Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the (...) CARE model provides a substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. (shrink)

A qualitative study with an exploratory, descriptive and documentary design that was conducted with the objective of identifying the elements to constitute a method for the analysis of accusations of and proceedings for professional ethics infringements. The method is based on underlying elements identified inductively during analysis of professional ethics hearings judged by and filed in the archives of the Regional Nursing Board of Santa Catarina, Brazil, between 1999 and 2007. The strategies developed were based on the results of an (...) analysis of the findings of fact (occurrences/infractions, causes and outcomes) contained in the records of 128 professional ethics hearings and on the structural elements (statements, rules and practices) identified in five example professional ethics cases. The strategies suggested for evaluating accusations of ethics infringements and the procedures involved in deliberating on ethics hearings constitute a generic proposal that will require adaptation to the context of specific professional ethics accusations. (shrink)

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and (...) methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)

A qualitative study with an exploratory, descriptive and documentary design that was conducted with the objective of identifying the elements to constitute a method for the analysis of accusations of and proceedings for professional ethics infringements. The method is based on underlying elements identified inductively during analysis of professional ethics hearings judged by and filed in the archives of the Regional Nursing Board of Santa Catarina, Brazil, between 1999 and 2007. The strategies developed were based on the results of an (...) analysis of the findings of fact (occurrences/infractions, causes and outcomes) contained in the records of 128 professional ethics hearings and on the structural elements (statements, rules and practices) identified in five example professional ethics cases. The strategies suggested for evaluating accusations of ethics infringements and the procedures involved in deliberating on ethics hearings constitute a generic proposal that will require adaptation to the context of specific professional ethics accusations. (shrink)

The aim of this article is to show how intimately connected Beth J. Singer's theory of operative rights is with her understanding of the deliberative process. I thus argue against Cynthia Gayman's effort to set in contrast Singer's theory of rights and Dewey's characteristic emphasis on reflective morality. Since I take the value of Singer's approach to be most evident in its relevance to the abortion debate as an ongoing deliberation, I question whether Mary Magada‐Ward sufficiently appreciates the dialogical (...) and deliberative emphases of Singer's stance. My goal, however, is not so much to argue against either Gayman or Magada‐Ward as it is to argue for taking Singer's position even more seriously than either author does. In particular, I want to highlight the finely nuanced character of Singer's philosophical intervention in the debate regarding abortion, especially stressing certain features that Gayman and Magada‐Ward overlook. (shrink)

This essay develops a new account of the phenomenon of imaginative resistance. Imaginative resistance is best conceived of as a limited phenomenon. It occurs when we try to engage imaginatively with different moral worlds that are insufficiently articulated so that they do not allow us either to quarantine our imaginative engagement from our normal moral attitudes or to agree with the expressed moral judgment from the perspective of moral deliberation. Imaginative resistance thus reveals the central (...) epistemic importance that empathy plays for our understanding of rational agents in a context where we try to make sense of the moral appropriateness of their reasons for acting. Reflecting on the phenomenon of imaginative resistance allows us to recognize important features of the relationship between imaginative perspective taking and ordinary moral deliberation. (shrink)

Many of us read Peter Singer ’ s work on our obligations to those in desperate need with our students. Famously, Singer argues that we have a moral obligation to give a significant portion of our assets to famine relief. If my own experience is not atypical, it is quite common for students, upon grasping the implications of Singer ’ s argument, to ask whether Singer gives to famine relief. In response it might be tempting to remind students of (...) the ad hominem fallacy of attacking the person advancing an argument rather than the argument itself. In this paper I argue that the “ ad hominem reply ” to students ’ request for information about Singer is misguided. First I show that biographical facts about the person advancing an argument can constitute indirect evidence for the soundness / unsoundness of the argument. Second, I argue that such facts are relevant because they may reveal that one can discard the argument without thereby incurring moral responsibility for failing to act on its conclusion even if the argument is sound. (shrink)

Empirical research in the field of moral cognition is increasingly being used to draw conclusions in philosophical moral psychology, in particular regarding sentimentalist and rationalist accounts of moral judgment. This paper calls for a reassessment of both the empirical and philosophical conclusions being drawn from the moral cognition research. It is proposed that moral decision making is best understood as a species of Kahneman and Frederick's dual-process model of decision making. According to this model, emotional (...) intuition-generating processes and reflective processes operate in an integrated way in moral deliberation, and metacognition is assigned an essential role in the monitoring and shaping of moral intuitions. In combination with observations from philosophical moral psychology, this proposal cautions against endorsing simple sentimentalism or rejecting rationalist accounts on the basis of the moral cognition research. (shrink)

