Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Postbus 7057, 1007 MB, Amsterdam, Netherlands.
Department of Medical Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089 a, 1081 HV, Amsterdam, Netherlands.
BMC Med Ethics. 2020 Jan 30;21(1):10. doi: 10.1186/s12910-020-0450-2.
In healthcare practice, care providers are confronted with decisions they have to make, directly affecting patients and inevitably harmful. These decisions are tragic by nature. This study investigates the role of Moral Case Deliberation (MCD) in dealing with tragic situations. In MCD, caregivers reflect on real-life dilemmas, involving a choice between two ethical claims, both resulting in moral damage and harm. One element of the reflection process is making explicit the harm involved in the choice. How harmful are our decisions? We investigated how facilitators of MCD experience the importance of addressing harm in MCD and what participants learn from reflecting on harm.
The study was qualitative, focusing on the views and experiences of the facilitators of MCD. Semi-structured interviews (N = 12) were conducted with facilitators of MCD. The research focuses on the subjective experiences of facilitators. Grounded Theory was used for analysis.
The results show two main categories. The first concerns the awareness of tragedy. Within this category, five themes were discerned: making explicit that there is no solution, visualizing consequences, uncovering pain, focusing on emotion, and exploring perspectives on harm. The second category concerns the support for healthcare professionals in dealing with the tragedy of the choices they face. In this category, five themes came forward: acknowledging, offering comfort, managing harm, consideration through dialogue and repairing harm.
Our study shows that addressing harm in MCD in tragic situations provides an important moral learning opportunity for participants. By formulating and becoming aware of harm, MCD aids healthcare professionals in the task they are faced with, namely making difficult and painful choices. MCD helps healthcare professionals to repair moral damage, making clear at the same time that harm cannot be undone.
在医疗保健实践中，护理人员面临着他们必须做出的决策，这些决策直接影响患者，且不可避免地会造成伤害。这些决策本质上是悲剧性的。本研究调查了道德案例审议（MCD）在处理悲剧情况中的作用。在 MCD 中，护理人员反思涉及在两个道德主张之间进行选择的现实生活困境，这两个主张都导致道德损害和伤害。反思过程的一个要素是明确所涉及的伤害。我们的决策有多有害？我们调查了 MCD 的协调员如何体验在 MCD 中解决伤害的重要性，以及参与者从反思伤害中学到了什么。
该研究是定性的，重点关注 MCD 协调员的观点和经验。对 MCD 的协调员进行了半结构化访谈（N=12）。该研究重点关注协调员的主观经验。采用扎根理论进行分析。
结果显示出两个主要类别。第一个涉及对悲剧的认识。在这一类中，发现了五个主题：明确表示没有解决方案，可视化后果，揭示痛苦，关注情感，以及探索对伤害的观点。第二个类别涉及为处理他们面临的选择的悲剧提供支持的医疗保健专业人员。在这一类中，出现了五个主题：承认、提供安慰、管理伤害、通过对话进行考虑以及修复伤害。
我们的研究表明，在处理悲剧情况的 MCD 中解决伤害为参与者提供了一个重要的道德学习机会。通过制定和意识到伤害，MCD 帮助医疗保健专业人员完成他们面临的任务，即做出困难和痛苦的选择。MCD 帮助医疗保健专业人员修复道德损害，同时明确表示伤害无法挽回。
