Skip to main content
Top
Published in: Medicine, Health Care and Philosophy 3/2017

Open Access 01-09-2017 | Scientific Contribution

Tragedy in moral case deliberation

Authors: Benita Spronk, Margreet Stolper, Guy Widdershoven

Published in: Medicine, Health Care and Philosophy | Issue 3/2017

Login to get access

Abstract

In healthcare practice, care providers are confronted with tragic situations, in which they are expected to make choices and decisions that can have far-reaching consequences. This article investigates the role of moral case deliberation (MCD) in dealing with tragic situations. It focuses on experiences of care givers involved in the treatment of a pregnant woman with a brain tumour, and their evaluation of a series of MCD meetings in which the dilemmas around care were discussed. The study was qualitative, focusing on the views and experiences of the participants. A case study design is used by conducting semi-structured interviews (N = 10) with health care professionals who both played a role in the treatment of the patient and attended the MCD. The results show that MCD helps people to deal with tragic situations. An important element of MCD in this respect is making explicit the dilemma and the damage, demonstrating that there is no simple solution. MCD prompts participants to formulate and share personal experiences with one another and thus helps to create a shared perception of the situation as tragic. The article concludes that MCD contributes to the sharing of tragic experiences, and fosters mutual interaction during a tragedy. Its value could be increased through explicit reflection on the aspect of contingency that characterises tragedy.
Footnotes
1
Recent research that discusses the gravity of forced decision-making: ‘Sharing the burden of deciding: How physicians and parents make end-of-life decisions’ (Vos-Broerse 2015).
 
2
In tragic cases, Fredriksen speaks not in terms of guilt, but in terms of responsibility. ‘Professionals do not have to accept responsibility in the sense of culpability—in the sense that they misjudged the situation and should have acted differently. But they must accept responsibility(-)’ (Fredriksen 2006, 452).
 
