Martine Kruijtbosch

154 Chap t e r 4 Phase 2: Judgment formation In step 7, the judgment-formation phase, all participants were given 10 minutes to answer five questions in which they made an individual choice of action and made their moral considerations explicit (Box 1, step 7). In order to facilitate the dialogue in the decision- making phase (phase 3) the facilitator may choose two contrasting choices of action or moral considerations. See Box 4 for an example of two of such contrasting judgements between participant x and participant y. BOX 4: Judgement formation moral case deliberation (MCD) session 1: Step 7 - Contrasting choices of action and moral considerations of participants x and y Participant x Participant y a) It is morally justified that I choose option … (A, B or an alternative) ‘I firstly choose option B: I contact the replacement physician and thereafter dispense the double anticoagulant medication.’ a) It is morally justified that I choose option … (A, B or an alternative) ‘I firstly choose option E: I contact the patient and thereafter dispense the double anticoagulant medication.’ b) Because of…. (which value or norm?) ‘Reliable and caring, I want confirmation from the physician.’ b) Because of…. (which value or norm?) ‘Commitment to the well-being of the patient, I want to know the perspective from the patient himself, and not from what I think of the situation, or what the physician or patient’s wife think of the situation.’ c) Despite of…. (which value or norm?) ‘Continuation of possibly incorrect double anticoagulation for a number of days with bleeding risk.’ c) Despite of…. (which value or norm?) ‘I don't know to what extent this man is actually competent and accountable. Perhaps he is suffering from dementia and pretends to be better than reality or does not actually have an opinion. When I stop or start the anticoagulant unjustly, I might not be acting in the right way.’ d)How can you limit the disadvantages of your choice mentioned under c? ‘I would inform the wife of the patient about the signs of oral anticoagulant toxicity such as bleeding and agree when she should call.’ d)How can you limit the disadvantages of your choice mentioned under c? ‘By formulating questions in a careful manner, for example by saying: ‘I would like to ask you some more information, because you are the one who stayed in the rehabilitation centre.’ e) What do you need to act according your answer under ‘a’? Not answered in the session. e) What do you need to act according your answer under ‘a’? Not answered in the session.