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

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 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.