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Chapter 9 Action Research on Ethical Deliberation Kenneth R. Melchin and Peter Monette The goals of this action-research stage of the project were twofold: (1) to determine, on the basis of an anecdotal study of the videos, if evidence of the features of ethical deliberation in multiprofessionalteams gleaned from the analyses of parts 1and 2 could be observed in the case conferences; (2) to use insightsfrom the literatureand observations from the videos to construct a Guide for Ethical Deliberation that could aid health care professionals in their ethical deliberations. The work of the action research went forward with these two goals pursued concurrently.The members of the research team, Peter Monette, Tim Flaherty and Kevin G. Murphy, under the direction of Kenneth R. Melchin, Jean-Marc Larouche and Hubert Doucet, began byconducting the background research for the case conference sessions, writing four case studies involving ethical issues typically encountered in pediatric chronic care and constructingthe analytical grid of questions from parts 1 and 2of the project. The analytical grid used in studying the deliberation sessions was prepared by Peter Monette and Tim Flaherty and is presented in appendixB. The case studieswere prepared by Kevin G. Murphyunder the direction of Hubert Doucet and are presented in appendix C of this volume. Arrangements were made for two sets of staged ethical deliberation sessions involving two teams of healthcare professionals. This was coordinated by Hubert Doucet. While the deliberations deal with prepared cases, the participants ensured that the discussions were representative of the sorts of sessions that typically arise in real-life contexts. The deliberation sessions of the first series wereone-hourlongand conducted in French, and each was devoted to the discussion of one case. The sessions were videotaped by the research team. As the tapes came in, they were examined by the team, first for preliminary anecdotal observations without explicit use of the analytical grid and, second, for more detailed casestudy observations, using the grid. 171 ACTION RESEARCH: ETHICAL DELIBERATION IN MULTIPROFESSIONAL HEALTHCARE TEAMS As the analysis of this first set of deliberationsessions proceeded, the research team began compiling notes and preparing a draft of the Guide for Ethical Deliberation. The final version of the guide is presented in chapter 10 of this volume.Arrangements were made for a second set of deliberation sessions involving an English-speakinghealth care team. The team membersweregiven the guideand wereasked to attempt a preliminary implementation of the guide in their deliberations.As the videos from these sessions came in, researchers studied them and made anecdotal observations,again using the three-part analytical grid. The project uses an action-research approach. This methodologyis an adaptation of the social analysis method of Holland and Henriot and the recherche-action method of Grand'Maison.1 This method was chosen because of its explicitconcern with values, social structuresand practical action.2 In addition, because the method does not focus on quantitative verification of existing hypotheseswithin the context of extant theory,it permits an anecdotalcase-study analysis to draw upon multiple theories and disciplines to contribute to the development of new insights, new theory and recommendationsfor practical action. By using acombination of literature review, multidisciplinary theoretical analysis and anecdotal case analysis, this project aimsat developingtheoretical and practical tools that couldbe subjected to more empirically rigorous scrutiny in future researchprojects. 1. See Joe Holland and Peter Henriot, Social Analysis, rev. ed. (Maryknoll, N.Y.: Orbis/ Center of Concern, 1984); Jacques Grand'Maison and Solange Lefebvre, eds., Line generation boucemissaires: Enquete sur les baby boomers, 3° dossier de la rechercheaction dans le diocese Saint-Jerome (Montreal: Fides, 1993); Jacques Grand'Maison and Solange Lefebvre, eds., La Pan des atnees: Recherche-action, 4C dossier (Montreal : Fides, 1994); Jean-Guy Nadeau, ed., La Praxeologie pastorale: Orientations et parcours, vols. 1 and 2. Cahiers d'etudes pastorales IV (Montreal: Fides, 1987); Colloque recherche action, Actes du Colloque recherche action, Universitedu Quebec a Chicoutimi, 1981 (Chicoutimi: Universite du Quebec a Chicoutimi, 1982); J. Billiet et al., Actes du colloque: Methodologie et pratique de la recherche-action (Brussels: Royautne de Belgique, Programme national de recherche en sciences sociales, 1980). 2. See Holland and Henriot, 98-100. One modification of the Holland-Henriot methodology involved the range of "root metaphors" informing the understandingof the social structures implicated in health care. Holland and Henriot draw upon Gibson Winter , Liberating Creation (New York: Crossroad, 1981), for an artistic "root metaphor" to guide their analysis. Consequently, their work has a "liberation" or "critique of domination" focus to it and, therefore, tends...

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