Skip to main content
SpringerLink
Log in

Implementing moral case deliberation in a psychiatric hospital: process and outcome

  • Scientific Contribution
  • Published:
Medicine, Health Care and Philosophy Aims and scope Submit manuscript

Abstract

Background

Clinical moral case deliberation consists of the systematic reflection on a concrete moral case␣by health care professionals. This paper presents the study of a 4-year moral deliberation project.

Objectives

The objectives of this paper are to: (a) describe the practice and the theoretical background of moral deliberation, (b) describe the moral deliberation project, (c) present the outcomes of␣the evaluation of the moral case deliberation sessions, and (d) present the implementation process.

Methods

The implementation process is both monitored and supported by an interactive responsive evaluation design with: (a) in-depth interviews, (b) Maastricht evaluation questionnaires, (c) evaluation survey, and (d) ethnographic participant observation. In accordance with the theory of responsive evaluation, researchers acted both as evaluators and moderators (i.e. ethicists).

Results

Both qualitative and quantitative results showed that the moral case deliberations, the role of the ethics facilitator, and the train-the-facilitator program were regarded as useful and were evaluated as (very) positive. Health care professionals reported that they improved their moral competencies (i.e. knowledge, attitude and skills). However, the new trained facilitators lacked a clear organisational structure and felt overburdened with the implementation process. The paper ends with both practical and research suggestions for future moral deliberation projects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abma T.A.: 2005, Patient Participation in Health Research. Research with and for People with Spinal Cord Injuries. Qualitative Health Research, 15(10), 1–19

    Article  Google Scholar 

  • Abma T.A., G.A.M. Widdershoven.: 2005, Sharing Stories: Narrative and Dialogue in Responsive Nursing Evaluation. Evaluation and the Health Professions, 28(1), 90–109

    Article  CAS  Google Scholar 

  • Abma T.A., G.A.M. Widdershoven.: 2006, Moral Deliberation in Clinical Psychiatric Nursing Practice. Nursing Ethics, 13(5), 1–12

    Article  Google Scholar 

  • Argyris C.: 1983, Action Science and Intervention. Journal of Applied Behavioural Science, 19(2), 115–140

    Article  Google Scholar 

  • ASBH Task Force on Standards for Bioethics Consultation: 1998, Core Competencies for Health Ethics Consultation. The Report of the American Society for Bioethics and Humanities. ASBH

  • Aulisio M.P., R.M. Arnold, S.J. Youngner (eds.).: 2003, Ethics Consultation: From Theory to Practice. Baltimore & London: The John Hopkins University Press

    Google Scholar 

  • CEG.: 2005, ‹Signalering ethiek en gezondheid’ [‹Agenda ethics and health care’], in CEG, Ethiek in de zorgopleidingen en zorginstellingen [Ethics in the Care Education and the Health Care Institutions] (ch. 6). Zoetermeer: Centrum voor Ethiek en Gezondheid [Center for Ethics and Health]

  • Dartel H. van: 1998, Van ethische commissie naar stuurgroep ethiek. Over de implementatie van moreel beraad in het kwaliteitsbeleid van instellingen voor gezondheidszorg [From Ethics Committee to Steering Committee. On the Implementation of Moral Deliberation Within the Quality Policy of Health Care Institutions]. Utrecht: CELAZ/Nederlandse Zorgfederatie

    Google Scholar 

  • Fox E.: 1996, Concepts in Evaluation Applied to Ethics Consultation Research. The Journal of Clinical Ethics, 7(2), 116–121

    PubMed  CAS  Google Scholar 

  • Fox E., R.M. Arnold.: 1996, Evaluating Outcomes in Ethics Consultation Research. The Journal of Clinical Ethics, 7(2), 127–138

    PubMed  CAS  Google Scholar 

  • Fox E., J.A. Tulsky.: 1996, Evaluation Research and the Future of Ethics Consultation. The Journal of Clinical Ethics, 7(2), 146–149

