Moral Dilemmas of Dutch Prison Staff; a Thematic Overview from All Professional Disciplines

ABSTRACT

Prison staff face situations with conflicting interests and values. To strengthen craftsmanship Dutch prison staff reflected upon personal moral dilemmas during Moral Case Deliberation (MCD) sessions. This research aims to gain systematic insight into themes and moral dilemmas Dutch prison staff encounter. Evaluation-forms of 171 MCD-sessions were collected (N = 1065 MCD-participants, N = 171 MCD-facilitators) from 22 teams of different professional disciplines at 3 locations. Our qualitative thematic content analysis included 154 moral dilemmas. We noted the organizational level and professional disciplines the moral dilemmas related to, and how dilemmas were formulated. All professional disciplines within prison work show to encounter a wide range of moral dilemmas, which emerge in and between all organizational levels. “Security” and “cooperation” were frequently mentioned themes, while dilemmas relating to the rehabilitation of prisoners were underrepresented. Some formulations of moral dilemmas were based on frustrations toward colleagues or the organization, expressed “powerlessness” to change practice, or contained normative arguments instead of an open formulation. These insights call for structural facilitation of methods for prison staff to deal with moral dilemmas. Ethics Support Services (ESS), such as MCD-sessions, can be used to further strengthen the moral craftsmanship of prison staff.

KEYWORDS:

• Prisons
• jails

Introduction

Prison staff often face situations in which conflicting interests and values lead to questions about the right action to take. The context of working in prison can lead to challenging situations (Schmalleger & Smykla, 2014). The two central aims of prison work, security and rehabilitation, can lead to value conflicts (Bruhn et al., 2010). Prison staff struggle with “opposing obligations” trying to find a balance between “the duty to care for prisoners and the duty to protect others” (Shaw et al., 2014). Moral dilemmas occur in situations in which two or more conflicting values raise doubts regarding the right action (Maclagan, 2003).

To maintain safety, many work processes are established in regulations and protocols. An emphasis on regulations can lead to a focus on “compliance strategies,” where organizations tend to examine and enforce rules, and thereby establish clear boundaries with regard to what is within and outside the norm. Organizations reinforce this by requiring adherence to codes of conduct and auditing practices (Karssing, 2000). In Dutch prisons, in response to incidents more regulations seem to be developed and enforced (Van Houwelingen et al., 2015). However, the answer to how prison staff should act responsibly to their duties cannot always be provided by following protocols. In addition to protocols, reflection on challenging situations is needed, as well as a level of “freedom of action and reasoning” (Karssing, 2000). In ethics, there is no single universal answer to the question: what is the right action or decision in this specific situation? A rigid focus on regulation – “rule-based-behavior” – can even pose a risk to morality (Falender & Shafranske, 2007), as it can create unjust situations in practice. A report on Dutch prisons mentions the risks of the present focus on incidents and related solutions: it can lead to a lack of moral awareness among employees. Also, hierarchy can be a force that prevents staff’s own initiative and responsibility (Van Houwelingen et al., 2015).Being aware of ethical content in a situation is a key condition for moral decision-making.

Research on moral challenges of prison staff often focuses on incidents and staff wrongdoing, with excesses such as mistreatment of prisoners (e.g., Torres & Turvey, 2013). Despite the emphasis on the importance of research on ethically challenging issues for prison staff (Shaw et al., 2014), the perspective of prison staff themselves and what they experience as morally challenging is not yet included in literature. Qualitative research is limited to prison health care practitioners (White et al., 2014). Until now, there is no data on morally conflicting situations for all professional disciplines within prisons. Empirical ethics research is often hindered by the “difficult-to-access prison environment” (Shaw et al., 2014). Increased knowledge about the moral challenges prison staff encounter, can provide insight into and suggestions for how to support staff in dealing with moral dilemmas.

This paper provides an overview of moral themes based on the analysis of self-perceived moral dilemmas of prison staff from all professional disciplines, expressed during team-based “Moral Case Deliberation” sessions (MCD). This research is part of a broader research project to evaluate a series of MCD-sessions and measure the contribution of MCD-sessions to the moral craftsmanship of prison staff.

