Abstract：
Moral distress forms a major threat to the well-being of healthcare professionals, and is argued to negatively impact patient care. It is associated with emotions such as anger, frustration, guilt, and anxiety. In order to effectively deal with moral distress, the concept of moral resilience is introduced as the positive capacity of an individual to sustain or restore their integrity in response to moral adversity. Interventions are needed that foster moral resilience among healthcare professionals. Ethics consultation has been proposed as such an intervention. In this paper, we add to this proposition by discussing Moral Case Deliberation (MCD) as a specific form of clinical ethics support that promotes moral resilience. We argue that MCD in general may contribute to the moral resilience of healthcare professionals as it promotes moral agency. In addition, we focus on three specific MCD reflection methods: the Dilemma Method, the Aristotelian moral inquiry into emotions, and CURA, a method consisting of four main steps: Concentrate, Unrush, Reflect, and Act. In practice, all three methods are used by nurse ethicists or by nurses who received training to facilitate reflection sessions with these methods. We maintain that these methods also have specific elements that promote moral resilience. However, the Dilemma Method fosters dealing well with tragedy, the latter two promote moral resilience by including attention to emotions as part of the reflection process. We will end with discussing the importance of future empirical research on the impact of MCD on moral resilience, and of comparing MCD with other interventions that seek to mitigate moral distress and promote moral resilience.
摘要：
道德困扰对医疗保健专业人员的福祉构成了重大威胁，并被认为会对患者护理产生负面影响。它与愤怒等情绪有关，挫败感,内疚，内疚和焦虑。为了有效应对道德困境,道德韧性的概念被引入作为个人在道德逆境中维持或恢复其完整性的积极能力。需要采取干预措施来培养医疗保健专业人员的道德韧性。道德协商已被提议作为这种干预措施。在本文中,我们通过讨论道德案例审议(MCD)作为促进道德适应力的临床伦理支持的特定形式来补充这一命题.我们认为，MCD通常可以促进医疗保健专业人员的道德韧性，因为它可以促进道德代理。此外,我们关注三种特定的MCD反射方法：困境方法，亚里士多德对情感的道德探究，CURA,一种由四个主要步骤组成的方法：浓缩，Unrush,反射,和行动。在实践中,护士伦理学家或接受过培训的护士使用这三种方法来促进这些方法的反思。我们坚持认为，这些方法也具有促进道德韧性的特定要素。然而,两难方法有利于处理好悲剧，后两者通过将对情绪的关注作为反思过程的一部分来促进道德韧性。最后，我们将讨论未来关于MCD对道德韧性的影响的实证研究的重要性，并将MCD与其他旨在减轻道德困扰和促进道德韧性的干预措施进行比较。
