Does facilitation improve moral case deliberation quality?

Background: Moral Case Deliberation (MCD) is a standardized method to support healthcare professionals in reflecting upon and making morally challenging decisions guided by a trained facilitator. Research questions: The study addresses the following research questions: (1) (How) does the addition of a trained MCD facilitator applying the stepwise plan of Bauduin and Kanne improve the quality of deliberation compared to regular case/team discussions/meetings? (2) (How) does the quality of the deliberation within the MCD intervention group improve differently over time compared to regular case/team discussions/meetings? Participants and research context: Three treatment teams of wards in a maximum secured forensic psychiatric hospital in the north of the Netherlands participated in this study. Research design: A control group deliberated six times about moral decisions as usual. Two other teams deliberated two times “as usual” and four times led by a trained facilitator. All deliberation sessions were video recorded. These videos were assessed on four factors by 54 applied university students: variety of argumentation, critical engagement, moral focus, and structure of deliberation. Ethical considerations: Written informed consent was obtained from all team members for the use of video recordings. In addition, a confidentiality statement was provided to all student assessors. Results: This study indicates that adding a trained MCD facilitator using a step-by-step plan improves the quality of deliberation within MCD compared to regular case/team discussions/meetings. A facilitator has shown a positive impact by enhancing the four factors of quality of deliberation within MCD. Also, the quality within both MCD intervention groups improved differently over time. Conclusions: This first step on how to conceptualize and measure quality of moral deliberations via video analysis will be useful for future ethics support and ethics education studies.