Moral craftsmanship and moral case deliberations

In 2017 the Dutch Custodial Institutions Agency (DCIA) initiated a training program for prison staff called “Craftsmanship,” to further develop their staff. This started based on the need to address changes in the population of prisoners (e.g., more psychological problems in nonspecialist institutions) and the requirement of staff to be more concerned with the handling (“bejegening”) of prisoners in addition to security. Moreover, in the years prior to the training program, in general an increase of incidents is seen and staff experience high work pressure (DCIA year plan 2017, Overheid, 2017). Part of the general training program on Craftmanship was a focus on “Moral Craftsmanship,” to support them in reflecting upon and dealing with morally challenging situations. “Moral Craftsmanship” is described as awareness of moral dilemmas and the ability to be open and constructive about differences in viewpoints (DCIA, internal documents, 2016/2017). In this program, MCD-sessions are introduced, based on the presupposition that a constructive, non-judgmental dialogue about moral dilemmas is more productive than merely focusing on potential wrongdoing of prison staff.

MCD is a specific form of Ethics Support Service (ESS) to help professionals in dealing with moral dilemmas in their practice. MCD originated in health care settings to improve the moral competency of professionals (Molewijk et al., 2008). After years of research and further developing the method, it is now used in non-health-care settings too, e.g., in the Dutch military or in counterterrorism (Kowalski, 2020; Van Baarle, 2018). The MCD-method offers a structured and dialogical approach in which professionals reflect upon and exchange views about a personally experienced moral dilemma (Widdershoven & Molewijk, 2010). MCD focuses on fostering the reflection process of professionals (Crigger et al., 2017),, guided by a trained MCD-facilitator, who has no advisory role regarding the content. A facilitator helps to recognize moral dimensions of cases, fosters moral reasoning, and facilitates dialogue from various perspectives among participants (Stolper et al., 2015). A variety of conversation methods can be used. During this research, MCD-facilitators used the “dilemma method.” The steps of this method can be seen in Appendix 1. This was the preferred method due to its focus on the moral dilemma of situations (Stolper et al., 2016). In a moral dilemma, the context of a situation plays a crucial role in considerations about what the right action should be based on (Widdershoven, Molewijk et al., 2009). Between permissible and objectionable acts there is a broad “grey area” where people must find their own way, through reflection (Musschenga, 2004, p. 180). MCD is an instrument that ensures space to present all types of morally challenging situations, not just doubts about excesses or wrongdoings. It can help deepen understanding and explore what could be a “morally right” act in that specific situation (Molewijk et al., 2008). Participants are stimulated to develop a dialogical attitude of mutual respect, ask open questions, and postpone judgments. The dialogue thus functions as an instrument toward a mutual learning process and fruitful moral reflections (Weidema, 2014). Outcomes of MCD-sessions vary from individual and personal development and collective learning, with impact on team cooperation, organizational and policy changes, to concrete actions immediately following an MCD-session (De Snoo-Trimp et al., 2018).

Methods

Participants and procedure

For this qualitative study we followed 22 teams in three Dutch prisons (Nieuwegein, Zwaag and Leeuwarden), ranging from 6 to 10 teams per location. Between September 2017 and February 2020 teams participated in a total of 170 MCD-sessions. The selection of DCIA-locations and involved teams was made by the Training Institute in consultation with local team managers and based on the locations’ registered preferences in the general training program. The Training Institute is responsible for the implementation of MCD at DCIA-locations. As researchers, for the selection of teams that participate we only emphasized our preference for a broad representation of the professional disciplines within the organization. Table 1 shows the professions represented in the selected teams. Since the MCD-sessions were team-based we did not gather data about the individuals per session. All team members who were present participated in the MCD-sessions, and most sessions were conducted without the team-manager being present. The team-manager only joined at the request of the team. Participating teams attended one introductory meeting to meet their facilitators, be informed about MCD and learn about morality, dialogs, and moral dilemmas. The subsequent MCD-sessions were scheduled for 120 to 180 minutes each. At the start of each session confidentiality was agreed. Each team had a fixed set of MCD-facilitators; a total of 18 were involved. The researchers were part of local Steering Committees at the participating locations. These Committees consisted of a member and/or managers from the teams that participated, the management team and a coordinator from the “Training Institute.” The aim was to monitor and evaluate the research and implementation process of the MCD-sessions and make adjustments when required.

