BACKGROUND In healthcare practice, care providers are confronted with decisions they have to make, directly affecting patients and inevitably harmful. These decisions are tragic by nature. This study investigates the role of Moral Case Deliberation (MCD) in dealing with tragic situations. In MCD, caregivers reflect on real-life dilemmas, involving a choice between two ethical claims, both resulting in moral damage and harm. One element of the reflection process is making explicit the harm involved in the choice. How harmful are our decisions? We investigated how facilitators of MCD experience the importance of addressing harm in MCD and what participants learn from reflecting on harm. METHODS The study was qualitative, focusing on the views and experiences of the facilitators of MCD. Semi-structured interviews (N = 12) were conducted with facilitators of MCD. The research focuses on the subjective experiences of facilitators. Grounded Theory was used for analysis. RESULTS The results show two main categories. The first concerns the awareness of tragedy. Within this category, five themes were discerned: making explicit that there is no solution, visualizing consequences, uncovering pain, focusing on emotion, and exploring perspectives on harm. The second category concerns the support for healthcare professionals in dealing with the tragedy of the choices they face. In this category, five themes came forward: acknowledging, offering comfort, managing harm, consideration through dialogue and repairing harm. CONCLUSION Our study shows that addressing harm in MCD in tragic situations provides an important moral learning opportunity for participants. By formulating and becoming aware of harm, MCD aids healthcare professionals in the task they are faced with, namely making difficult and painful choices. MCD helps healthcare professionals to repair moral damage, making clear at the same time that harm cannot be undone.

中文翻译：

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解决道德案件审议中的损害：调解人的观点和经验。

背景技术在医疗保健实践中，护理提供者面临他们必须做出的决定，直接影响患者并且不可避免地有害。这些决定本质上是悲惨的。这项研究调查了道德案件审议（MCD）在处理悲剧情况中的作用。在MCD中，看护人会反思现实生活中的困境，包括在两种道德主张之间做出选择，这两种行为都会造成道德损害和伤害。反思过程的要素之一是明确选择所涉及的危害。我们的决定有多有害？我们调查了MCD的促进者如何体验解决MCD中的伤害的重要性，以及参与者从对伤害的反思中学到了什么。方法本研究是定性的，重点是MCD促进者的观点和经验。与MCD的主持人进行了半结构式访谈（N = 12）。该研究侧重于主持人的主观经验。扎根理论用于分析。结果结果显示了两个主要类别。首先是对悲剧的认识。在这一类别中，辨别出五个主题：明确指出没有解决方案，可视化后果，发现痛苦，关注情感以及探索危害观点。第二类涉及在应对医务人员面临的选择悲剧时对他们的支持。在这一类别中，提出了五个主题：承认，提供安慰，管理伤害，通过对话进行考虑和修复伤害。结论我们的研究表明，应对悲剧性环境中MCD的危害为参与者提供了重要的道德学习机会。通过制定和了解危害，MCD帮助医疗保健专业人员完成他们面临的任务，即做出困难而痛苦的选择。MCD帮助医疗保健专业人员修复精神损害，同时明确指出无法消除损害。