Skip to main content
Log in

Learning by Doing. Training Health Care Professionals to Become Facilitator of Moral Case Deliberation

  • Published:
HEC Forum Aims and scope Submit manuscript

Abstract

Moral case deliberation (MCD) is a dialogue among health care professionals about moral issues in practice. A trained facilitator moderates the dialogue, using a conversation method. Often, the facilitator is an ethicist. However, because of the growing interest in MCD and the need to connect MCD to practice, healthcare professionals should also become facilitators themselves. In order to transfer the facilitating expertise to health care professionals, a training program has been developed. This program enables professionals in health care institutions to acquire expertise in dealing with moral questions independent of the expertise of an (external) ethicist. Over the past 10 years, we developed a training program with a specific mix of theory and practice, aiming to foster the right attitude, skills and knowledge of the trainee. The content and the didactics of the training developed in line with the philosophy of MCD: pragmatic hermeneutics, dialogical ethics and Socratic epistemology. Central principles are: ‘learning by doing’, ‘reflection instead of ready made knowledge’, and ‘dialogue on dialogue’. This paper describes the theoretical background and the didactic content of the current training. Furthermore, we present didactic tools which we developed for stimulating active learning. We also go into lessons we learned in developing the training. Next, we provide some preliminary data from evaluation research of the training program by participants. The discussion highlights crucial aspects of educating professionals to become facilitators of MCD. The paper ends with concluding remarks and a plea for more evaluative evidence of the effectiveness and meaning of this training program for doing MCD in institutions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. Moral case deliberation is also practiced with patients, family members, managers, house holding staff (in and outside the domain of health care).

  2. A hypothetical case is not connected with personal experiences including personally felt values and moral concerns. Moreover a hypothetical case misses a connection with relevant facts, which entails the risk that participants make their moral opinions based on assumptions about facts.

  3. In this paper we distinguish between ‘dialogue’ and ‘debate’. A dialogue aims at mutual understanding through asking sincere questions and postponing one’s own initial judgments. It requires an attitude of listening and questioning, arising from honest inquisitiveness to the underlying motives of the other person. A debate starts with a judgment or normative position and aims at convincing the other.

References

  • Abma, T. A., Molewijk, B., & Widdershoven, G. A. M. (2009). Good care in ongoing dialogue: Improving the quality of care through moral deliberation and responsive evaluation. Health Care Analysis, 17(3), 217–235.

  • Birnbacher, D. (1999). The Socratic method in teaching medical ethics: Potentials and limitations. Medicine, Health Care and Philosophy, 2(3), 219–224.

    Article  Google Scholar 

  • Dauwerse, L., Abma, T. A., Molewijk, B., & Widdershoven, G. A. M. (2011). Need for ethics support in healthcare institutions: Views of Dutch board members and ethics support staff. Journal of Medical Ethics, 37, 456–460.

  • Dewey, J. (1960). Theory of the moral life. New York: Holt Rinehart and Winston.

    Google Scholar 

  • Gadamer, H. G. (1960). Wahrheit und methode. Tubingen: Mohr JCB.

    Google Scholar 

  • Heckmann, G. (1981). Das sokratische gesprach. Erfahrungen in philosophischen Hochschulseminaren. Hannover: Schroedel.

    Google Scholar 

  • Kessels, J., Mostert, P., & Boers, E. (2006). Free space. Philosophy in organisations. Amsterdam: Boom.

    Google Scholar 

  • Kessels, J., Mostert, P., & Boers, E. (2009). Free space: Field guide to conversations (workbook). Amsterdam: Boom.

    Google Scholar 

  • Molewijk, B., Abma, T. A., Stolper, M., & Widdershoven, G. (2008a). Teaching ethics in the clinic: The theory and practice of moral case deliberation. Journal of Medical Ethics, 34, 120–124.

    Article  Google Scholar 

  • Molewijk, B., Verkerk, M., Milius, H., & Widdershoven, G. (2008b). Implementing moral case deliberation in a psychiatric hospital: Process and outcome. Medicine Health care and philosophy, 11, 43–56.

  • Molewijk, B., Zadelhoff, E., Lendemeijer, B., & Widdershoven, G. (2008c). Implementing moral case deliberation in Dutch health care: Improving moral competency of professionals and quality of care. Bioethica Forum, 1(1), 57–65.

  • Molewijk, B., & Ahlzen, R. (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.

    Article  Google Scholar 

  • Nelson, L. (1994). De socratische methode. Translated by Kessels, J., Amsterdam: Boom.

  • Plantinga, M., Molewijk, B., de Bree, M., Moraal, M., Verkerk, M., & Widdershoven, G. A. (2012). Training healthcare professionals as moral case deliberation facilitators: Evaluation of a Dutch training programme. Journal of Medical Ethics, 38, 630–635.

  • Steinkamp, N., & Gordijn, B. (2003). Ethical case deliberation on the ward: A comparison of four methods. Medicine, Health Care and Philosophy, 6(3), 235–246.

    Article  Google Scholar 

  • Dam, van der S., Abma, T. A., Molewijk, A. C., Kardol, M. J., Schols, J. M., & Widdershoven, G. A. (2011). Organizing moral case deliberation in mixed groups: Experiences in two Dutch nursing homes. Nursing Ethics, 18(3), 327–340.

  • Vlastos, G. (1991). Socrates. ironist and moral philosopher. New York: Cambridge University Press.

    Book  Google Scholar 

  • Weidema, F. C., Molewijk, A. C., Widdershoven, G. A. M., & Abma, T. A. (2012). Enacting Ethics: Bottom-up Involvement in Implementing moral case deliberation. Health Care Analysis, 20(1), 1–19.

    Article  Google Scholar 

  • Widdershoven, G. A. M., & Molewijk, A. C. (2010). Philosophical foundations of clinical ethics: A hemeneutic perspective. In Schildmann, Gordon, & Vollmann (Eds.), Clinical ethics consultation. Theories and methods, implementation, evaluation (pp. 37–51). Surrey: Ashgate Publishing Limited.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Margreet Stolper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stolper, M., Molewijk, B. & Widdershoven, G. Learning by Doing. Training Health Care Professionals to Become Facilitator of Moral Case Deliberation. HEC Forum 27, 47–59 (2015). https://doi.org/10.1007/s10730-014-9251-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10730-014-9251-7

Keywords

Navigation