    PubMed  CAS  Google Scholar 

  • Fox E., K.A. Berkowitz, B.L. Chanko, T. Powell.: 2004, Integrated Ethics. Improving Ethics Quality in Health Care. Ethics Consultation, Responding to Ethics Concerns in Health Care. Washington, D.C.: National Center for Ethics in Health Care, Veterans Health Administration

    Google Scholar 

  • Gabriel, Y.: 2000, Storytelling in Organizations. Facts, Fictions, and Fantasies. Oxford: Oxford University Press

    Google Scholar 

  • Gadamer, H.G.: 1960, Wahrheit und Methode. Tübingen: J.C.B. Mohr

    Google Scholar 

  • Geertz, C.: 1973, The Interpretation of Cultures. New York: Basic Books

    Google Scholar 

  • Gracia, D.: 2003, Ethical Case Deliberation and Decision-Making. Medicine Health Care and Philosophy, 6(3), 227–233

    Article  Google Scholar 

  • Greene, J.C.: 1988, Stakeholder Participation and Utilization Program Evaluation. Evaluation Review, 12(2), 91–116

    Article  Google Scholar 

  • Guba, E.G., Y.S. Lincoln.: 1989, Fourth Generation Evaluation. Beverly Hills: Sage

    Google Scholar 

  • Hammersley M., P.M. Atkinson.: 1995, Ethnography: Principles in Practice (2nd ed.). New York: Routledge

    Google Scholar 

  • Hull S.C., H.A. Taylor, N.E Kass.: 2001, Qualitative Methods. in J. Sugarman, & D.P. Sulmasy (Eds.), Methods in Medical Ethics (pp. 146–168). Washington, D.C.: Georgetown University Press

    Google Scholar 

  • Koch, T.: 2000, ‹Having a Say:’ Negotiation in Fourth Generation Evaluation. Journal of Advanced Nursing, 31(1): 117–125

    Article  PubMed  CAS  Google Scholar 

  • Lave J., E. Wenger.: 1991, Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press

    Google Scholar 

  • Leder, D.: 1994, Toward a Hermeneutical Bioethics. in E. Dubose, R. Hamel, L. O’Connell. (Eds.), A Matter of Principles? (pp. 240–259). Valley Forge: Trinity Press International

    Google Scholar 

  • Manschot H. and H. van Dartel (eds.).: 2003. In gesprek over goede zorg. Overlegmethoden voor ethiek in de praktijk [Being engaged in conversations on good care. Conversations methods for ethics in practice]. Amsterdam: Boom

  • MacIntryre, A.: 1981, After Virtue. London: Duckworth

    Google Scholar 

  • Marshall P.L., B.A. Koenig.: 2001, Ethnographic Methods. in J. Sugarman, D.P. Sulmasy (Eds.), Methods in Medical Ethics (pp. 169–191). Washington, D.C.: Georgetown University Press

    Google Scholar 

  • Merleau-Ponty, M.: 1945, Phénoménologie de la perception. Paris: Gallimard

    Google Scholar 

  • Min. VWS.: 2005, Agenda ethiek en gezondheid 2006 [Agenda Ethics and Health Care 2006]. The Hague: Ministry of Health Care, Welfare and Sport

  • Molewijk, B.: 2004, Tussen evaluatie Moreel Beraad project Vijverdal-Riagg Maastricht [Interim Research Report of the Moral Deliberation Project Vijverdal-Riagg Maastricht]. Maastricht

  • Molewijk B., G. Widdershoven: 2006, Moreel beraad en goede zorg voor ouderen veronderstellen en versterken elkaar [Moral deliberation both presupposes and strengthen good care for the elderly] Tijdschrift voor Geneeskunde [Journal of Medicine (Belgium)], 62(23), 1693–1701

    Article  Google Scholar 

  • Molewijk, B. and G. Widdershoven: 2007, ‹Report of the Maastricht meeting of the European Clinical Ethics Network’, Clinical Ethics 2(1), 42–45

    Google Scholar 

  • Molewijk, B., T. Abma, M. Stolper and G. Widdershoven: 2007, ‹Teaching Ethics in the Clinic. The Theory and Practice of Moral Case Deliberation’, Journal of Medical Ethics, in press

