 years BC, nowadays medical practice is still imbued with the Oath’s basic principle: ‘primum non nocere,’ literally, ‘you shall not harm.’ This core value of ethical care is connected to the following aspects: a) respecting the patient’s autonomy, b) serving patients to their best interests by doing them justice, c) treating them with dignity and d) acting with transparency, which enables informed consent for the received care (Pellegrino, 2006). Once these aspects of ethical care are at risk of becoming jeopardized, either by the patient’s self-determination or due to reaching the limits of medicine and its technology, one may speak of the emergence of a moral dilemma (De Haan, 2001). As soon as a moral dilemma emerges, some skills to solve the dilemma are necessary as an impetus of ethical decision making and good clinical practice. Beholding the presumption that healthcare delivery is a moral enterprise, inherently moral dilemmas, and moral conflicts occur on a daily basis. For this, the overarching research question of this doctoral thesis is: “What factors influence healthcare personnel in dealing with moral dilemmas? In this thesis, I study the antecedents of ethical decision-making among two master’s trained professionals, namely those of Physician Assistants and Nurse Practitioners, who both hold their own professional responsibility in treating patients. 1.1 Background of sampling Physician Assistants and Nurse Practitioners Around the year 1995, a medical workforce shortage was predicted for the Dutch healthcare system. A solution was sought in medical task shifting by introducing nurse practitioners (NPs) and physician assistants (PAs) in the years 1995 and 2002, respectively, to support medical doctors in patient care. Both professionals are trained at the master’s level but distinguish in their professional scope of practice. NPs, in the Netherlands are viewed as ‘nursing specialists’, who largely conduct medical tasks categorically arising from their domain of nursing practice, whereas PAs practice medicine in the full breadth of a medical specialty and are classified as a new type of medical provider. Both professions have acquired a legal foundation to practice autonomously, though in collaboration with a medical doctor (De Bruijn-Geraets et