Article Text

Download PDFPDF

Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities
  1. Mia Svantesson1,
  2. Janine C de Snoo-Trimp2,
  3. Göril Ursin3,
  4. Henrica CW de Vet4,
  5. Berit S Brinchmann5,
  6. Bert Molewijk2,6
  1. 1 University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  2. 2 Department of Medical Humanities, VU Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
  3. 3 Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
  4. 4 Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
  5. 5 Nordland Hospital Trust, Nord University, Bodø, Norway
  6. 6 Center of Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
  1. Correspondence to Associate professor Mia Svantesson, University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro 702 81, Sweden; mia.svantesson-sandberg{at}


Background There is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.

Methods A North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.

Results All outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.

Conclusions The findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument.

  • clinical ethics
  • ethics committees/consultation
  • health personnel
  • applied and professional ethics
  • education for health care professionals

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors MS and BM initiated and coordinated the study. MS recruited Swedish workplaces and collected this data, analysed both the quantitative and qualitative data, and drafted the manuscript. BM participated in the design of the study, the recruitment of Dutch workplaces, the collection of data, the qualitative analysis and participated in the drafting the manuscript. JS-T participated in the recruitment of Dutch workplaces and collection of data, the qualitative and quantitative analysis, and the writing of the manuscript. GS recruited and collected the Norwegian data, participated in the qualitative analysis, and commented on the manuscript. BS-B participated in the design of the study, recruited Norwegian workplaces, participated in the qualitative analysis and commented on the manuscript. RV made substantial contributions to the quantitative analysis with statistical expertise and to the writing of the manuscript. All authors read and approved the final manuscript.

  • Funding This study was funded by AFA Försäkring ( and grant number: 120125 and The Norwegian Association of Local and Regional Authorities.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.