166 Chapter 9 Dialogue among all instead of discussion among some Participants often voiced appreciation of the fact that all MCD participants were encouraged to contribute and that disagreements were discussed in a less polarizing way than is customary. Due to the structure of the dilemma method and the MCD facilitator’s role, participants have to take the time to listen to others instead of attempting to convince others of their own point of view. This enabled the participants to structure the relevant arguments and take a more open attitude towards other perspectives. The dilemma method encourages the participants to incorporate the arguments and merits of ‘the other side’ of the dilemma rather than to try to discredit a colleague’s opinion. “Sometimes our disagreements are expressed with so much emotion, that you can get the impression that the one [team member] who expresses the strongest emotion has the truth on their side. Moral case deliberation is good at neutralizing the emotions and returning participants to the crux of the matter. Moral case deliberation encourages you to acknowledge the merits of both sides of a dilemma.” - Individual interview with a clinician “I like the fact that you do not have to persuade anyone else of your point of view [in a moral case deliberation session], and that it is possible for several opinions to coexist. This does not happen in regular meetings, because in those meetings decisions have to be made and all you want is to get your own point of view across.” - Focus group with clinicians Paying closer attention to your own arguments and contextual factors, rather than blindly following protocol Another frequently mentioned positive experience with MCD was that it enabled the teams to explore in great detail how they had handled a given protocol and why they had done so, which gave them deeper insight. Furthermore, the teams often used MCD sessions to discuss cases or requests not covered by the existing protocol. During the MCD sessions, the participants exchanged ideas on the question, ‘Which rules do we view as absolute and which can be handled with greater flexibility, and when it comes to the latter, under what conditions may we do so?’. “Certain decisions can be found in our protocol, but in moral case deliberation, you are encouraged to ask questions like: ‘Why do we do things that way?’ and ‘What, precisely, is the risk if we take this step?’” - Individual interview with a clinician “In the collaboration between Amsterdam and Leiden, we also look at the boundaries of the protocol and how we handle these boundaries in practice.” - Individual interview with a clinician