Objective: To identify moral dilemmas regarding coercion and restraint among professionals working at a psychiatric ward, to get insight in the value of Moral Case Deliberation meetings about these dilemmas, and in the implementation of such meetings.
Methods: Qualitative explorative study with interviews, focus group and participant observation.
Results: Professionals experience dilemmas related to closing the ward (freedom versus safety), coercive treatment (freedom versus health), and camera surveillance (privacy versus safety). The introduction of Moral Case Deliberation contributes to changes concerning quality of treatment, professionalism of healthcare providers, and cooperation in the treatment team. The implementation of Moral Case Deliberation depends on an atmosphere of trust, expertise of the facilitator, and active involvement of a local coordinator. Bottlenecks for implementation include the availability of physicians, time-pressure and intervals between meetings.
Conclusion: Moral Case Deliberation fosters quality of treatment and moral competence of professionals in dealing with ethical dilemmas in psychiatric practice. Continuity of Moral Case Deliberation meetings motivates the participants and provides the opportunity to learn and practice ethical skills.
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