The discovery of deliberation. From ambiguity to appreciation through the learning process of doing Moral Case Deliberation in Dutch elderly care

• Published in: Social science & medicine (1982) Vol. 83; pp. 125 - 132
• Main Authors: van der Dam, Sandra, Schols, Jos M.G.A., Kardol, Tinie J.M., Molewijk, Bert C., Widdershoven, Guy A.M., Abma, Tineke A.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.04.2013; Elsevier; Pergamon Press Inc
• Subjects: Adult Care Services; Aged; Ambiguity; Attitude of Health Personnel; Attitudes; Bioethics; Biological and medical sciences; Care of the aged; Clinical ethics; Competence; Doctors; Elder care; Elderly; Elderly care; Ethics; Ethics, Clinical - education; Everyday ethics; Focus Groups; Geriatrics - ethics; Health care; Health care industry; Health Care Services; Health Personnel - education; Health Personnel - psychology; Homes for the Aged - ethics; Humans; Interprofessional Relations; Learning; Long-term care; Medical sciences; Miscellaneous; Moral Case Deliberation; Moral Development; Morality; Netherlands; Nursing Homes - ethics; Psychological Distress; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative Research; Teaching. Deontology. Ethics. Legislation; The Netherlands; Netherlands; Europe; The Netherlands; Moral Case Deliberation; Everyday ethics; Clinical ethics; Elderly care; Long-term care; Human; Discoveries; Care; Learning; Ethics; Acquisition process; Social medicine; Dutch; Elderly; Public health; Long term care
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2013.01.024

In the field of bioethics a trend can be noticed toward deliberative and collective forms of moral reflection among practitioners. Moral Case Deliberation (MCD) is an example of this development and currently introduced in an increasing number of health care organizations in the Netherlands, including elderly care. The purpose of this article is to evaluate the process of implementation of MCD focusing on the learning experiences of practitioners over time. The article is grounded in a naturalistic evaluation of the implementation of MCD in two elderly care institutions between 2006 and 2012. Methods included interviews, participant observations and focus groups. The results indicate that gaining experience with MCD brought about a learning process in which both the learning of competence for reflection and deliberation (e.g. an exploratory attitude) and experiencing the benefits (e.g. relief of moral distress) were key elements. We conclude that doing ethics is the best way to motivate practitioners to engage in moral deliberations on the work floor. Gaining practical experience should be explicitly stimulated bottom-up and facilitated top-down. ► Moral Case Deliberation (MCD) reflects a trend toward collective, deliberative ethical reflection in everyday practice. ► MCD is currently introduced in an increasing number of Dutch health care organizations, including elderly care. ► MCD projects in 2 elderly care organizations (2006–2012) brought about a learning process with a crucial role for doing MCD. ► Health care practitioners become motivated for MCD when they develop competencies and experience benefits.