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

Abstract

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.

Does Moral Case Deliberation Change Current Views on Restrictions?: Staff Perceptions on Restrictions

“…The MCD sessions in our study were organized in line with the dilemma-method, a widely used form of MCD in healthcare organizations (Gerritsen et al, 2020). According to the dilemma-method (Gerritsen et al, 2020), the facilitator asks the participants to describe two opposite sides within the discussed dilemma and to summarize the corresponding values belonging to both sides. Subsequently, values are to be weighed against each other and participants discuss which values should prevail.…”

“…Furthermore, MCD provides support staff with the ability to learn from each other (Rasoal, 2018). MCD, more specific the dilemma‐method, 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” (Gerritsen, Widdershoven, Bossenbroek, & Voskes, 2020, p. 2). Furthermore, by examining what is morally right in a specific care situation, MCD contributes to the improvement of the ethical climate and the moral quality of the care process (Molewijk, Verkerk, Milius, & Widdershoven, 2008).…”