Many social trends are conspiring to drive the adoption of greater automation in society, and we will certainly see a greater offloading of human decisionmaking to robots in the future. Many of these decisions are morally salient, including decisions about how benefits and burdens are distributed. Roboticists and ethicists have begun to think carefully about the moral decision making apparatus for machines. Their concerns often center around the plausible claim that robots will lack many of the mental capacities that (...) are indispensable in human moral decision making, such as empathy. To the extent that robots may be robustly artificially intelligent, these concerns subside, but they give way to new worries about creating artificial agents to do our bidding, if those artificial agents have moral standing. We suggest that the question of AI consciousness poses a dilemma. Whether artificially intelligent agents will be conscious or not, we will face serious difficulties in programming them to reliably make moral decisions. (shrink)

In Chapter 9 of The Practice of Moral Judgment and her later article Making Room for Character, Barbara Herman offers a distinctive response to a familiar set of concerns with the room left for character and personal relationships in Kantian ethics. She begins by acknowledging the shortcomings of her previous response on this issue and by distancing herself from a standard kind of indirect argument for the importance of personal commitments according to which these have moral weight in (...) virtue of their connection with the psychological health of individuals. Agreeing with an imagined critic’s concern that Kantian ethics must do more than merely tolerate motives of connection, she proposes that we adopt a deliberative field account of practical deliberation incorporating a developmental model of desire formation. I argue that, while this is a subtle and interesting account of desire development, it is not one that will satisfy the critic and should not satisfy the Kantian. I claim that the Kantian cannot forgo instrumental arguments for the importance of personal relationships and commitments and that they should not be shy of endorsing these arguments. (shrink)

This paper considers the question of whether predictions of wrongdoing are relevant to our moral obligations. After giving an analysis of 'won't' claims, the question is separated into two different issues: firstly, whether predictions of wrongdoing affect our objective moral obligations, and secondly, whether self-prediction of wrongdoing can be legitimately used in moral deliberation. I argue for an affirmative answer to both questions, although there are conditions that must be met for self-prediction to be appropriate in (...) deliberation. The discussion illuminates an interesting and significant tension between agency and prediction. (shrink)

Pragmatism has been understood by bioethicists as yet another rival in the “methods wars,” as yet another theory of moral deliberation. This has led to criticism of pragmatic bioethics as both theoretically and practically inadequate. Pragmatists’ responses to these objections have focused mainly on misunderstandings of pragmatism’s epistemology. These responses are insufficient. Pragmatism’s commitment to radical empiricism gives it theoretical resources unappreciated by critics and defenders alike. Radical empiricism, unlike its more traditional ancestors, undercuts the gaps between theory (...) and practice, and subjective and objective accounts of experience, and in so doing provides the metaphysical and epistemological basis for a thoroughgoing empirical naturalism in ethics. Pragmatism’s strength as an approach to moral problems thus emerges as a result of a much wider array of resources than contemporary interpreters have acknowledged, which makes it a richer, deeper framework for understanding moral deliberation in general and bioethical decision making in particular. (shrink)

Sunstein represents moral heuristics as rigid rules that lead us to jump to moral conclusions, and contrasts them with reflective moral deliberation, which he represents as independent of heuristics and capable of supplanting them. Following John Dewey's psychology of moral judgment, I argue that successful moral deliberation does not supplant moral heuristics but uses them flexibly as inputs to deliberation. Many of the flaws in moral judgment that Sunstein attributes to (...) heuristics reflect instead the limitations of the deliberative context in which people are asked to render judgments. (shrink)

"Application of the possibilities for this renewal of temperance comes with an examination of how emotion will help moral deliberation in the clinical practice of medicine. Sir William Osler (1849-1919) and his doctrine of aequanimitas is greatly misunderstood to be the founder of emotional detachment in physician/patient relations. This book offers the most detailed look at aequanimitas in print and equates it with a normative view of temperance as a moral virtue." "For upper-level undergraduate and graduate-level students (...) interested in ethics, bioethics, and moral psychology; Oslerians; and students of Aristotle's and Aquinas' views of the moral virtues."--BOOK JACKET. (shrink)

