Which ethical problems arise in Moral Case Deliberation concerning patients whose voices are impaired?

Background: Ethically difficult situations are frequently encountered by healthcare professionals. Moralcase deliberation is one form of clinical ethics support, which has the goal to support staff to manageethical difficulties. However, little is known which difficult situations healthcare teams need to discuss. Aim: To explore which kinds of ethically difficult situations interprofessional healthcare teams raise duringmoral case deliberation. Research design: A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedishworkplaces. A descriptive, qualitative approach was applied, using thematic content analysis. Ethical considerations: An advisory statement specifying no objections to the study was provided froman Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moralcase deliberation. Findings: Three themes emerged: powerlessness over managing difficult interactions with patients andnext-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over caredecisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or managepatient’s/next-of-kin’s emotional needs or emotional outbursts and discouragement over motivatingpatients not taking responsibility for themselves. They could be uncertain over the patient’sautonomy, who should have power over life and death, disclosing the truth or how much power nextof-kin should have. Discussion: The findings suggest that the nature of the ethically difficult situations brought to moral casedeliberations contained more relational-oriented ethics than principle-based ethics, were permeated byemotions and the uncertainties were pervaded by power aspects between stakeholders.Conclusion: MCD can be useful in understanding the connection between ethical issues and emotionsfrom a team perspective