Learning Practical Wisdom from Moral Case Deliberation Through Morisprudence

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. "

Moral case deliberation

2017 ◽  
Vol 18 (3) ◽  
pp. 181-186 ◽  
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.

scholarly journals Moral Competence, Moral Teamwork and Moral Action – The European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

2020 ◽  
Author(s):  
Janine de Snoo-Trimp ◽  
Riekie de Vet ◽  
Guy Widdershoven ◽  
Bert Molewijk ◽  
Mia Svantesson
Keyword(s):  
Healthcare Professionals ◽  
Field Studies ◽  
Current Status ◽  
Future Research ◽  
Moral Action ◽  
Moral Case Deliberation ◽  
Sentence Structure ◽  
Moral Competence ◽  
Revision Process ◽  
Moral Case

Abstract Background Clinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.Methods The revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.Results The Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.Conclusions : The Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD.

scholarly journals Moral Competence, Moral Teamwork and Moral Action – The European Moral Case Deliberation Outcomes (Euro-MCD) Instrument 2.0 and its revision process

2020 ◽  
Author(s):  
Janine de Snoo-Trimp ◽  
Riekie de Vet ◽  
Guy Widdershoven ◽  
Bert Molewijk ◽  
Mia Svantesson
Keyword(s):  
Healthcare Professionals ◽  
Field Studies ◽  
Current Status ◽  
Future Research ◽  
Moral Action ◽  
Moral Case Deliberation ◽  
Sentence Structure ◽  
Moral Competence ◽  
Revision Process ◽  
Moral Case

Abstract Background Clinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process. Methods The revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.Results The Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.Conclusions: The Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD.

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

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.

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

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. "

What Outcomes do Dutch Healthcare Professionals Perceive as Important Before Participation in Moral Case Deliberation?

Bioethics ◽  
2017 ◽  
Vol 31 (4) ◽  
pp. 246-257 ◽  
Author(s):  
Janine de Snoo-Trimp ◽  
Guy Widdershoven ◽  
Mia Svantesson ◽  
Riekie de Vet ◽  
Bert Molewijk
Keyword(s):  
Healthcare Professionals ◽  
Moral Case Deliberation ◽  
Moral Case

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

2019 ◽  
Vol 45 (9) ◽  
pp. 608-616 ◽  
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.

Training healthcare professionals as moral case deliberation facilitators: evaluation of a Dutch training programme

2012 ◽  
Vol 38 (10) ◽  
pp. 630-635 ◽  
Author(s):  
Mirjam Plantinga ◽  
Bert Molewijk ◽  
Menno de Bree ◽  
Marloes Moraal ◽  
Marian Verkerk ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Training Programme ◽  
Moral Case Deliberation ◽  
Moral Case

The role of emotions in Moral Case Deliberation: Visions and experiences of facilitators

2021 ◽  
pp. 147775092110114
Author(s):  
Benita Spronk ◽  
Guy Widdershoven ◽  
Hans Alma
Keyword(s):  
Healthcare Professionals ◽  
Moral Case Deliberation ◽  
Negative Aspect ◽  
Positive Aspect ◽  
Moral Question ◽  
Deliberation Process ◽  
Moral Case ◽  
Moral Resilience

Moral Case Deliberation is intended to assist healthcare professionals faced with difficult dilemmas in their work. These are situations that involve emotions. During Moral Case Deliberation, participants are invited to reflect on moral views and deliberate on them. Emotions are not explicitly addressed. This article aims to elucidate the role of emotions in Moral Case Deliberation, by analysing experiences of Moral Case Deliberation facilitators. Our research shows the role of emotions varies according to the phase of the Moral Case Deliberation process. One negative aspect of emotions is that they can obstruct the Moral Case Deliberation discussion or distract from the moral question. A positive aspect is that they bring the dilemma into sharper focus. Devoting attention to emotions can help to ensure that responsible decisions are made, while also increasing the moral resilience of participants.

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

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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