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Developing an ethics support tool for dealing with dilemmas around client autonomy based on moral case deliberations.

L A Hartman1, S Metselaar2, A C Molewijk2,3

  • 1Department of Medical Humanities, VU University Medical Centre, APH, Amsterdam, The Netherlands. la.hartman@vumc.nl.

BMC Medical Ethics
|December 23, 2018
PubMed
Summary

This study developed the "moral compass," a new tool to help healthcare professionals reflect on moral dilemmas concerning client autonomy. It offers a low-threshold, case-based approach complementing existing methods for enhanced clinical ethics support.

Keywords:
AutonomyClinical ethics supportLong-term careMoral case deliberationMoral compassMoral dilemmaTheme-based ethics support

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Area of Science:

  • Bioethics
  • Healthcare Ethics
  • Clinical Ethics Support

Background:

  • Moral Case Deliberations (MCDs) are effective clinical ethics support (CES) but have limitations.
  • Existing MCDs lack knowledge sharing, limit moral learning to participants, require significant organization, and are case-specific.
  • These limitations necessitate the development of complementary CES tools for healthcare professionals.

Purpose of the Study:

  • To develop a low-threshold CES tool based on a series of MCDs focused on autonomy in long-term care.
  • To create a complementary tool that addresses the limitations of traditional MCDs.

Main Methods:

  • A qualitative research design was employed, analyzing 28 MCDs (transcripts and summary reports) using thematic content analysis.
  • The analysis results were iteratively combined with theoretical reflections on CES.
  • The developed tool underwent evaluation and adjustment through three focus groups.

Main Results:

  • A CES tool named 'moral compass' was developed, presented as a 23-page booklet.
  • The 'moral compass' guides users through six questions for methodical reflection on moral dilemmas, integrating norms, values, and strategies for client autonomy.
  • It incorporates insights from previous MCDs on client autonomy.

Conclusions:

  • A thematic, low-threshold CES tool, the 'moral compass,' was developed to support healthcare professionals with moral questions on client autonomy.
  • This tool complements MCDs by integrating insights from prior cases and offering a structured reflection process.
  • The methodology can be adapted to create similar tools for different topics and healthcare settings.