title: [Moral case deliberation about coercion in psychiatry. Dilemmas, value and implementation].
abstract: OBJECTIVE
  To identify moral dilemmas regarding coercion and restraint among professionals working at a psychiatric ward, to get insight in the value of Moral Case Deliberation meetings about these dilemmas, and in the implementation of such meetings.
  
  
  METHODS
  Qualitative explorative study with interviews, focus group and participant observation.
  
  
  RESULTS
  Professionals experience dilemmas related to closing the ward (freedom versus safety), coercive treatment (freedom versus health), and camera surveillance (privacy versus safety). The introduction of Moral Case Deliberation contributes to changes concerning quality of treatment, professionalism of healthcare providers, and cooperation in the treatment team. The implementation of Moral Case Deliberation depends on an atmosphere of trust, expertise of the facilitator, and active involvement of a local coordinator. Bottlenecks for implementation include the availability of physicians, time-pressure and intervals between meetings.
  
  
  CONCLUSIONS
  Moral Case Deliberation fosters quality of treatment and moral competence of professionals in dealing with ethical dilemmas in psychiatric practice. Continuity of Moral Case Deliberation meetings motivates the participants and provides the opportunity to learn and practice ethical skills.
authors.affiliation: Medizinisches Zentrum der Freien Universität Amsterdam, Niederlande.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Voskes
authors.affiliation: Medizinisches Zentrum der Freien Universität Amsterdam, Niederlande.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Evenblij
authors.affiliation: Medizinisches Zentrum der Freien Universität Amsterdam, Niederlande.
authors.forename: Eric
authors.initials: E
authors.lastname: Noorthoorn
authors.affiliation: Medizinisches Zentrum der Freien Universität Amsterdam, Niederlande.
authors.forename: Rouven
authors.initials: R
authors.lastname: Porz
authors.affiliation: Medizinisches Zentrum der Freien Universität Amsterdam, Niederlande.
authors.forename: Guy
authors.initials: G
authors.lastname: Widdershoven
mesh_terms: D002983:Clinical Competence; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D003299:Cooperative Behavior; D033061:Ethics Consultation; D004992:Ethics, Medical; D006801:Humans; D033183:Interdisciplinary Communication; D009014:Morals; D009426:Netherlands; D011570:Psychiatry / Q000941:ethics*; D012149:Restraint, Physical / Q000941:ethics*