title: Implementing moral case deliberation in a psychiatric hospital: process and outcome.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Health, Ethics and Society/metamedica Faculty of Health, Medicine and Life Sciences, School of Public Health and Primary care (Caphri), Maastricht University, Maastricht, The Netherlands. b.molewijk@zw.unimaas.nl
authors.forename: Bert
authors.initials: B
authors.lastname: Molewijk
authors.forename: Maarten
authors.initials: M
authors.lastname: Verkerk
authors.forename: Henk
authors.initials: H
authors.lastname: Milius
authors.forename: Guy
authors.initials: G
authors.lastname: Widdershoven
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D028661:Complicity; D033061:Ethics Consultation; D026690:Ethics, Clinical; D005260:Female; D006778:Hospitals, Psychiatric / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*