Thesis

17 General introduction diversity is the starting point; hence, where initial ideas or beliefs clash (Inguaggiato, Porz, et al., 2019). That creates a context to explore together, when all participants are willing to investigate the case and the perspectives. ‘Being anti-dogmatic and ready to revise given theories and practices sets moral reasoning in motion and is the driving force behind moral progress’ (Inguaggiato, Porz, et al., 2019). Because of the focus on concrete situations in MCD, the newly developed insights, skills or attitude can be more easily translated to work practice. Furthermore, during the dilemma method there is attention to potential harmful aspects of situations or decisions, and possible ways to minimalize such ‘moral damage’ (Stolper et al., 2016). Hence, the dilemma method aims to help participants make the translation from the dialogue toward how to act in practice. Research on MCD as an Ethics Support Service MCD is introduced at DCIA as an intervention to develop the prison staff’s moral craftsmanship. In general, MCD is stated to be a ‘quality-enhancing tool’ (De Bree & Veening, 2012, p. 13). Health care organizations consider it a good employment practice2 to offer ethics support to their staff (Hartman et al., 2016, p. 34). Positive statements about the outcomes of MCD are not always substantiated with empirical data. So far, for example, no positive impact of MCD was found on reducing moral distress (Kälvemark Sporrong et al., 2007) or improving the work climate (Forsgärde, 2000). A literature review on the evaluation of the significance of MCD in health care did show how systematic moral reflection improves participants’ understanding of moral challenges, but whether it led to better care practices was not certain (Hem et al., 2015). Another literature review on various MCD evaluation studies shows that MCD does indeed increase insight into moral issues, and that MCD improves the constructive handling of different viewpoints and helps develop team cooperation (Haan et al., 2018). Also new research questions arise. Can instruments such as MCD help decrease moral (dis)stress levels or increase the moral resilience of professionals (Hartman et al., 2016, p. 40)? Can MCD help professionals by addressing the inherent tragic dimension of (potential) harmful situations and experiences (Spronk et al., 2020)? More in general, MCD is said to be able to help develop participants ‘moral learning process’ (Metselaar et al., 2015). Yet research on the exact meaning of moral learning for professionals is relatively underdeveloped (Railton, 2017). Most articles that state MCD fosters a moral learning process, do not accompany the statement with related empirical data (as seen in e.g., Inguaggiato et al., 2 For the accreditation of health care institutions these institutions are increasingly required to have ethics support structures for their employees (Hartman et al., 2022; JCI, 2018). 1

RkJQdWJsaXNoZXIy MjY0ODMw