Table 1. Professions represented in the selected teams of Dutch prison staff.

Professional disciplines of Dutch prison staff	Security guards
	Correctional officers
	Correctionals officers for repeated offenders
	Labor instructors
	Healthcare professionals
	Case-managers re-integration services
	Backoffice re-integration services
	Middle management
	Management team

Data collection

To evaluate the content of the MCD-sessions, two types of evaluation forms were used: one for MCD-participants and one for MCD-facilitators. For this paper, we analyzed responses to the question: “Please describe the discussed case and write down the moral dilemma.” The MCD-participants’ form only asked the case-presenter to answer the question, and to also “briefly describe the situation and the decision (A or B) you had to make.” The following inclusion criteria of MCD-sessions were applied: a) one or more moral dilemmas discussed in-depth, and b) answers provided sufficient information to code a main theme. The exclusion criteria of MCD-sessions were based on the availability of sufficient and reliable information. Sessions with missing evaluation forms or non-informative data in the forms were excluded. After the first steps of our analyses, we excluded MCD-sessions based on content criteria (see, Figure 1), e.g., sessions based solely on the exchange of emotions or opinions, without in-depth and systematic deliberation of at least one moral dilemma.

Figure 1. Overview of selection of MCD-sessions and related moral dilemmas.

Data analyses

Taking a qualitative approach with a thematic content analysis, we created “a map” of the content across the dataset “summarizing the variation and regularities in the data” (Green & Thorogood, 2013). In our “conventional content analysis” we attempted to stay close to the respondents’ words and avoided “preconceived categories” (Hsieh & Shannon, 2005). In the first step of analyzing all cases of moral dilemmas we distinguished three levels: a) the main discussed moral dilemma or question in the case, b) the main moral theme in the case, and c) the most important subthemes derived from the context of the case. Here we used an inductive process; when possible, the moral dilemma or question was copied directly from the evaluation forms (Ryan & Bernard, 2003). In the main themes we tried to grasp the essence of the case in one word or concept, and subthemes were based on explicitly mentioned words. To reach consensus on the formulation and coding style, we used a pilot of 30 cases where four researchers independently analyzed 10 cases before discussing the final coding. Subsequently, two junior researchers independently analyzed all cases, discussed their viewpoints, and together formulated final themes. In case of disagreement or doubt a senior researcher was consulted. We created reliability and credibility of the analyses by this triangulation of researchers (Green & Thorogood, 2013). In between analyses, we were constantly reflective about the data, to prevent biases. We intent to increase the reliability by being transparent about our methods and its challenges. In case of doubts about the correct interpretation, information from the facilitator-forms was often leading, as these usually offered more detailed information than forms of MCD-participants. In addition to collecting themes and subthemes, we wrote down observations regarding the formulation and context of the dilemma. After consulting such additional notes with the three researchers (including one senior), we worked toward consensus in order to come to final categorizations. This triangulation of data and researchers – complementing each other with additional information about the cases – as well led to a stronger credibility of this data analyses. Our coding-method asked for intermediate and ongoing consultations by several researchers, therefore it was not possible to calculate inter-rater reliability scores.

During the second step, we used the MindMeister program to create a mind map in which we further categorized main themes, by means of a more deductive process. We included abstract concepts that could accommodate multiple coded themes, e.g., “professional responsibility” or “deviation from protocol.” We merged themes that clearly overlapped. Newly created main themes were expanded with layers of subthemes, based on step one of our analyses. We verified that every case was correctly covered by its main theme, as well as the names of themes. The search for meaningful and context-relevant categories resulted in 9 main themes, and 2 to 5 subthemes per main theme. Furthermore, we included an overview of the “organizational levels” (Table 2) which provided insight into the organizational level at or between which the dilemma occurred, e.g., between a team and their supervisor. Each subtheme showed to have multiple ramifications based on this organizational structure. We checked our additional notes about observations regarding the formulations of dilemmas, to reach consensus on conclusions. During previous steps we were unaware of which team mentioned which dilemma.