An Integrative Model of Moral Deliberation suggests that the inadequacy of models of moral deliberation to deal effectively with contemporary moral complexity is a result of the lack of an inadequate theory of moral cognition. Drawing from work in neuroscience, evolutionary psychology, social theory, dual process cognitive theory, and the work of William James, this book develops a theory of moral cognition to be used as the basis for a model of moral (...) deliberation. This model portrays moral deliberation as a back and forth movement between intuitive and analytic cognitions, by which narrative scenarios are constructed and then assessed by aesthetic sensibilities. (shrink)

The experience of the last thirty years has shown that whether the different methodologies used in clinical ethics work well or not depends on certain external factors, such as the mentality with which they are used. This article aims to analyze two of these mentalities: the “dilemmatic” and the “problematic.” The former uses preferably the decision-making theory, whilst the latter emphasizes above all the role of deliberation. The author considers that Clinical Ethics must be deliberationist, and that only in (...) this context the different methodologies can be used correctly. (shrink)

This paper develops themes addressed in an article by Eric Wiland in the Journal of Medical Ethics 2000;26:466–8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel understanding of why analogy is an essential component in the attempt to justify moral beliefs. I seek to show how analogical argument both encapsulates (...) and exercises the notions of rationality and imagination and that the construction, development, and comparison of analogies fundamentally underpins ethical argument. In so doing, it enables us to adopt imaginative and ethically illuminating perspectives but in a manner that does not relinquish any claims to intellectual rigour. I present a critique of a brand of “moral particularism” by showing how it cannot, if construed in a certain way, adequately conceive of how we use analogies and imaginary cases in ethics. Although such a particularism is thus impotent with regard to ethical debate, I show that the wider motivation behind particularism that can be extracted is of clear relevance and importance to medical practitioners. (shrink)

This article argues that congregations should be seen as grassroots public moral agents, on the ground working to bring what they discern as God's preferred future into being. Deliberations among congregations of all social backgrounds are a way of doing ethics "polycentrically," without a dominant center. Because cultural and social boundaries are permeable and people in various social groups can imaginatively enter the worlds of people unlike themselves, they can engage those perspectives morally on an equal footing. The essay (...) addresses ethicists' participation in congregations' moral deliberation and action, and concludes with a plea for theological ethicists to consider congregations in their work. (shrink)

It is widely accepted in psychology and cognitive science that there are two “systems” in the mind: one system is characterized as quick, intuitive, perceptive, and perhaps more primitive, while the other is described as slower, more deliberative, and responsible for our higher-order cognition. I use the term “reflectivism” to capture the view that conscious reflection—in the “System 2” sense—is a necessary feature of good moral judgment and decision-making. This is not to suggest that System 2 must operate alone (...) in forming our moral decisions, but that it plays a normatively ineliminable role. In this paper, I discuss arguments that have been offered in defense of reflectivism. These arguments fit into two broad categories; let us think of them as two sides of a coin. On the first side are arguments about the efficaciousness of conscious reasoning—for example, without conscious deliberation we will make bad moral judgments and decisions. On the other side of the coin are arguments about the centrality of conscious deliberation to normative actions—for example, without conscious deliberation we are no more agential than animals or automatons. Despite their attractiveness, I argue that these arguments do not successfully establish that reflection is a necessary component of good moral judgment and decision-making. If I am right, the idea that good moral judgment and decision-making can result from entirely automatic and subconscious processes gains traction. My goal in this paper is to show that reflectivism fails to include the full range of cases of moral decision-making and that a theory of automaticity may do a better job. I briefly discuss at the end of the paper how an account of successful automatic moral judgment and decision-making might begin to take shape. (shrink)

Health, such as the industry, university or city, is immersed in a process of digital transformation generated by the possibility and technological convergence of the Internet of Things (IoT), Big Data and Artificial Intelligence on the one hand and their consequences on the other: hyperconnectivity, datafication and algorithmization. This is a process of transformation towards what has come to be called Smart Health, Health 4.0 or mHealth. However, despite the enormous potential that underlies the digitization of the healthcare sector, this (...) process can have very negative effects both for the sector and its organizations and for the system’s user. One of the most worrying questions at this moment is the aspect and the force that bioethification is taking; that is, the process by which mass data on the opinions, preferences and behaviors of the hyperconnected users of the cyber-physical assistance system are stored, crossed and processed, on the basis of an utilitarian criterion, to determine through mathematical models what is morally valid. The aim of the present study is to analyze the present and future consequences of bioethification in the health field, as well as to propose guidelines to undertake a socially responsible and morally valid digitalization. Key words: bioethification, moral deliberation, discursive ethics, clinical practice, smart health, smart hospital. (shrink)

