Tragedy in moral case deliberation

Spronk, Benita; Stolper, Margreet; Widdershoven, Guy

doi:10.1007/s11019-016-9749-7

Cited by 10 publications

(16 citation statements)

References 22 publications

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“…In healthcare, professionals are frequently confronted with morally complex and sometimes tragic situations in which difficult treatment and care decisions with far-reaching consequences have to be made [ 1 ]. Clinical ethics support (CES) helps in dealing with these complex issues.…”

Section: Introductionmentioning

confidence: 99%

Impact of moral case deliberation in healthcare settings: a literature review

Haan¹,

Gurp²,

Naber³

et al. 2018

BMC Med Ethics

102

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BackgroundAn important and supposedly impactful form of clinical ethics support is moral case deliberation (MCD). Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings.MethodsA systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science (June 2016). Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of our decisions. The qualitative analysis was supported by ATLAS.ti.ResultsBased on a qualitative analysis of 25 empirical papers, we identified four clusters of themes: 1) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organization; 2) changes that are brought about on a personal and inter-professional level, with regard to professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and awareness of the importance of reflection; 3) changes that are brought about in caring for patients and families; and 4) changes that are brought about on an organizational level.ConclusionsThis review shows that MCD brings about changes in practice, mostly for the professional in inter-professional interactions. Most reported changes are considered positive, although challenges, frustrations and absence of change were also reported. Empirical evidence of a concrete impact on the quality of patient care is limited and is mostly based on self-reports. With patient-focused and methodologically sound qualitative research, the practice and the value of MCD in healthcare settings can be better understood, thus making a stronger case for this kind of ethics support.

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Section: Introductionmentioning

confidence: 99%

Impact of moral case deliberation in healthcare settings: a literature review

Haan¹,

Gurp²,

Naber³

et al. 2018

BMC Med Ethics

102

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“…MCD has mostly been conducted and studied in the Netherlands (Dauwerse et al 2014 ; Spronk et al 2017 ). So far, research has mainly focused on the implementation of the method itself, and on the education of facilitators (Molewijk et al 2008a , b ; Plantinga et al 2012 ; Stolper et al 2015 ; Weidema et al 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Relational autonomy in the care of the vulnerable: health care professionals’ reasoning in Moral Case Deliberation (MCD)

Heidenreich

Bremer

Materstvedt

et al. 2017

Med Health Care and Philos

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In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans.

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“…MCD can help in this regard [43]. In terms of moral distress, MCD differs in its approach by assuming at the outset that no satisfactory choice is possible, since both alternatives will be accompanied by moral harm [10].…”

Section: Discussionmentioning

confidence: 99%

“…Tragic situations require choices that involve suffering and death. These choices are often accompanied by feelings of powerlessness, and entail threats to human dignity [10]. If there is any place where such situations abound, it is in hospitals.…”

Section: The Concept Of Tragedymentioning

confidence: 99%

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Addressing harm in moral case deliberation: the views and experiences of facilitators

2020

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Background: In healthcare practice, care providers are confronted with decisions they have to make, directly affecting patients and inevitably harmful. These decisions are tragic by nature. This study investigates the role of Moral Case Deliberation (MCD) in dealing with tragic situations. In MCD, caregivers reflect on real-life dilemmas, involving a choice between two ethical claims, both resulting in moral damage and harm. One element of the reflection process is making explicit the harm involved in the choice. How harmful are our decisions? We investigated how facilitators of MCD experience the importance of addressing harm in MCD and what participants learn from reflecting on harm. Methods: The 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. The research focuses on the subjective experiences of facilitators. Grounded Theory was used for analysis. Results: The results show two main categories. The first concerns the awareness of tragedy. Within this category, five themes were discerned: making explicit that there is no solution, visualizing consequences, uncovering pain, focusing on emotion, and exploring perspectives on harm. The second category concerns the support for healthcare professionals in dealing with the tragedy of the choices they face. In this category, five themes came forward: acknowledging, offering comfort, managing harm, consideration through dialogue and repairing harm. Conclusion: Our study shows that addressing harm in MCD in tragic situations provides an important moral learning opportunity for participants. By formulating and becoming aware of harm, MCD aids healthcare professionals in the task they are faced with, namely making difficult and painful choices. MCD helps healthcare professionals to repair moral damage, making clear at the same time that harm cannot be undone.

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Tragedy in moral case deliberation

Cited by 10 publications

References 22 publications

Impact of moral case deliberation in healthcare settings: a literature review

Impact of moral case deliberation in healthcare settings: a literature review

Relational autonomy in the care of the vulnerable: health care professionals’ reasoning in Moral Case Deliberation (MCD)

Addressing harm in moral case deliberation: the views and experiences of facilitators

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