Should Moral Case Deliberation Be Part of Clinical Practice? : A Review of Certain Assumptions within the Concept of Moral Case Deliberation

Abstract: Healthcare professions are known to be inherently moral. They confront on a daily basis essential ethical problems. However, my experience as a nurse shows a different reality. In practice healthcare professionals often have difficulty to even identify the ethical problem before attempting to resolve the situation. In a plethora of literature moral case deliberation (MCD) is discussed as method to address these limitations of healthcare professionals. In general MCD can be defined as a discussion with the different parties involved about the ethical issues of a real case in clinical practice. In order to achieve a more comprehensive understanding of MCD I identified MCD's main features and reviewed two methods (Clinical pragmatism and the Hermeneutic method) as examples. This review  unfolded certain assumed normative ideas more or less common in many models of MCD. However it is unclear how to understand these normative ideas and as to whether they should indeed guide MCD. Throughout the thesis I concentrate on some of these assumptions. I focused on the three, which I considered the most relevant for the implementation of MCD into clinical practice: 1) the involvement of everyone concerned the case, 2) consensus as an ideal within MCD and 3) MCD improves decision making. The aim of the thesis was to reflect on how these assumptions could be reasonably understood and to outline remaining ambiguities and points for critique in their application within MCD. Hence I am not arguing whether MCD should be part of clinical practice or not, I am critically reviewing the process of MCD within clinical practice. Finally, in the thesis it is illustrated that for each assumption various plausible explanations are possible, which all might have a role in practice. The usefulness of MCD might depend on what relevance these explanations are given in practice.