Please note that whilst the views, opinions
and experiences arising from the MCD
sessions provide great insight into the
practice of palliative sedation in the
participating countries, this information
cannot be generalised. In other words, the
results of these MCD sessions do not
necessarily represent the views or practices
of other healthcare providers in the
respective countries. Any mention of a
country in the following text refers to an
MCD session in that respective country, and
not to views or practices of the country as a
whole, unless specified as such.
Healthcare professionals, who care for adult
patients with palliative care needs, often
encounter complex cases where difficult
decisions need to be made. (1-3) Decisionmaking
concerning whether and how to use
palliative sedation, in many cases, poses
ethical issues for healthcare professionals,
patients, and family members. (4-6) Moral
case deliberation (MCD) supports
professionals in recognizing and discussing
ethical questions and making difficult ethical
decisions. (5,7) MCDs are sessions where
healthcare professionals gather to discuss
and reflect in a structured way on a
particular clinical case in which they face
ethical dilemmas. (5) The sessions are led by
a trained facilitator who helps to structure
moral debate and supports the participants
in the process of reflection. The dilemma
method is frequently used in MCD. An
ethical dilemma means choosing between
options that may cause distress to one or
more stakeholders, often occurring in
clinical practice. (8) All stakeholders'
viewpoints, values and norms are presented
in MCD sessions. Patients' and family
members' perspectives are usually
represented by the family members
themselves or a healthcare professional.
(8,9) Besides supporting healthcare
professionals, the MCD method can also be
applied as a research tool that may provide
valuable insight into the ethical issues
perceived by healthcare professionals
concerning a particular clinical practice - in
this case, palliative sedation. (1)
In the Palliative Sedation study, 32 MCD
sessions were conducted in eight countries
(Belgium, Germany, Hungary, Italy, the
Netherlands, Romania, Spain, United
Kingdom) with the participation of
healthcare professionals (doctors, nurses,
psychologists, physical therapists,
counsellors, social workers, and priests). In
16 clinical sites, two MCD sessions were
held, discussing controversial cases where
ethical questions arose regarding refractory
symptoms or palliative sedation. One
vignette case, which was the same across all
sites, was discussed at the first session. A
real clinical case, involving a closed or
ongoing ethically challenging case
encountered by the given site's healthcare
professionals, was then discussed at the
second session. With the help of the
dilemma method, healthcare professionals
investigated what they perceived as the best
way to act morally in the presented cases. All
topics and questions that the MCD
participants identified as ethical questions
were considered ethical issues during the
MCD sessions.
Introduction The moral case deliberation
(MCD) sessions
32