In this article I offer an account of normative thought inspired by Plato's proposal in the Theaetetus that judgement is ‘speech spoken … silently.’ After arguing that force conventionalism is the speech act theory best suited for modeling dialogic inner speech, I close the article by sketching the picture of normative thought that results. Though I defend a particular theory of normative speech elsewhere, the core insights of this article can be used by other theorists as well. The arguments offered (...) here also serve as an important step forward for the more general program of using social speech to better understand thought. (shrink)

Together we can achieve things that we could never do on our own. In fact, there are sheer endless opportunities for producing morally desirable outcomes together with others. Unsurprisingly, scholars have been finding the idea of collective moral obligations intriguing. Yet, there is little agreement among scholars on the nature of such obligations and on the extent to which their existence might force us to adjust existing theories of moral obligation. What interests me in this paper is the (...) perspective of the moral deliberating agent who faces a collective action problem, i.e. the type of reasoning she employs when deciding how to act. I hope to show that agents have collective obligations precisely when they are required to employ ‘we-reasoning’, a type of reasoning that differs from I-mode, best response reasoning, as I shall explain below. More precisely, two (or more) individual agents have a collective moral obligation to do x if x is an option for action that is only collectively available (more on that later) and each has sufficient reason to rank x highest out of the options available to them. (shrink)

The use of Scripture for deliberation and justification in making moral judgments is a crucial and neglected function of the Bible in Christian ethics.

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes and the questions how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a heterogeneous composition and (...) were organized apart from existing institutional communication structures. As part of a naturalistic evaluation, systematic observations, interviews and focus groups were completed. The findings indicate that the heterogeneous composition and MCD meetings separate from existing structures have benefits. However, the participants also reported negative experiences. This gives rise to the question whether a mixed MCD group which meets separately is an effective way to embed MCD as an instrument for reflection on moral issues in daily practice. We conclude that there is no single answer to that question. In the end, the two implementation strategies (i.e. within existing communication structures and a mixed MCD group) can be complementary to each other. (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

My aim in this note is to shed light on ways of interpreting Kant’s Formula of Universal Law (FUL), by looking at relevant similarities and differences between Pauline Kleingeld and Mark Timmons. I identify both their readings as a formal interpretation of Kant’s FUL, in contrast to the substantive interpretations that favor a robust conception of rational agency as a necessary requirement for moral deliberation. I highlight the benefits that arise from Kleingled’s interpretation in showing the immediacy involved (...) in the volitional self-contradiction when universalizing a maxim. Alongside Timmons, I address a question as to whether Kleingeld’s interpretation is completely free from at least a minimal set of assumptions about practical deliberation more broadly, that seem to play a role in generating the volitational self-contradiction she is defending. I close by raising some skeptical worries about the capacity of this kind of contradiction to translate into a moral judgment triggering action. (shrink)

Moral distress forms a major threat to the well-being of healthcare professionals, and is argued to negatively impact patient care. It is associated with emotions such as anger, frustration, guilt, and anxiety. In order to effectively deal with moral distress, the concept of moral resilience is introduced as the positive capacity of an individual to sustain or restore their integrity in response to moral adversity. Interventions are needed that foster moral resilience among healthcare professionals. Ethics (...) consultation has been proposed as such an intervention. In this paper, we add to this proposition by discussing Moral Case Deliberation (MCD) as a specific form of clinical ethics support that promotes moral resilience. We argue that MCD in general may contribute to the moral resilience of healthcare professionals as it promotes moral agency. In addition, we focus on three specific MCD reflection methods: the Dilemma Method, the Aristotelian moral inquiry into emotions, and CURA, a method consisting of four main steps: Concentrate, Unrush, Reflect, and Act. In practice, all three methods are used by nurse ethicists or by nurses who received training to facilitate reflection sessions with these methods. We maintain that these methods also have specific elements that promote moral resilience. However, the Dilemma Method fosters dealing well with tragedy, the latter two promote moral resilience by including attention to emotions as part of the reflection process. We will end with discussing the importance of future empirical research on the impact of MCD on moral resilience, and of comparing MCD with other interventions that seek to mitigate moral distress and promote moral resilience. (shrink)

