Working towards implementing moral case deliberation in mental healthcare: Ongoing dialogue and shared ownership as strategy

Weidema, Froukje; Dartel, Hans van; Molewijk, Bert

doi:10.1177/1477750916644932

Cited by 17 publications

(14 citation statements)

References 63 publications

(74 reference statements)

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“…Their criticisms of the MCD process focused on: the length of time dedicated to discussing individual cases, the need for more practical and concrete results after MCD sessions and the lack of follow-up and integration of MCD into regular work process. These results are in line with other studies on MCD, which show that the follow-up, organization, and implementation of CES can be challenging in clinical practice (Finder & Bliton, 2011;Hartman, Inguaggiato, Widdershoven, Wensing-Kruger, & Molewijk, 2019a;Hartman et al, 2019b;Hem et al, 2015;Weidema, van Dartel, & Molewijk, 2016).…”

Section: Discussionsupporting

confidence: 89%

Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation

et al. 2020

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Treatment teams providing affirmative medical transgender care to young people frequently face moral challenges arising from the care they provide. An adolescent’s capacity to consent, for example, could raise several issues and challenges. To deal with these challenges more effectively, several Dutch treatment teams started using a relatively well-established form of clinical ethics support (CES) called Moral Case Deliberation (MCD). MCD is a facilitator-led, collective moral inquiry based on a real case. This study’s purpose is to describe the teams’ perceived value and effectiveness of MCD. We conducted a mixed methods evaluation study using MCD session reports, individual interviews, focus groups, and MCD evaluation questionnaires. Our results show that Dutch transgender care providers rated MCD as highly valuable in situations where participants were confronted with moral challenges. The health care providers reported that MCD increased mutual understanding and open communication among team members and strengthened their ability to make decisions and take action when managing ethically difficult circumstances. However, the health care providers also expressed criticisms of MCD: some felt that the amount of time spent discussing individual cases was excessive, that MCD should lead to more practical and concrete results, and that MCD needed better integration and follow-up in the regular work process. We recommend future research on three matters: studying how MCD contributes to the quality of care, involvement of transgender people themselves in MCD, and integration of CES into daily work processes.

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Section: Discussionsupporting

confidence: 89%

Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation

et al. 2020

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“…The aim of CESS is to support healthcare professionals, hospital management, patients, and relatives when confronted with an ethical concern, question or dilemma (Molewijk et al 2016 ). CESS have been implemented differently in parts of the world and come in various forms including clinical ethics committees, clinical ethics consultants, rapid reviews, ethics drop-in sessions, moral case deliberation, ethics reflection groups, ethics rounds, and seminars and conferences (Magelssen et al 2016 ; Molewijk et al 2016 ; UK CEN; Weidema et al 2016 ). CESS typically have four functions: (a) consultation on ethical issues relating to clinical cases, (b) participation in development of guidelines for good clinical practice, (c) education, and (d) reflection on ethical issues from the acute clinical setting (Andereck 1992 ; Førde and Pedersen 2011 ; Fost and Cranford 1985 ; Rosner 1985 ).…”

Section: Clinical Ethics Support In Contextmentioning

confidence: 99%

Making the (Business) Case for Clinical Ethics Support in the UK

Machin

Wilkinson

2020

HEC Forum

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This paper provides a series of reflections on making the case to senior leaders for the introduction of clinical ethics support services within a UK hospital Trust at a time when clinical ethics committees are dwindling in the UK. The paper provides key considerations for those building a (business) case for clinical ethics support within hospitals by drawing upon published academic literature, and key reports from governmental and professional bodies. We also include extracts from documents relating to, and annual reports of, existing clinical ethics support within UK hospitals, as well as extracts from our own proposal submitted to the Trust Board. We aim for this paper to support other ethicists and/or health care staff contemplating introducing clinical ethics support into hospitals, to facilitate the process of making the case for clinical ethics support, and to contribute to the key debates in the literature around clinical ethics support. We conclude that there is a real need for investment in clinical ethics in the UK in order to build the evidence base required to support the wider introduction of clinical ethics support into UK hospitals. Furthermore, our perceptions of the purpose of, and perceived needs met through, clinical ethics support needs to shift to one of hospitals investing in their staff. Finally, we raise concerns over the optional nature of clinical ethics support available to practitioners within UK hospitals.

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“…To address this issue, the two authors openly discussed and explored possible aims and ownership of the evaluation study. They emphasized that the evaluation research was not an end in itself, but a necessary means to develop an integrative CES approach in that it would enable them to adjust CES to the staff's needs and to increase the CES's usefulness and impact (Weidema et al 2016). Hence, a guiding principle in the evaluation study was that it was not merely an evaluation of the CES as a product, but a means of jointly learning from the staff's CES experience in order to better address their needs and challenges (i.e., a responsive evaluation study).…”

Section: Evaluation Researchmentioning

confidence: 99%

Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned

et al. 2019

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Clinical ethics support (CES) for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria (CEGD) at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice.

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Working towards implementing moral case deliberation in mental healthcare: Ongoing dialogue and shared ownership as strategy

Cited by 17 publications

References 63 publications

Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation

Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation

Making the (Business) Case for Clinical Ethics Support in the UK

Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned

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