Moral case deliberation

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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Field-testing the Euro-MCD Instrument: Experienced outcomes of moral case deliberation

Nursing Ethics ◽

10.1177/0969733019849454 ◽

2019 ◽

Vol 27 (2) ◽

pp. 390-406 ◽

Cited By ~ 5

Author(s):

Janine C de Snoo-Trimp ◽

Bert Molewijk ◽

Gøril Ursin ◽

Berit Støre Brinchmann ◽

Guy AM Widdershoven ◽

...

Keyword(s):

The Netherlands ◽

Factor Structure ◽

Healthcare Professionals ◽

Field Testing ◽

Daily Practice ◽

Delphi Panel ◽

Moral Case Deliberation ◽

Ethics Support ◽

Exploratory Factor Analyses ◽

Moral Case

Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare.

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Dealing with Moral Dilemmas in Psychotherapy: The Relevance of Moral Case Deliberation

The Oxford Handbook of Psychotherapy Ethics ◽

10.1093/oxfordhb/9780198817338.013.83 ◽

2020 ◽

Author(s):

Guy A. M. Widdershoven ◽

Andrea M. Ruissen

Keyword(s):

Healthcare Professionals ◽

Moral Dilemma ◽

Ethics Consultation ◽

Moral Dilemmas ◽

Moral Issue ◽

Martha Nussbaum ◽

Moral Case Deliberation ◽

Moral Issues ◽

Moral Case ◽

Dilemma Method

This chapter addresses the nature of moral issues in psychotherapy, and the way in which psychotherapists can be supported in dealing with them. It first explains the notion of moral dilemma, making use of the work of the philosopher Martha Nussbaum. Next it addresses Moral Case Deliberation (MCD) as an approach to support healthcare professionals. In MCD, a group of healthcare professionals deliberates on a moral issue in a concrete case. The deliberation is guided by a facilitator, who applies a deliberation method. The method presented here is the Dilemma Method. The chapter provides an example of a deliberation on a case in psychotherapy, concerning a patient with a request for euthanasia. It also describes experienced effects of MCD, and compares the approach with ethics consultation.

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Moral Competence, Moral Teamwork, Moral Action – Outcomes of Moral Case Deliberation in the Euro-MCD 2.0 For Evaluating Clinical Ethics Support

Studia Universitatis Babeş-Bolyai Bioethica ◽

10.24193/subbbioethica.2021.spiss.38 ◽

2021 ◽

Vol 66 (Special Issue) ◽

pp. 67-67

Author(s):

Janine de Snoo-Trimp ◽

◽

Keyword(s):

Clinical Ethics ◽

Healthcare Professionals ◽

Moral Action ◽

Moral Case Deliberation ◽

Moral Competence ◽

Revision Process ◽

Clinical Ethics Support ◽

Ethics Support ◽

Moral Case ◽

Difficult Situations

"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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Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities

Journal of Medical Ethics ◽

10.1136/medethics-2018-104745 ◽

2019 ◽

Vol 45 (9) ◽

pp. 608-616 ◽

Cited By ~ 4

Author(s):

Mia Svantesson ◽

Janine C de Snoo-Trimp ◽

Göril Ursin ◽

Henrica CW de Vet ◽

Berit S Brinchmann ◽

...

Keyword(s):

Empirical Research ◽

Emotional Support ◽

Healthcare Professionals ◽

Field Survey ◽

Moral Case Deliberation ◽

Moral Attitude ◽

Ethics Support ◽

Outcome Instrument ◽

The Future ◽

Moral Case

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument.

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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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Perceptions of Important Outcomes of Ethics Case Reflection Rounds: A Qualitative Study among Healthcare Professionals in Childhood Cancer Care

10.21203/rs.3.rs-24104/v1 ◽

2020 ◽

Author(s):

Charlotte Weiner ◽

Pernilla Pergert ◽

Bert Molewijk ◽

Anders Castor ◽

Cecilia Bartholdson

Keyword(s):

