How Moral Case Deliberation Supports Good Clinical Decision Making

Inguaggiato, Giulia; Metselaar, Suzanne; Molewijk, Bert; Widdershoven, Guy

doi:10.1001/amajethics.2019.913

Cited by 21 publications

(10 citation statements)

References 15 publications

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“…MCD is a specific approach in CES that aims to foster systematic reflection on moral questions (10). MCD has a theoretical background in pragmatic hermeneutics and dialogical ethics (12). This background manifests itself by an emphasis on a concrete, practice-oriented case, which is experienced by the participating care professionals themselves, or is easy to envision for them.…”

Section: Methodsmentioning

confidence: 99%

Moral Dilemmas in Contact-Based Care: The Relevance of Moral Case Deliberation for Forensic Psychiatry

et al. 2020

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Currently, forensic psychiatry shows a shift from a control-based to a contact-based approach. Working from contact may, however, entail new moral questions and dilemmas. How to secure safety when focusing on contact? Does contact imply being physically close to the patient, or should one refrain from intimate relations? In order to help care professionals to deal with these moral issues, clinical ethics support can be useful. A specific approach in clinical ethics support is moral case deliberation (MCD). An MCD is a structured dialogue between professionals on a moral issue they experience in practice, structured by a conversation method and guided by a facilitator. In this article, we describe the background and procedures of MCD. Furthermore, we present a case example in which care professionals reflect on the moral question of whether provision of care in forensic psychiatry may entail physical closeness. The MCD shows that an open conversation results in a better understanding of different perspectives and creates the basis for finding a joint way to proceed in the case. We conclude that MCD can enable professionals to reflect on moral issues and develop shared values in forensic psychiatry.

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Section: Methodsmentioning

confidence: 99%

Moral Dilemmas in Contact-Based Care: The Relevance of Moral Case Deliberation for Forensic Psychiatry

et al. 2020

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“…Ethics deliberation is dynamic: science or cultural norms may have evolved or relied on reasoning may have been flawed or tainted by unconscious or implicit bias. This approach may unintentionally risk limiting that which CESS is designed to ensure—moral space for rich discussion, encouraging new and alternate viewpoints and allowing each individual case to be judged on its own merits, including embracing and exploring dissensus 2…”

Section: Patterns and Process: Complimentary Approachesmentioning

confidence: 99%

“…We advocate that rather than solely focusing on MCD pattern-related content , ensuring structured, consistent, facilitated processes for fair and ‘robust’ MCD is similarly essential to promote organisational QI. Characteristics of such a process may include ensuring appropriate stakeholder participation, systematic presentation of facts, eliciting and thorough exploration all stakeholder values and use of collaborative dialogue 2. MCD should also emphasise capacity to foster acknowledgement of a lack of consensus and ensure openness to diverse values to develop a deeper understanding of the case and courses of action 2.…”

Section: Patterns and Process: Complimentary Approachesmentioning

confidence: 99%

“…Characteristics of such a process may include ensuring appropriate stakeholder participation, systematic presentation of facts, eliciting and thorough exploration all stakeholder values and use of collaborative dialogue 2. MCD should also emphasise capacity to foster acknowledgement of a lack of consensus and ensure openness to diverse values to develop a deeper understanding of the case and courses of action 2. That is, more experience undertaking systematic deliberation by applying a methodical, structured framework and practicing facilitated moral reasoning drives improved performance of ethical reflection, critical reasoning and construction of robust ethical rationales applicable to all cases, beyond their content.…”

Section: Patterns and Process: Complimentary Approachesmentioning

confidence: 99%

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Towards organisational quality in ethics through patternsandprocess

2022

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“…The goal of quality improvement is to raise the entire healthcare quality curve within the organisation 14 15. CESS evaluation research has, however, mainly focused on the quality of CESS provision itself,9 15–18 the quality improvement in a single case where CESS were provided,16 or on individual outcome variables rather than organisational outcomes 5 9 12 19–25. Admittedly, these research endeavours have led to theoretical rationales for how CESS benefit individual learning and how they provide quality in single-patient cases .…”

Section: Introductionmentioning

confidence: 99%

Morisprudence: a theoretical framework for studying the relationship linking moral case deliberation, organisational learning and quality improvement

et al. 2022

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There is a claim that clinical ethics support services (CESS) improve healthcare quality within healthcare organisations. However, there is lack of strong evidence supporting this claim. Rather, the current focus is on the quality of CESS themselves or on individual learning outcomes. In response, this article proposes a theoretical framework leading to empirical hypotheses that describe the relationship between a specific type of CESS, moral case deliberation and the quality of care at the organisational level. We combine insights from the literature on CESS, organisational learning and quality improvement and argue that moral case deliberation causes healthcare professionals to acquire practical wisdom. At the organisational level, where improving quality is a continuous and collective endeavour, this practical wisdom can be aggregated into morisprudence, which is an ongoing formulation of moral judgements across cases encountered within the organisation. Focusing on the development of morisprudence enables refined scrutinisation of CESS-related quality claims.

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How Moral Case Deliberation Supports Good Clinical Decision Making

Cited by 21 publications

References 15 publications

Moral Dilemmas in Contact-Based Care: The Relevance of Moral Case Deliberation for Forensic Psychiatry

Moral Dilemmas in Contact-Based Care: The Relevance of Moral Case Deliberation for Forensic Psychiatry

Towards organisational quality in ethics through patternsandprocess

Morisprudence: a theoretical framework for studying the relationship linking moral case deliberation, organisational learning and quality improvement

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