Table 2. Overview of “organizational levels” of DCIA prison locations.

Organizational levels	Prisoners
	Prison employees
	Supervisors of prison employees
	Management team of one prison
	National headquarters of DJI, at the Ministery of Justice and Safety
	External contacts and visitors of prisoners

For our last step of analysis, we added team names, and therefore the professions of participating staff, to examine whether moral dilemmas and themes were associated with specific teams or professional backgrounds.

All steps were regularly presented to the research team, leading to adaptations. Only with consensus among the whole team we continued the process. In-between analyses were independently reviewed by the senior researchers to increase the reliability of our analyses by this triangulation of researchers. After final modifications, all involved researchers approved the categorization and naming within the mind map.

Research ethics

The Medical Ethics Review Committee of the Amsterdam UMC declared a full ethical review was not necessary for this research. Permission for the research was given by the DCIA at the Dutch Ministry of Justice and Security. Involved researchers signed a DCIA-confidentiality agreement. Before participating, participants received information about the research project. All evaluation forms stated participation was voluntary, could be discontinued at any moment without specifying reasons, and emphasized the confidential use of the information by the researchers. All MCD-participants and MCD-facilitators gave informed consent by using these evaluation forms. The evaluation forms of MCD-participants were collected anonymously. We also collected information about the date and location of the session and the professional discipline of MCD-participants.

Main findings

In total, we collected 1065 evaluation forms from MCD-participants and 171 forms from MCD-facilitators. From the initial 171 MCD-sessions, we included and analyzed a total of 154 cases of moral dilemmas retrieved from the included 148 MCD-sessions. Figure 1 shows the criteria on which this selection was based.

Main themes and subthemes

Our analysis shows a broad range of moral dilemmas and themes within prison work. Figure 2 presents an overview of the 9 main themes with their subthemes that cover all 154 cases of moral dilemmas of prison staff. The 9 main themes each contain from 2 to 5 subthemes. The subthemes show a wide variety of topics, ranging from individual doubts and interpersonal communication aspects to organizational or policy questions regarding addressing discontent. Based on our analysis with the “organizational levels” (Table 2), we noticed how moral dilemmas are present in and between all levels of the organization. Within one subtheme, the cases may vary from moral dilemmas on a personal level, to dilemmas related to a relationship between team and prisoner, or from staff toward management team, and vice versa. Below we present descriptions of the main themes and subthemes, including examples of dilemmas from the practice of prison staff. The themes are in random order: the layout does not reflect any rating or normative indication.

Figure 2. Overview of main themes and subthemes of moral dilemmas from prison staff practice.

Security risks

The first theme in Figure 2 “security risks,” contains cases in which prison staff experienced moral dilemmas related to the safety of either prison staff or prisoners. The subtheme “manageability” is related to prisoners causing a commotion or showing risk of escape. This leads to dilemmas related to the manageability of the situation, and whether the prisoner should be transferred to a special department or not. Dilemmas about whether and how to “report” a possible threat to security are often related to immediate colleagues. For example, should I report a colleague who against the rules decided to remove a prisoner from solitary confinement on her/his own, or should I confront my colleague personally? The subtheme “act appropriately when understaffed” contains dilemmas where situations must be controlled and kept as safe as possible, despite non-ideal circumstances. We mainly encounter staff being on their own with a group of prisoners, wondering about risks and whether to follow or ignore protocols while waiting for assistance from colleagues. E.g., to lock up the prisoners when you are alone with them or continue the daily schedule and take them to the labor department. The final subtheme, “breaching professional confidentiality,” is a distinctive category; medical staff experience dilemmas when they see or hear information from prisoners that may pose a safety risk to prisoners or colleagues. (When) Should they breach their code of confidentiality? For example, when a prisoner talks about a fight or when there are signs of the presence of an illegal tattoo needle?

