Emotions and Clinical Ethics Support. A Moral Inquiry into Emotions in Moral Case Deliberation

"Background: For Moral Case Deliberation (MCD), like any form of Clinical ethics support (CES), it is important to know whether it reaches its presumed goal of supporting healthcare professionals in their ethical challenges. Evaluation is needed to gain insight in the value of MCD. Therefore, the Euro-MCD instrument was developed to assess outcomes of MCD, and has now been revised. The aim of this presentation is to present the revised Instrument: the Euro-MCD 2.0. Methods: The revision process was an iterative dialogue in which field study findings were integrated with theoretical reflections and expert-input. Results: The Euro-MCD 2.0 has three domains: 1) Moral Competence, 2) Moral Teamwork and 3) Moral Action. Moral Competence includes items on moral sensitivity, analytical skills and a virtuous attitude, like ‘I speak up in ethically difficult situations’. Moral Teamwork refers to open dialogue and supportive relationships, for example ‘We feel secure to share emotions in ethically difficult situations’. Moral Action includes items about moral decision-making and responsible care, like ‘We are able to explain and justify our care towards patients and their families’. Discussion: The Euro-MCD 2.0 is shorter and more strongly substantiated by empirical data and theoretical reflections. At the conference, we will reflect on the revision process and the underlying foundations of the domains. The revised instrument helps to get insight in the MCD related outcomes for healthcare professionals in their daily practice. Our research can further improve implementation of MCD and contribute to the research field of evaluation of CES in general. "

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The Role of Worldview in Moral Case Deliberation: Visions and Experiences of Group Facilitators

Journal of Religion and Health ◽

10.1007/s10943-021-01246-1 ◽

2021 ◽

Author(s):

Benita Spronk ◽

Guy Widdershoven ◽

Hans Alma

Keyword(s):

Clinical Ethics ◽

Daily Practice ◽

Moral Dilemmas ◽

Moral Case Deliberation ◽

Structured Interviews ◽

Clinical Ethics Support ◽

Ethics Support ◽

Moral Case ◽

Role Concerns

AbstractThis study investigates the role of worldview in moral case deliberation (MCD). MCD is a form of clinical ethics support which aims to assist caregivers in reflection on moral dilemmas, experienced in daily practice. Bioethicists acknowledge that existential and religious aspects must be taken into account in the analysis of ethical questions, but it remains unclear how these elements are addressed in clinical ethics support. We investigated how facilitators of MCD address worldview in MCD. MCD facilitation is often done by spiritual caregivers, but not in their role as spiritual caregiver. Discussing worldview is no standard part of the procedure in MCD. This study was qualitative, focusing on the views and experiences of the facilitators of MCD. Semi-structured interviews (N = 12) were conducted with facilitators of MCD. Grounded theory was used for analysis. The results show that worldview plays both an explicit and an implicit role in the MCD process. The explicit role concerns the religious beliefs of patients and professionals. This calls for avoiding stereotyping and devoting attention to different visions. The implicit role comes to the fore in addressing core values and spiritual fulfillment. In order to clarify the fundamental nature of values, more explicit attention for worldview might be useful during MCD. However, this should be done with caution as the term ‘worldview’ might be interpreted by participants in terms of religious and personal beliefs, rather than as an invitation to reflect on one’s view of the good life as a whole.

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How to Train and Assess the Quality of Facilitators for Moral Case Deliberation? Experiences with and Evaluation of Self-Reflection and Observation Forms for Facilitators of Moral Case Deliberation

Studia Universitatis Babeş-Bolyai Bioethica ◽

10.24193/subbbioethica.2021.spiss.116 ◽

2021 ◽

Vol 66 (Special Issue) ◽

pp. 170-170

Author(s):

Margreet Stolper ◽

◽

Bert Molewijk ◽

◽

Keyword(s):

International Health ◽

Learning Goals ◽

Moral Case Deliberation ◽

Moral Inquiry ◽

Self Reflection ◽

Personal Learning ◽

Ethics Support ◽

Open Questions ◽

Moral Case

"In Europe, Moral Case Deliberation (MCD) has been well-known and established as a form of Clinical Ethics Support (CES) and implemented in many international (health care) institutions. Since 2007 Amsterdam UMC organizes training for professionals to become a facilitator of MCD. To support and asses the development of those future facilitators MCD, an instrument has been developed which can be used by both trainees and trainers. The instrument consists of a self-reflection form and an observation form. Both forms are almost identical and contain a part of open questions reflecting upon the personal learning goals of the trainee and a part of 56 closed questions. The part of closed questions contains concrete descriptions of preferred skills and attitude of the MCD facilitator trainee, related to MCD in general and the specific steps of the Dilemma method and the Socratic Dialogue in particular. Special attention is being paid to concrete actions for fostering a dialogue and deepening the moral inquiry. The instrument can also be used by trained and more experienced facilitators of MCD to reflect upon their acquired skills and attitude, and indirectly on the quality of CES they provide. In this presentation we will present the instrument and share our experiences in using the two forms in order to train and assess (the quality of) facilitators of MCD. Furthermore, we will present preliminary results of the analysis of more than 1200 forms collected in the past decade from trainings on national and international level. "