  • Ranson, S., B. Molewijk and G. Widdershoven: 2006, ‹Deliberating on Deliberation. An Evaluation on Empirical Evaluation Studies on Ethics Consultation and Moral Deliberation’, paper presented at the EACME conference in Leuven, Belgium

  • Rapoport, R.: 1970, Three Dilemmas in Action Research. Human Relations, 23(6), 499–513

    Article  Google Scholar 

  • Ricoeur, P.: 1983, Temps et récit, I. Paris: Editions du Seuil

    Google Scholar 

  • Rosen, M.: 1991, Coming to Terms with the Field: Understanding and Doing Organisational Ethnography Journal of Management Studies, 28(1), 1–24

    Article  Google Scholar 

  • Schwandt, T.A.: 2001, A Postscript on Thinking About Dialogue Evaluation, 7(2), 264–276

    Article  Google Scholar 

  • Shulha L.M., J.B. Cousins.: 1997, Evaluation Use: Theory, Research, and Practice Since 1986. Evaluation Practice 18(3) 195–208

    Article  Google Scholar 

  • Stake, R.E.: 1975, To Evaluate an Arts Program in R.E. Stake (ed) Evaluating the Arts in Education: A Responsive Approach (pp. 13–31). Colombus, Ohio: Merrill

    Google Scholar 

  • Stake R., D. Trumbell.: 1982, Naturalistic Generalizations Review Journal of Philosophy and Social Science, 1, 1–12

    Google Scholar 

  • Steinkamp N., B. Gordijn.: 2003, Ethical Case Deliberation on the Ward. A Comparison of Four Methods Medicine Health Care and Philosophy, 6(3), 235–246

    Article  Google Scholar 

  • Steinkamp N., B. Gordijn.: 2004, Ethik in der Klinik. Ein Arbeitsbuch [Ethics in the Clinic. A workbook]. Köln-München: Springer-Verlag

    Google Scholar 

  • Verkerk, M.J.: 2004, Trust and Power on the Shop Floor. An Ethnographical, Ethical, and Philosophical Study on Responsible Behaviour in Industrial Organisations. Delft: Eburon

    Google Scholar 

  • Verkerk M.J., J. de Leede, A.H.J. Nijhof.: 2001, From Responsible Management to Responsible Organisations: The Democratic Principle for Managing Organizational Ethics Business and Society Review, 106(4), 353–378

    Article  Google Scholar 

  • Walker, M.U.: 1998, Moral Understanding: A Feminist Study in Ethics. NY: Routledge

    Google Scholar 

  • Weick, K.E.: 1995, Sense Making in Organisations. London: Sage

    Google Scholar 

  • Whyte, W.F. (ed.).: 1991, Participatory Action Research. Newbury Park: Sage

  • Widdershoven, G.A.M.: 2001, Dialogue in Evaluation: A Hermeneutic Perspective. Evaluation, 7(2), 253–263

    Article  Google Scholar 

  • Widdershoven, G.A.M.: 2005, Interpretation and Dialogue in Hermeneutic Ethics. in R. Ashcroft, A. Lucassen, M. Parker, M. Verkerk, G. Widdershoven (Eds.), Case Analysis in Clinical Ethics (pp. 57–75). Cambridge: Cambridge UP

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Health, Ethics and Society/metamedica Faculty of Health, Medicine and Life Sciences, School of Public Health and Primary care (Caphri), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands

    Bert Molewijk & Guy Widdershoven

  2. GGnet, Mental Health Care Institution, Zutphen, The Netherlands

    Bert Molewijk

  3. Vijverdal Maastricht, Psychiatric Hospital, Maastricht, The Netherlands

    Maarten Verkerk & Henk Milius

Authors
  1. Bert Molewijk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maarten Verkerk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henk Milius
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guy Widdershoven
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bert Molewijk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Molewijk, B., Verkerk, M., Milius, H. et al. Implementing moral case deliberation in a psychiatric hospital: process and outcome. Med Health Care and Philos 11, 43–56 (2008). https://doi.org/10.1007/s11019-007-9103-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11019-007-9103-1

Keywords

Search

Navigation