3
As opposed to the Socratic Dialogue, which uses a conceptual question as a starting point (Kessels et al. 2006, 2009).
 
Literature
go back to reference Alma, H.A. 2005. De parabel van de blinden: psychologie en het verlangen naar zin (The parable of the blind: Psychology and the longing for significance). Amsterdam: Humanistics University Press. Alma, H.A. 2005. De parabel van de blinden: psychologie en het verlangen naar zin (The parable of the blind: Psychology and the longing for significance). Amsterdam: Humanistics University Press.
go back to reference Aulisio, M.P., R.M. Arnold, and S.J. Youngner. 2000. Health care ethics consultation: Nature, goals, and competencies. Annals of Internal Medicine 133(1): 59–69.CrossRef Aulisio, M.P., R.M. Arnold, and S.J. Youngner. 2000. Health care ethics consultation: Nature, goals, and competencies. Annals of Internal Medicine 133(1): 59–69.CrossRef
go back to reference Benson, J., and K. Magraith. 2005. Compassion fatigue and burnout: The role of Balint groups. Australian Family Physician 34(6): 497–498. Benson, J., and K. Magraith. 2005. Compassion fatigue and burnout: The role of Balint groups. Australian Family Physician 34(6): 497–498.
go back to reference Browall, M., I. Henoch, C. Melin-Johansson, S. Strang, and E. Danielson. 2014. Existential encounters: Nurses’ description of critical incidents in end-of-life cancer care. European Journal of Oncology Nursing 18: 636–644.CrossRef Browall, M., I. Henoch, C. Melin-Johansson, S. Strang, and E. Danielson. 2014. Existential encounters: Nurses’ description of critical incidents in end-of-life cancer care. European Journal of Oncology Nursing 18: 636–644.CrossRef
go back to reference Dauwerse, L. 2014. Moving ethics: State of the art of clinical ethics support in the Netherlands. ‘s-Hertogenbosch: Uitgeverij BOXPress. Dauwerse, L. 2014. Moving ethics: State of the art of clinical ethics support in the Netherlands. ‘s-Hertogenbosch: Uitgeverij BOXPress.
go back to reference Dauwerse, L., T. Abma, B. Molewijk, and G. Widdershoven. 2011. Goals of clinical ethics support. Perceptions of Dutch Health Care Institutions. Health Care Analysis. doi:10.1007/s10728-011-0189-5. Dauwerse, L., T. Abma, B. Molewijk, and G. Widdershoven. 2011. Goals of clinical ethics support. Perceptions of Dutch Health Care Institutions. Health Care Analysis. doi:10.​1007/​s10728-011-0189-5.
go back to reference Deleuze, G., and F. Guattari. 2003 (orig. 1987). A thousand plateaus: Capitalism and schizophrenia. London, New York: Continuum. Deleuze, G., and F. Guattari. 2003 (orig. 1987). A thousand plateaus: Capitalism and schizophrenia. London, New York: Continuum.
go back to reference Ford, P.J., and D.M. Dudzinski (eds.). 2008. Complex ethics consultations: Cases that haunt us. Cambridge: Cambridge University Press. Ford, P.J., and D.M. Dudzinski (eds.). 2008. Complex ethics consultations: Cases that haunt us. Cambridge: Cambridge University Press.
go back to reference Gadamer, H.G. 1960. Wahrheit und Methode: Grundzüge einer philosophischen Hermeneutic (Truth and method: Introduction to philosophical hermeneutics). Tübingen: J.C.B. Mohr. Gadamer, H.G. 1960. Wahrheit und Methode: Grundzüge einer philosophischen Hermeneutic (Truth and method: Introduction to philosophical hermeneutics). Tübingen: J.C.B. Mohr.
go back to reference Janoff-Bulman, R. 1992. Shattered assumptions: Towards a new psychology of trauma. New York, Toronto: The Free Press, Maxwell Macmillan Canada. Janoff-Bulman, R. 1992. Shattered assumptions: Towards a new psychology of trauma. New York, Toronto: The Free Press, Maxwell Macmillan Canada.
go back to reference Johnson, A.H., D.E. Nease, L.C. Milberg, and R.B. Addison. 2004. Essential characteristics of effective Balint group leadership. Family Medicine 36(4): 253–259. Johnson, A.H., D.E. Nease, L.C. Milberg, and R.B. Addison. 2004. Essential characteristics of effective Balint group leadership. Family Medicine 36(4): 253–259.
go back to reference Kessels, J., P. Mostert, and E. Boers. 2006. Free space. Philosophy in organisations. Amsterdam: Boom. Kessels, J., P. Mostert, and E. Boers. 2006. Free space. Philosophy in organisations. Amsterdam: Boom.
go back to reference Kessels, J., P. Mostert, and E. Boers. 2009. Free space. Field guide to conversations (workbook). Amsterdam: Boom. Kessels, J., P. Mostert, and E. Boers. 2009. Free space. Field guide to conversations (workbook). Amsterdam: Boom.
go back to reference Manschot, H. 2003. De betekenis van het tragische voor de ethiek van de zorg- en hulpverlening (The meaning of tragedy in the ethics of healthcare and aid assistance). In In gesprek over goede zorg: overlegmethoden voor ethiek in de praktijk (Discussing good healthcare: consultation methods for ethics in practice), ed. H. Manschot, and H. van Dartel, 225–241. Amsterdam: Boom. Manschot, H. 2003. De betekenis van het tragische voor de ethiek van de zorg- en hulpverlening (The meaning of tragedy in the ethics of healthcare and aid assistance). In In gesprek over goede zorg: overlegmethoden voor ethiek in de praktijk (Discussing good healthcare: consultation methods for ethics in practice), ed. H. Manschot, and H. van Dartel, 225–241. Amsterdam: Boom.
go back to reference Molewijk, B., and R. Ahlzen. 2011. Clinical Ethics Committee Case 13: Should the school doctor contact the mother of a 17-year-old girl who has expressed suicidal thoughts? Clinical Ethics 6(1): 5–10.CrossRef Molewijk, B., and R. Ahlzen. 2011. Clinical Ethics Committee Case 13: Should the school doctor contact the mother of a 17-year-old girl who has expressed suicidal thoughts? Clinical Ethics 6(1): 5–10.CrossRef
