“Here’s My Dilemma”. Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care

• Published in: Health care analysis Vol. 20; no. 3; pp. 250 - 267
• Main Authors: van der Dam, S., Abma, T. A., Kardol, M. J. M., Widdershoven, G. A. M.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-09-2012; Springer Nature B.V
• Subjects: Aged; Assistants; Attitude of Health Personnel; Blind spots; Care of the aged; Caregivers - psychology; Communication; Elder care; Ethical dilemmas; Ethics; Geriatric medicine; Geriatric Nursing - ethics; Health Informatics; Health professionals; Homes for the Aged - ethics; Humans; Medical ethics; Medical personnel; Medicine; Medicine & Public Health; Moral aspects; Morality; Morals; Netherlands; Nursing; Nursing homes; Nursing Homes - ethics; Organization theory; Original; Original Article; Philosophy of Medicine; Public Health; Reflection; Netherlands; Care home; Moral case deliberation; Clinical ethics; Elderly care; Ethical issues; Nursing home
• ISSN: 1065-3058; 1573-3394
• DOI: 10.1007/s10728-011-0185-9

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’.