Working with prisoners

Prison staff experience moral dilemmas related to the specific situation of “working with prisoners.” In the subtheme “coercion and threats” questions arise whether to give in to prisoners who manipulate or even threaten staff, e.g., when prisoners insist on seeing a doctor. In the subtheme “refusal of care,” staff wonder whether to keep offering help to a prisoner who refuses all kind of care. As to dilemmas regarding the “degree of independence” of prisoners, staff question what to allow within specific departments, e.g., can a prisoner call the hospital himself? The subtheme “feelings of involvement” shows staff feeling concern toward prisoners and how far this may reach. For example, should I tell a prisoner about earlier treatment of his father? The subtheme “impact on private life” contains one specific case, about a dilemma of a correctional officer who is in doubt whether to let his young daughter go to a children’s birthday at a former prisoner’s home.

Integrity

These cases directly address dilemmas about dealing with or suspicions of unethical behavior by prison staff. However, most dilemmas within this main theme concern “being suspicious” of unethical conduct. Once an employee is suspected of acting contrary to ethical standards, and it does not immediately result in an official investigation, different types of dilemmas emerge in all levels of the organization. E.g., the management team wonders whether they should dismiss the suspected employee? A supervisor doubts whether to inform the employee about confidential plans, such as the timing of a search for contraband? Or: team members who experience dilemmas based on trust-issues toward that colleague. The subtheme “preventing suspicion” concerns dilemmas arising from staffs’ desire to prevent suspicion of unethical actions. Prison staff individually experience dilemmas based on a high level of alertness about what others might think. Even when staff know they act with integrity, they tend to act differently based on this alertness. They are highly aware that a lack of transparency might cause unwanted rumors, e.g., if you were alone with a prisoner during a drug-test.

Good employment practices

Both top-down and bottom-up, there are dilemmas related to “good employment practices.” From staff toward supervisors or the organization, we identified dilemmas about “job insecurity,” e.g., due to rumors about closing the prison site, staff question “Should I stay out of loyalty to my team or should I start looking for an alternative job?” These dilemmas also occur after labor disputes. Top-down cases about “fair treatment” of prison staff demonstrate struggles of supervisors or management teams about “punishing” or firing staff and how to handle in a morally sound way. To what degree do we allow mistakes? Should I fire an employee who refuses to carry out an assignment? This theme also involves cases regarding “good care” for prison staff. Is it acceptable to let my staff work in non-ideal conditions, e.g., with prisoners in a room with a broken door?

Compliance with top-down vision

This theme represents dilemmas in which hierarchy plays a substantial role and which are seen in all layers of the organization. The subtheme “discontent with policy” shows individual team members, entire teams and supervisors deliberating whether they should express their discontent to the management team. However, most cases are related to the organization as a whole. We used a broad interpretation of “policy,” i.e., relating to management choices, ranging from practical daily matters to the central goals of prison work. In most dilemmas, staff question whether to comply with newly implemented policies when they feel they were not part of the deliberation process, e.g., regarding participating in a pilot with irregular working hours or the degree of punishment of prisoners following incidents. Subtheme “carrying out assignments” presents dilemmas in which staff members are unsure about following orders of superiors. Should I still carry out the assignment given by the superior, even if I do not agree with the decision made?

Deviating from protocol

The first subtheme “degree of humanity” shows how working with the value of “humanity” can lead to doubts about following standard procedures. This kind of dilemma is experienced at all organizational levels: from supervisor toward staff, from staff toward prisoners, but also regarding visitors of prisoners. The latter is remarkable since we did not encounter many visitor-related cases in other themes. Staff wonder how much leeway they have, especially when dealing with protocols. For example, should we frisk a visiting child? Are we allowed to discuss confidential information about a prisoner with his family members? Dilemmas involving deviation occur when standard procedures seem inadequate. For example, toward staff, when against the rules an advance on salary is granted. Possible deviations from protocol are mainly questioned in medical contexts, e.g., giving medication to a prisoner in an isolation cell, or in the procedure with recovering drug-addicted prisoners? The final subtheme of “tolerating” arises when staff tolerates certain actions or situations, e.g., prisoners smoking near the labor area, and doubt whether it is justified, and if they should continue this practice or not. In other cases, prison staff experience a lack of clarity about existing rules or procedures and their limits. A small category of deviation-cases concerns situations in which staff deviated from protocol to avoid troublesome situations or commotion among prisoners. For example, not reporting a missing knife or drugs brought in by visitors.

