Does Moral Case Deliberation Help Professionals in Care for the Homeless in Dealing with Their Dilemmas? A Mixed-Methods Responsive Study

Abstract

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation (MCD) is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people's perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization.

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

“…3,9,10 For instance, in the study of Söderhamn et al, 9 healthcare professionals reported to have experienced an enhanced moral awareness of ethical issues and that they learned more about themselves in order to become better healthcare professionals. More recently, and also with use of a (quantitative) questionnaire, Spijkerboer et al 3 found that MCD fosters working together and fosters communication. Furthermore, a recent literature review reported that impact of MCD was mainly shown at both the individual level and in the relationships between professionals.…”

“…1 MCD i has been implemented now for more than two decades in many healthcare settings. [2][3][4][5] MCD is a group dialogue in which professionals (sometimes with patients and family) jointly investigate a moral question that emerges out of a situation they experienced in their daily practice, by reflecting on relevant values and norms from different perspectives and on possible solutions. The dialogue is led by a trained facilitator.…”

“…6 In literature about MCD, various goals have been described, like improving collaboration among colleagues, learning to identify moral questions, and, by becoming aware of one's own viewpoint, acknowledging viewpoints of others. [6][7][8] Furthermore, several studies have been carried out to evaluate MCD through ways of dealing with moral dilemmas, 3,9 satisfaction among MCD participants 10,11 and assessment of MCD content. 7,[12][13][14] As such, these studies were qualitative in nature and focused on the experiences of participants during the MCD sessions.…”

Ethical Dilemmas and Areas of Social Work Intervention in Spain

“…These dilemmas have their origin in the budgetary cuts of the Welfare State and in the change of social policies because of the economic crisis. These changes generate new ethical tensions in social workers and, apparently, to a greater extent in this area of intervention, as stated in previous studies (Banks, 2011;Spijkerboer, van der Stel, Widdershoven & Molewijk, 2017).…”

“…These services are organized and managed in regards to the sections of the population at which they are aimed. The following factors are taken into account, without forgetting the previous contributions of other researchers: health (Goldman & Tabak, 2010;Greene & Kulper, 1990;Kadushin, 2001;Proctor, Morrow-Howell & Lott, 1993;Sparks, 2006), childhood (Meysen & Kelly, 2018), immigrants (Furman, Ackerman, Loya, Jones & Egi, 2012;Mänttarivan der Kuip, 2016), women (Cervantes, 1993;Lindhorst, Macy & Nurius, 2005;Wiech, 2009), family (Handon, 2009), homeless (Banks, 2011;Spijkerboer, van der Stel, Widdershoven & Molewijk, 2017), ethnic minorities (Pergert, Ekblad, Enskär & Biörk, 2008;Van Keer, Deschepper, Francke, Huyghens & Bilsen, 2015), youth (Banks, 2012), prisoners (Baldry & Sotiri, 2009;Toi, 2015), the elderly (Bergeron & Gray, 2003;Fitting, 1986;Smebye, Kirkevold & Engedal, 2016), refugees (Barrero, 1993;Hayes & Humphries, 2004), educational centres (Allen-Meares, 2004;Constable, 2002;Dupper, 2003;Openshaw, 2008;Reamer, 2003;Roberts, 1971;Villarreal, 2017), mental health (Molewijk, Hem & Pedersen, 2015), disability (Donat, 2005;Iacono & Murray, 2003;Wilkins, 2012), and drugs …”