170 Chapter 9 “Within [a] moral case deliberation [session], you take the content and that particular patient into account. What are the criteria and arguments on which we base a decision? And what are the advantages and disadvantages? This also has a learning effect for cases that are similar.” - Individual interview with a clinician “I notice that you internalize what has been talked about [during a moral case deliberation session] and that you bear that in mind during subsequent contact with patients […] In my opinion, that is an important added value of a moral case deliberation session: that you learn to break through the standard pathways and ideas.” - Focus group with clinicians Participants became aware of the normative dimension of a problem. “Due to moral case deliberation, I realised that our care is full of moral dilemmas. I first had the impression that it was all more or less determined. This realisation is sometimes unsettling, but also a good thing.” - Individual interview with a clinician Improved decision-making process Most participants stated that the quality of treatment decisions improved in different ways. “You’re forced to think about it [the case at hand] systematically and not to make decisions too quickly. It helps you to carefully consider things, and this improves the quality of the decision.” - Individual interview with a clinician The MCD method structured the conversation. All pro and con arguments are given a place, creating coherence. The MCD framework contributed to more nuanced judgments in which the separate and sometimes conflicting values and norms are considered and weighed. Some participants said they had learned to give a better explanation and justification for certain decisions. They reported being able to explain more precisely why they had made a certain decision and had learned to give substantiated arguments to the patient, family, and colleagues. “The decisions we make are very impactful […] you do have the responsibility to the patient to explain why you are starting treatment, or why not. […] [Therefore] it is important to make the underlying idea explicit. […] So I think that, especially in this population, it is good to have some sort of mini moral case deliberation on very difficult cases.” - Individual interview with a clinician