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Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care

BMC Medical Ethics ◽

10.1186/s12910-021-00597-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Charlotte Weiner ◽

Pernilla Pergert ◽

Bert Molewijk ◽

Anders Castor ◽

Cecilia Bartholdson

Keyword(s):

Quality Of Care ◽

Childhood Cancer ◽

Clinical Ethics ◽

Cancer Care ◽

Healthcare Professionals ◽

Well Being ◽

Clinical Ethics Support ◽

Ethics Support ◽

Moral Case

Abstract Background In childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden. Methods This study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation. Results Data was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows: Interprofessional well-being in team interactions on a team level; Professional comfort when dealing with moral challenges on a personal level; and Improved quality of care for the child and the family on a care level. Conclusions Healthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support.

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48. Clinical ethics support services in veterinary practice

Professionals in food chains ◽

10.3920/978-90-8686-869-8_48 ◽

2018 ◽

Author(s):

S. Springer ◽

U. Auer ◽

F. Jenner ◽

H. Grimm

Keyword(s):

Support Services ◽

Clinical Ethics ◽

Clinical Ethics Support ◽

Veterinary Practice ◽

Ethics Support

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Managing ethical issues in patient care and the need for clinical ethics support

Australian Health Review ◽

10.1071/ah14034 ◽

2015 ◽

Vol 39 (1) ◽

pp. 44 ◽

Cited By ~ 3

Author(s):

Evan Doran ◽

Jennifer Fleming ◽

Christopher Jordens ◽

Cameron L Stewart ◽

Julie Letts ◽

...

Keyword(s):

Patient Care ◽

Clinical Ethics ◽

Ethical Issues ◽

Public Hospitals ◽

Cross Sectional Survey ◽

Convenience Sample ◽

Clinical Ethics Support ◽

Ethical Environment ◽

Ethics Support ◽

A Priority

Objective To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. Methods A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Results Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. Conclusion Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia. What is known about the topic? Clinicians working in hospitals in the US, Canada and UK have access to ethics expertise to help them manage ethical issues that arise in patient care. How Australian clinicians currently manage the ethical issues they face has not been investigated. What does this paper add? This paper describes the types of ethical issues faced by Australian clinicians, how they manage these issues and whether they think ethics support would be helpful. What are the implications for practitioners? Clinicians frequently encounter ethically and legally difficult decisions and want additional ethics support. Helping clinicians to provide ethically sound patient care should be a priority of public hospitals in NSW and elsewhere in Australia.

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Moral case deliberation

Practical Neurology ◽

10.1136/practneurol-2017-001740 ◽

2017 ◽

Vol 18 (3) ◽

pp. 181-186 ◽

Cited By ~ 5

Author(s):

Daniel Y B Tan ◽

Bastiaan C ter Meulen ◽

Albert Molewijk ◽

Guy Widdershoven

Keyword(s):

Support Services ◽

Healthcare Professionals ◽

Ethical Dilemmas ◽

Daily Practice ◽

Moral Case Deliberation ◽

Ethics Support ◽

Moral Case ◽

Moral Damage ◽

Dilemma Method

Ethical dilemmas in general are characterised by a choice between two mutually excluding options neither of which is satisfactory, because there always will be a form of moral damage. Within the context of medicine several ethics support services have been developed to support healthcare professionals in dealing with ethical dilemmas, including moral case deliberation. In this article, we describe how moral case deliberation works in daily practice, illustrated with a case example from the neurology ward. The article is meant as an introduction to moral case deliberation according to the dilemma method. We show its relevance to the clinic and the context needed to put it into practice.

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Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?

Journal of Medical Ethics ◽

10.1136/medethics-2016-104042 ◽

2017 ◽

Vol 44 (1) ◽

pp. 27-31 ◽

Cited By ~ 14

Author(s):

Rosalind J McDougall ◽

Lynn Gillam ◽

Clare Delany ◽

Yasmin Jayasinghe

Keyword(s):

Fertility Preservation ◽

Clinical Ethics ◽

Reproductive Potential ◽

Clinical Ethics Support ◽

Prepubertal Children ◽

Ethics Support ◽

Future Fertility ◽

Difference Of Opinion ◽

Proven Efficacy ◽

Pathway Of Care

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia.

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