Despite all the attention given to Kant’s universalizability tests, one crucial aspect of Kant’s thought is often overlooked. Attention to this issue, I will argue, helps us resolve two serious problems for Kant’s ethics. Put briefly, the first problem is this: Kant, despite his stated intent to the contrary, doesn’t seem to use universalization in arguing for duties to oneself, and, anyway, it is not at all clear why duties to oneself should be grounded on a procedure that envisions a (...) world in which everyone wills the contrary of those duties. The second, more global problem is that if we follow Barbara Herman in holding that Kantian ethics can provide a structure for moral deliberation, we need an interpretation of the universalization procedure that unproblematically allows it to generate something like prima facie duties to guide that deliberation; but it is not at all clear that we have such an interpretation. I argue here that if we expand our limited way of thinking about universalization, we can solve the first problem and work towards a solution to the second. We can begin by recalling that Kant’s ‘Law of Nature’ formulation (FLN) of the Categorical Imperative obligates us to ‘act as if the maxim of your action were to become by your will a universal law of nature’ (G, 421). (shrink)

ExtractIn developing moral theories, philosophers seek to fulfill at least two tasks: to guide moral judgment and to guide moral deliberation. In moral judgment, moral agents assess moral status. In moral deliberation, moral agents decide how to act. It is important to work out how these two things are related. One suggestion is to posit a direct connection between them according to which moral agents are required to deliberate in (...) terms of correct moral judgment. There are various ways of spelling out this requirement. For example, moral agents might be required to rank prospective actions according to a correct moral judgment of them and choose the highest ranked action. Moral agents would thus be required to choose the morally best action available to them. Alternatively, moral agents might be required to separate prospective actions into those that are permissible actions and those that are impermissible and choose, perhaps on non-moral grounds, from the class of morally permissible actions. (shrink)

Although moral case deliberation (MCD) is evaluated positively as a form of clinical ethics support (CES), it has limitations. To address these limitations our research objective was to develop a thematic CES tool. In order to assess the philosophical characteristics of a CES tool based on MCDs, we drew on hermeneutic ethics and pragmatism. We distinguished four core characteristics of a CES tool: (a) focusing on an actual situation that is experienced as morally challenging by the user; (b) (...) stimulating moral inquiry into the moral concepts, questions and routines in the lived experience of the CES tool user; (c) stimulating moral learning by exploring other perspectives; and (d) incorporating contextual details. We provide an example of a CES tool developed for moral dilemmas over client autonomy. Our article ends with some reflections on the normativity of the CES tool, other application areas and the importance of evaluation studies of CES tools. (shrink)

A research project by the Schools of Theology and Psychology of Australia’s Charles Sturt University surveyed a large sample of Salvation Army officers. This article considers survey responses to two questions relating to end-of-life care: the use of pain medications that may shorten life, and the cessation of fluid and food intake. The results of the analyses are evaluated in terms of Michael Banner’s proposal that moral theology should more assiduously converse with ‘patient ethnographic study’, which the survey instantiates (...) to some extent. Banner’s proposal and the results of the survey are contrasted to Peter Singer’s analytical moral philosophical dictums on end-of-life care. The results are also compared to a metastudy by Andrea Rodríguez-Prat and Evert van Leeuwen of 14 ethnographic studies of those who wish to hasten death at the end of life. We conclude that respondents exemplify a form of moral reasoning that is embedded within Christian spirituality; counters the assumptions of Singer’s approach; contrasts the diminishment of ‘meaning’ at the end of life, as seen in Rodríguez-Prat and van Leeuwen; and deserves further respectful ethnographic study. (shrink)

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes and the questions how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a heterogeneous composition and (...) were organized apart from existing institutional communication structures. As part of a naturalistic evaluation, systematic observations, interviews and focus groups were completed. The findings indicate that the heterogeneous composition and MCD meetings separate from existing structures have benefits. However, the participants also reported negative experiences. This gives rise to the question whether a mixed MCD group which meets separately is an effective way to embed MCD as an instrument for reflection on moral issues in daily practice. We conclude that there is no single answer to that question. In the end, the two implementation strategies (i.e. within existing communication structures and a mixed MCD group) can be complementary to each other. (shrink)

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.Objectives 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. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals (...) with the question: What is the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)