Addressing work climate

All cases of “addressing work climate” consist of relationships with others. In the subtheme “stand up for rights” prison staff experience pressure, from superiors or due to workload, and try to act on the basis of good self-care. It mainly concerns bottom-up cases, about not getting days off, or having too many tasks. The dilemmas reflect doubts about the level of freedom to (not) perform a task or about where to turn with complaints: supervisor, director, workers union? Cases in the subtheme of “work ethic” are about whether to confront colleagues about their work ethic. Most dilemmas are team-based and address the question whether one can and should impose one’s own values on others. Some cases involve situations in which staff criticize colleagues for not showing the conduct necessary to work together more effectively and safely. For example, should you speak up to security guards who are leaving early while prisoners are still being counted? In the subtheme “bullying and discrimination” dilemmas occur between staff and supervisor, and vice versa: “Should I stand up for my colleagues when our supervisor lashes out during a team meeting?.” Some interpersonal cases concerned situations of bullying, ”black talk” (i.e. speak ill of a person behind their back), or discrimination among team members (subtheme VII.c). They wonder, generally afterward, whether they should have spoken up, and have doubts about the right way to do so.

Mutual coordination

Dilemmas within this main theme arise mostly when there is a lack of clarity about cooperation and/or expectations. Within the subtheme of “prioritization” many dilemmas are about the demarcation of duties, but most concern loyalty toward immediate colleagues. Limitations in being able to fulfill the standard of loyalty are mainly present in situations with high work pressure. Should I always give priority to my tasks for the “internal crisis assistance team” over my tasks as a correctional officer? As a result of implicit expectations and delineation of tasks staff doubt the correctness of their decisions. The subtheme of “demarcation of tasks” contains dilemmas related to situations in which it is unclear who is responsible for what task. Most dilemmas occur in exceptional situations, when doubts arise despite a clear division of roles. For example, in a fight between a prisoner and correctional officers; may I as a spiritual counselor, prompted by my loyalty, physically assist my colleagues or do I stick to my role and keep my distance? The subtheme of “stand by agreements” shows cases in which a colleague has made a decision, and one doubts whether to go along with it or hold on to one’s own considerations of what is right. For example, should I go along with a supervisor’s decision on penalty cell placement or do I challenge the decision? Lastly, between colleagues, dilemmas can emerge from “correctly informing each other” to ensure to do the job well. This subtheme involves having knowledge but being unsure whether to share it. On the other hand, a lack of information can also cause dilemmas. For example, medical confidentiality creates doubt if and how personal information about prisoners’ condition, which is needed to perform a job, can be obtained. Or staff doubt how to correctly follow-up on decisions toward prisoners because necessary information was not transferred between shifts.

Professional conduct

This main theme focuses on individual challenges of professional conduct, such as limitations in dealing with or doubts about whether to cross boundaries. The first subtheme reflects a “sense of duty” that staff feel toward colleagues or prisoners. Most cases show this sense of duty is negatively affected by workload-related constraints, and a few show a lack of clarity about the organization’s appreciation of tasks: Should I continue facilitating a specific rehabilitation training for prisoners or should I phase it out due to a lack of organizational support? Other cases show dilemmas regarding “task versus convenience,” where staff experience procedures as cumbersome and wonder whether shortcuts are an option. The final subtheme of “self-control” presents situations in which staff experience doubts about professional limits of self-control in intense situations. Is it justified to express emotions and frustrations in reactions toward prisoners, colleagues or external visitors?