go back to reference Molewijk, A.C.T., M. Abma, and G.Widdershoven Stolper. 2008. Teaching ethics in the clinic: The theory and practise of moral case deliberation. Journal of Medical Ethics 34(2): 120–124.CrossRef Molewijk, A.C.T., M. Abma, and G.Widdershoven Stolper. 2008. Teaching ethics in the clinic: The theory and practise of moral case deliberation. Journal of Medical Ethics 34(2): 120–124.CrossRef
go back to reference Molewijk, B., D. Kleinlugtenbelt, S.M. Pugh, and G. Widdershoven. 2011a. Emotions and clinical ethics support. A moral inquiry into emotions in moral case deliberation. HEC Forum. doi:10.1007/s10730-011-9162-9. Molewijk, B., D. Kleinlugtenbelt, S.M. Pugh, and G. Widdershoven. 2011a. Emotions and clinical ethics support. A moral inquiry into emotions in moral case deliberation. HEC Forum. doi:10.​1007/​s10730-011-9162-9.
go back to reference Nussbaum, M.C. 2000. The costs of tragedy: Some moral limits of cost-benefit analysis. Journal of Legal Studies 29: 1005–1036.CrossRef Nussbaum, M.C. 2000. The costs of tragedy: Some moral limits of cost-benefit analysis. Journal of Legal Studies 29: 1005–1036.CrossRef
go back to reference Nussbaum, M.C. 2001a (orig. 1986). The fragility of goodness: Luck and ethics in Greek tragedy and philosophy. Cambridge: University Press. Nussbaum, M.C. 2001a (orig. 1986). The fragility of goodness: Luck and ethics in Greek tragedy and philosophy. Cambridge: University Press.
go back to reference Nussbaum, M.C. 2001b. Upheavals of thought: The intelligence of emotions. Cambridge: Cambridge University Press.CrossRef Nussbaum, M.C. 2001b. Upheavals of thought: The intelligence of emotions. Cambridge: Cambridge University Press.CrossRef
go back to reference Patton, M.Q. 1990. Qualitative evaluation and research methods, 2nd ed. California: Sage. Patton, M.Q. 1990. Qualitative evaluation and research methods, 2nd ed. California: Sage.
go back to reference Renzenbrink, I. (ed.). 2011. Caregiver stress and staff support in illness, dying, and bereavement. Oxford: Oxford University Press. Renzenbrink, I. (ed.). 2011. Caregiver stress and staff support in illness, dying, and bereavement. Oxford: Oxford University Press.
go back to reference Saldaña, J. 2013, second edition. (First edition published 2009). The coding manual for qualitative researchers. Los Angeles: SAGE. Saldaña, J. 2013, second edition. (First edition published 2009). The coding manual for qualitative researchers. Los Angeles: SAGE.
go back to reference Sloterdijk, P. 2004. Sphären III: Schäume (Spheres III: Foams). Frankfurt am Main: Suhrkamp Verlag. Sloterdijk, P. 2004. Sphären III: Schäume (Spheres III: Foams). Frankfurt am Main: Suhrkamp Verlag.
go back to reference Stolper, M., S. van der Dam, G. Widdershoven, and B. Molewijk. 2010. Clinical ethics in the Netherlands: Moral case deliberation in health care organizations. In Clinical ethics consultation. Theories and methods, implementation, evaluation, ed. J. Schildmann, J.-S. Gordon, and J. Vollmann. Farnham, Burlington: Ashgate. Stolper, M., S. van der Dam, G. Widdershoven, and B. Molewijk. 2010. Clinical ethics in the Netherlands: Moral case deliberation in health care organizations. In Clinical ethics consultation. Theories and methods, implementation, evaluation, ed. J. Schildmann, J.-S. Gordon, and J. Vollmann. Farnham, Burlington: Ashgate.
go back to reference Stolper, M., B. Molewijk, and G. Widdershoven. 2016. Bioethics consultation in clinical settings: theory and practice of the dilemma method of moral case deliberation. BMC Medical Ethics. doi:10.1186/s12910-016-0125-1. Stolper, M., B. Molewijk, and G. Widdershoven. 2016. Bioethics consultation in clinical settings: theory and practice of the dilemma method of moral case deliberation. BMC Medical Ethics. doi:10.​1186/​s12910-016-0125-1.
go back to reference Taels, J. 2008. Laughing matters: The unstoppable rise of the comic perspective. In The locus of tragedy, ed. A. Cools, T. Crombez, R. Slegers, and J. Taels, 299–318. Leiden, Boston: Brill.CrossRef Taels, J. 2008. Laughing matters: The unstoppable rise of the comic perspective. In The locus of tragedy, ed. A. Cools, T. Crombez, R. Slegers, and J. Taels, 299–318. Leiden, Boston: Brill.CrossRef
go back to reference Tarzian, A.J., and ASBH Core Competencies Update Taskforce. 2013. Health care ethics consultation: An update on core competencies and emerging standards from the American Society for Bioethics and Humanities’ Core Competencies Update Task Force. The American Journal of Bioethics 13(2): 3–13.CrossRef Tarzian, A.J., and ASBH Core Competencies Update Taskforce. 2013. Health care ethics consultation: An update on core competencies and emerging standards from the American Society for Bioethics and Humanities’ Core Competencies Update Task Force. The American Journal of Bioethics 13(2): 3–13.CrossRef
go back to reference Vos-Broerse, M.A. 2015. Sharing the burden of deciding: How physicians and parents make end-of-life decisions. Thesis. The Netherlands: University of Amsterdam. Vos-Broerse, M.A. 2015. Sharing the burden of deciding: How physicians and parents make end-of-life decisions. Thesis. The Netherlands: University of Amsterdam.
go back to reference Yin, R.K. 2014 (5th edition, 1st edition 1984). Case study research: Design and methods. Thousand Oaks: Sage. Yin, R.K. 2014 (5th edition, 1st edition 1984). Case study research: Design and methods. Thousand Oaks: Sage.
Metadata
Title
Tragedy in moral case deliberation
Authors
Benita Spronk
Margreet Stolper
Guy Widdershoven
Publication date
01-09-2017
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 3/2017
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-016-9749-7

Other articles of this Issue 3/2017

Medicine, Health Care and Philosophy 3/2017 Go to the issue