Thesis

142 Chapter 6 Moral Case Deliberation MCD is an instrument that is focused on group reflections in a stepwise approach (Appendix 2) by means of dialogue (Molewijk et al., 2008; Weidema et al., 2013). Six to 12 professionals reflect on a personally experienced case with moral doubts or disagreements. MCD is based on the pragmatic hermeneutical viewpoint that experiences are the source of moral learning and that making moral judgments requires a full understanding of a situation and its context (Widdershoven & Molewijk, 2010). Trained facilitators (Stolper et al., 2015) enable a joint moral learning process in which knowledge is co-created by all involved in the case (Inguaggiato, Metselaar, et al., 2019). Within MCD, professionals learn to recognize and deal with moral challenges, which may lead to new courses of action (Metselaar et al., 2015). Studies of MCD in health care report positive results regarding the collaborative learning processes and improved team cooperation (De Snoo-Trimp et al., 2020; Weidema et al., 2013) indicating, e.g., MCD participants’ increased awareness and understanding of perspectives on the discussed case (Haan et al., 2018; Hem et al., 2015). However, such outcomes do not provide information about the potential moral learning during MCD. Moral learning There is a long tradition and ongoing debate about how to understand moral learning, how it evolves, and how it can be stimulated. For example, some experts position the start of moral development in the exploration of standards of right and wrong (Gibbs, 2014; Kohlberg, 1976; Piaget, 1965; Rest, 1979). Moral learning processes show ‘transformations that occur in a person’s form or structure of thought’ (Kohlberg & Hersh, 1977, p. 54). Transformations occur because the ‘rules of moral reasoning [...] are reinterpreted and contextualized because of the moral complexities of adult life’ (Brookfield, 1998). Additionally, Gilligan (1982) emphasizes that relational aspects and caring for others influences moral judgements, e.g., when determining how decisions will affect others. Brookfield (1998) mentions that moral learning can also be considered becoming ‘critically reflective’, e.g., through awareness of the contextuality of reasoning, learning about moral limitations, and being self-reflective on one’s reasoning. Hence, there is no consensus on what the moral learning of professionals entails (Brookfield, 1998; Railton, 2017). Based on the pragmatic hermeneutic vision on ethics and ethics support (Widdershoven & Molewijk, 2010), we consider the following aspects relevant for moral learning: 1) Making good moral judgments requires a profound understanding of the contextuality

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