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Relational autonomy in the care of the vulnerable: health care professionals' reasoning in Moral Case Deliberation (MCD)
Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.ORCID iD: 0000-0002-1983-9813
Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden.
Department of Philosophy and Religious Studies, Faculty of Humanities, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Glasgow End of Life Studies Group, School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK.
University Health Care Research Center, Region Örebro County, Örebro, Sweden.
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2018 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 21, no 4, p. 467-477Article in journal (Refereed) Published
Abstract [en]

In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient's nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient's autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients' influence and at the same time take responsibility for their needs as vulnerable humans.

Place, publisher, year, edition, pages
Dordrecht, Netherlands: Springer Netherlands, 2018. Vol. 21, no 4, p. 467-477
Keywords [en]
Clinical ethics, ethics consultation, health care professionals, moral case deliberation, ualitative research
National Category
Medical Ethics
Identifiers
URN: urn:nbn:se:oru:diva-63400DOI: 10.1007/s11019-017-9818-6ISI: 000451022600004PubMedID: 29243015Scopus ID: 2-s2.0-85038102190OAI: oai:DiVA.org:oru-63400DiVA, id: diva2:1171918
Available from: 2018-01-08 Created: 2018-01-08 Last updated: 2024-11-05Bibliographically approved
In thesis
1. Making ethics visible: Doctors´moral reasoning in patient care
Open this publication in new window or tab >>Making ethics visible: Doctors´moral reasoning in patient care
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare is infused with values concerning what is important to patients and healthcare professionals and, thereby, ethics might seem to be inherent and self-evident. However, in clinical practice, ethics is elusive and difficult to articulate, and a gap persists between theory and practice. Thus, the overall aim of this thesis was to generate understandings about ethics close to practice by exploring doctors’ moral reasoning when caring for the patient.

The research design was qualitative and explorative. The phenomenon of‘moral reasoning’ was explored in 22 audio recorded ethical reflection groups (Moral case deliberation) (I), 27 interviews with UK consultants about their experiences of the complex decision-making process of initiating intensive care (II), 19 Swedish vascular surgeons in the outpatient setting (III), and observation and audio recording of 7 team conferences accompanied by 23 follow-up interviews with vascular surgeons (VI). The data were analysed by using content analysis, employing a phenomenological-hermeneutical method, and systematic text condensation.

A composite result of the four studies revealed moral reasoning as a proces sof balancing between promoting the patient’s best interests and the patients’ preferences, deliberating one’s moral responsibility in the patient’s care, and expanding understandings of complex situations through multiple perspectives. Moral reasoning is embedded in the clinical language, and the patient encounter emerges as the hub for these reasonings. As such, the patient encounter signifies carefully exploring the clinical details of the case to weigh conflicting values, to expand one’s understanding of the patient’s health and life beyond the diseases, and to explore the patient’s wishes for care. Meetings between doctors to discuss the patient’s care entailed learning by broadening their understanding of complex situations as well as balancing different perceptions to reach reasonable decisions. The doctors’ own security instanding in complex decision-making and critical situations can be facilitated through discussions with colleagues as well as meetings by expanding perspectives and generating new understanding of what is important in a clinical situation. The clinical implications of this knowledge are that ethics is a tangible part of doctors’ care of patients that needs continuous exploration and verbalizing as a means of maintaining quality of care, which is a moral obligation in itself.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2024. p. 116
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 306
Keywords
medical ethics, qualitative research, moral case deliberation, intensive care, vascular surgery, surgeons, physicians
National Category
General Practice Medical Ethics
Identifiers
urn:nbn:se:oru:diva-116066 (URN)9789175296067 (ISBN)9789175296074 (ISBN)
Public defence
2024-11-29, Örebro universitet, Campus USÖ, hörsal X1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
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Supervisors
Available from: 2024-09-16 Created: 2024-09-16 Last updated: 2024-11-25Bibliographically approved

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Heidenreich, KajaSvantesson, Mia

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