Training facilitators of Moral Case Deliberation: a successful experience with external health care professionals in the sessions and in feedback to the trainees

Abstract

Moral Case Deliberation (MCD) is a form of clinical ethics support that focuses on concrete moral problems in practice [1]. A group of health care professionals together investigates a moral question in a concrete case from their own practice, guided by a trained facilitator. Cases are diverse, ranging from whether or not to involve the family of a client in decisions about treatment to whether or not to follow an agreed arrangement concerning the care for a client when the situation seems to ask for acting otherwise. The facilitator guides the group stepwise through the joint moral inquiry which is set up as a dialogue. Compared to other forms of clinical ethics support [2], the focus is not on the moral knowledge and expertise of the facilitator, but on the moral experience of the participants and their reflections. The facilitator does not give advice, but helps the health care professionals in the group to reflect on their own values and norms and to jointly develop a better understanding of the ethical issues of the case at hand. Although the facilitator of MCD may be a trained philosopher or ethicist, the facilitator role can be performed by a health care professional as well. Both on theoretical and on practical grounds, we deem it important to train health care professionals as facilitators of MCD. Theoretically, this fits in with the presupposition that fostering moral reflection (in the form of MCD) does not require theoretical ethics expertise. Practically, the number of ethicists available is not sufficient to answer the growing demand in health care organizations. Based on these theoretical and practical considerations, we have developed a program which aims to train health care professionals as facilitators of MCD [3]. The trainees learn to practice the role of MCD facilitator by exercising and reflecting on their experiences within training sessions and in their own team or health care institution [3, 4]. The training entails an experiental learning style, in which the trainees investigate what it means to be a good facilitator by jointly reflecting on their experiences; this fits well with the dialogical learning process within MCD itself, in which the MCD participants investigate and learn what is morally good to do. In the Netherlands, we have Abstract