Quality Of Care ◽

Childhood Cancer ◽

Cancer Care ◽

Healthcare Professionals ◽

Well Being ◽

Moral Case Deliberation ◽

Individual Level ◽

Ethics Support ◽

Moral Case

Abstract BACKGROUND: In childhood cancer care, healthcare professionals mustdeal 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 want ethics support to help them deal with morally difficult situations.Ethics case reflection (ECR)roundsare one example of ethics support. However, there is little research intohealthcare professionals’ perceptions of important outcomes prior to participation in ethics case reflectionrounds in childhood cancer care. The aim was to explorehealthcare professionals’ perceptions of outcomes of ECR rounds important for handling moral challenges prior to participation in ECR rounds in childhood cancer care.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 Moral Case Deliberation questionnaire,before participating in regular ECR rounds. 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 who were invited to participate. The responses included healthcare professionals’ perceptions of which ethics case reflection round-related outcomes they found important for handling moral challenges. Three different themes of important outcomes emerged from the analysis of the data: Inter-professional wellbeing, Being in a professional comfort zone, and Improved quality of care. The themes are related to teams, individuals and care, respectively.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. To realize these perceived important outcomes, conditions for ECR rounds need to be improved. The results of this study can be used in future training for facilitators of ECR rounds, as well as providing information to healthcare managers wishing to implement this kind of ethics support.

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

10.21203/rs.3.rs-24104/v3 ◽

2020 ◽

Author(s):

Charlotte Weiner ◽

Pernilla Pergert ◽

Bert Molewijk ◽

Anders Castor ◽

Cecilia Bartholdson

Keyword(s):

Quality Of Care ◽

Childhood Cancer ◽

Cancer Care ◽

Healthcare Professionals ◽

Well Being ◽

Moral Case Deliberation ◽

Individual Level ◽

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 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 HCPs 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 Moral Case Deliberation Outcomes Instrument, before participating in regular MCDs. 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 who were invited to participate. 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 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 tailor the conditions.

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

10.21203/rs.3.rs-24104/v2 ◽

2020 ◽

Author(s):

Charlotte Weiner ◽

Pernilla Pergert ◽

Bert Molewijk ◽

Anders Castor ◽

Cecilia Bartholdson

Keyword(s):

Quality Of Care ◽

Childhood Cancer ◽

Cancer Care ◽

Healthcare Professionals ◽

Well Being ◽

Moral Case Deliberation ◽

Individual Level ◽

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 want 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 MCD related outcomes that HCPs in childhood cancer care considered important to achieve, before MCDs were implemented, in order to support them in handling moral challenges in every day clinical practice.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 Moral Case Deliberation questionnaire, before participating in regular MCDs. 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 who were invited to participate. 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: Inter-professional wellbeing, Being in a professional comfort zone, and Improved quality of care. The themes are related to teams, individuals and care, respectively.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 for information in 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 tailor the conditions. Finally, this study contributes to the reflection upon and evaluation of appropriate CESS outcomes in general.

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Learning Practical Wisdom from Moral Case Deliberation Through Morisprudence

Studia Universitatis Babeş-Bolyai Bioethica ◽

10.24193/subbbioethica.2021.spiss.68 ◽

2021 ◽

Vol 66 (Special Issue) ◽

pp. 106-106

Author(s):

Jos Kole ◽

◽

Keyword(s):

Medical School ◽

Conceptual Analysis ◽

Healthcare Professionals ◽

Practical Wisdom ◽

Teaching Method ◽

Moral Case Deliberation ◽

Organizational Contexts ◽

Moral Case ◽

Strong Relation ◽

The Individual

"Moral case deliberation is regularly used as a teaching method at our medical school. Besides we facilitate moral case deliberation on the ward in our hospital. In both instances, our assumption is that practicing moral case deliberation will assist our (future) healthcare professionals to cultivate the virtue of practical wisdom. But, is this assumption, right? The answer to this question requires both empirical research and conceptual analysis. This paper focuses on the latter. The claim defended is that we can elucidate the relation between moral case deliberation and practical wisdom through an analysis of so called morisprudence. We start with discussing two divergent but related interpretations of morisprudence: one introduced by Toulmin and Jonsen, related to casuistry, and one related to a Dutch interpretation with a strong relation to moral case deliberation. The combination of the both interpretations shed new light on the conceptual connections between cultivating prudence (practical wisdom) and moral case deliberation, but it also provides new insights into the individual and collective dimensions of practical wisdom, of character formation within organizational contexts. Finally, it may have consequences for how moral case deliberation should actually be employed to teach practical wisdom. "

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