An empirical investigation into moral challenges of (breaching) confidentiality and needs for ethics support when facilitating moral case deliberation

Abstract

Ethics support staff help others to deal with moral challenges. However, they themselves can also experience moral challenges such as issues regarding (breaching) confidentiality when practicing ethics support. Currently there is no insight in these confidentiality issues and also no professional guidance for dealing with them. To gain insight into moral challenges related to Moral Case Deliberation (MCD), we studied a) beliefs and experiences of MCD facilitators regarding breaching confidentiality, b) considerations for (not) breaching confidentiality, and c) needs for an ethics support tool. Data collection consisted of qualitative research methods: six semi-structured interviews; analyses of a) two recorded MCD sessions, and b) a focus group with MCD facilitators. Findings: MCD facilitators mention different conceptions and interpretations of confidentiality and various moral challenges. Questions concerning confidentiality ultimately cause reflections on roles and responsibilities of facilitators. Needs for ethics support vary from seeking advice to procedural and sometimes normative guidance for MCD facilitators. Education for MCD facilitators should focus on developing a concrete tool that stimulates awareness and reflection(skills).

Ethics support for ethics support: the development of the Confidentiality Compass for dealing with moral challenges concerning (breaching) confidentiality in moral case deliberation

“…Based on some critical confidentiality incidents when offering MCD (e.g., when participants in MCD decided upon illegal actions or when external parties, like the Health Inspectorate, asked the MCD facilitator to report about the content of a MCD session, [7]) and because of the lack of guidance or policy, we started to develop an ethics support tool for moral challenges related to (breaching) confidentiality in MCD. At the same time the project aimed to protect the trustworthiness and quality of MCD (facilitators) and ethics support services as such, as dealing in a morally appropriate way with confidentiality issues in CES is strongly related to trust and quality.…”

“…In definitions it is often associated with different concepts like privacy, trust and reliability. The content of what exactly should be kept confidential according to MCD facilitators also varies from details from the case, notes, decisions, participants, and aspects of the content and the process of the specific MCD session [7].…”