Implementing moral case deliberation in a psychiatric hospital: process and outcome.
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.
Molewijk
Bert
B
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
Verkerk
Maarten
M
Milius
Henk
H
Widdershoven
Guy
G
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*