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

Abstract

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.

‘Ethics Between the Lines’ – Nurses’ Experiences of Ethical Challenges in Long-Term Care

“…Some methods of ethical reflection are based on what is morally right according to policies and laws (Schuchter & Heller, 2018), while other methods focus on how participants perceive and construct moral rightness where legal or ethical principles might be a part of the dialogue, but not necessarily (Molewijk et al, 2011). The latter approach, known as moral case deliberation, acknowledges emotions and can promote a better understanding of oneself and give emotional support like comfort and enhanced resilience (Molewijk et al, 2011; Spronk et al, 2020). This accords with our findings.…”

Euthanasia in advanced dementia; the view of the general practitioners in the Netherlands on a vignette case along the juridical and ethical dispute

“…This implies that there is also a need for a proactive, broader, multidisciplinary decision-making process for complex euthanasia requests of PWADs, for instance supported by moral case deliberation (MCD). A recent study showed that addressing harm in MCD aids healthcare professionals in the task they are facing [36]. Giving GPs better access towards MCD would be a sensible policy as it may counteract polarization within the profession and society.…”

“…The relatively high response rate emphasizes GPs' high involvement in this topic, as other surveys among Dutch GPs mostly had much lower response rates (around 30%) [38][39][40]. The respondents are representative for the Dutch GP practice, as checked for age, gender and region [36].…”

Title Euthanasia in advanced Dementia; the view of the GPs in the Netherlands on a vignette case along the juridical and ethical dispute . A survey among Dutch general practitioners

“…A recent study showed that addressing harm in MCD aids healthcare professionals in the task they are facing. [34] Giving GPs better access towards MCD would be a sensible policy as it may counteract polarization within the profession and society. In our earlier study we also argued for creating awareness of the possibility to consult a spiritual care provider.…”