title: Emotions and clinical ethics support. A moral inquiry into emotions in moral case deliberation.
abstract: Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In a moral case deliberation, the participants are invited to place themselves in the position of the case presenter and to investigate their own emotions in the situation. It is about critically assessing the facts in the case that cause the emotion and the related (moral) thoughts that accompany the emotion. It is also about finding the right emotion in a given situation and finding the right balance in dealing with that emotion. These steps in the moral inquiry give rise to group learning. It is a process of becoming open towards the perspectives of others, leading to new insights into what is an appropriate emotion in the specific situation. We show how this approach works in moral case deliberation. A physician presents a situation in which he is faced with a pregnant woman who is about to deliver multiple extremely premature infants at the threshold of viability. The moral deliberation of the case and the emotions therein leads to the participants' conclusion that "compassion" is a more adequate emotion than "sadness". The emotion "sadness" is pointed towards the tragedy that is happening to the woman. The emotion "compassion" is pointed towards the woman; it combines consideration and professional responsibility. Through the shift towards compassion, participants experienced more creativity and freedom to deal with the sad situation and to support the woman. The paper ends with an analysis and reflection on the deliberation process. In the conclusion we argue for more attention to emotions in clinical ethics support and offer some directions for doing this in the right way.
authors.affiliation: Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. b.molewijk@vumc.nl
authors.forename: Bert
authors.initials: B
authors.lastname: Molewijk
authors.forename: Dick
authors.initials: D
authors.lastname: Kleinlugtenbelt
authors.forename: Scott M
authors.initials: SM
authors.lastname: Pugh
authors.forename: Guy
authors.initials: G
authors.lastname: Widdershoven
mesh_terms: D003657:Decision Making / Q000941:ethics*; D003695:Delivery of Health Care; D004644:Emotions; D028741:Ethics Committees, Clinical; D006801:Humans; D009014:Morals; D010684:Philosophy