Distribution of themes within the teams

As multiple types of teams participated in our research, we finally analyzed whether moral themes were associated with specific teams or professional backgrounds. Almost all themes contain dilemmas from a mix of teams. However, certain teams are overrepresented or underrepresented in some subthemes. For example, “case managers of the re-integration services” frequently expressed moral dilemmas related to a high workload, most of which come under the subtheme of “prioritizing” their work. Teams of security guards expressed no moral dilemmas in the main theme of “working with prisoners”; instead, their dilemmas often concerned the subtheme “security risks.” However, the dilemmas, within those “security risks,” were not directly linked to prisoners. Most of the mentioned dilemmas related to decisions or actions of colleagues that could increase security risks. Furthermore, it is remarkable that teams of healthcare professionals express moral dilemmas in all themes and subthemes. Middle management teams are overrepresented in the main theme of “compliance with top-down vision,” and the subtheme of “discontent with policy.”

Discussion

Observations about the content of moral dilemmas

The main findings show a large number and wide variety of moral cases in which prison staff deliberate and search for insights and answers to often challenging situations. Based on the two main aims of prison work – security and rehabilitation – one might expect both themes to be clearly present within our findings. However, our data of self-perceived moral dilemmas from prison staff show an imbalance: security-related cases are clearly dominant, while the rehabilitation-related cases are underrepresented. Although our research did include teams involved in the rehabilitation of prisoners, we did not find a main theme with moral dilemmas related to “rehabilitation.” Also, rehabilitation dilemmas are not strongly present within other themes. Only a small number of cases reveal rehabilitation-related situations, where staff indicate feeling restricted in their ability to act in the interest of the prisoner, e.g., in trying to organize a father-child day for prisoners. However, in such cases the focus of the MCD-participants was on moral dilemmas regarding other themes within the case, e.g., adequate cooperation with colleagues or correctly dealing with protocols.

Prison work demands a high level of alertness regarding security issues, and security issues are indeed represented in a larger number of moral dilemmas. Security-related dilemmas are not only found in the main theme “security risks,” they are also indirectly present in many other (sub)themes. The indirect presence of security risks is seen in the context of a case, or as a consequence of actions. Often potentially unsafe situations show an impact on all persons involved: the individual prisoner, other prisoners, and prison staff. For example, when prisoners create a commotion or reveal plans to escape. The perspective of ensuring the safety of society is rarely mentioned in the description of the situations and moral dilemmas. For example, in a case where a prisoner violates the rules while on leave, the focus is on deviations from protocol rather than the security aim regarding society. It may have been discussed during MCD, but was not mentioned in the evaluation forms.

It is remarkable how often dilemmas refer to cooperation challenges among prison staff. We observe many cases, in different main themes, in which “speaking up to each other or not” is the central dilemma. Cooperation-related challenges are mostly seen in the main themes of “addressing work climate” (VIII) and “mutual coordination” (IX). Prison staff express the need to be backed up and be able to trust colleagues at all times. This focus on back-up can lead to dilemmas when confronted with mistakes of others, or to frustrations as a result of the actions of others. Staff experience doubt whether to speak up to a colleague in question or take it up with a superior.

Another recurring element is the question of “compliance or deviation.” Based on existing rules and procedures, staff regularly wonder to what extent they have the right to deviate from existing rules and procedures and determine themselves what correct action is. Sometimes a deviation-dilemma is based on the value placed on the humanitarian attitude toward prisoners. For example, should I allow extra leave for a prisoner to say goodbye to his dying father while the rules prohibit this? Our data shows that superiors also experience dilemmas of comply or deviate: should I withdraw a request for more staff when the management team advise me to do so? Both overarching topics of “address or not” and “compliance or deviation” refer to situations in which staff deal with doubts regarding the limits to their “freedom of action.” Our observations in the following paragraph show the presence of this topic.

Observations about the formulations of moral dilemmas

Irrespective of the content of moral dilemmas, we performed an additional analysis on how moral dilemmas, including the cases and situations, were formulated in the evaluation forms. We observed that many moral dilemmas included or arose from feelings of indignation and frustration of prison staff. For example, “why am I not being heard when I address a security risk?” Furthermore, many formulations reflected criticism or judgment toward the behavior of others. Ranging from expressed irritations about colleagues taking extensive breaks to remarks about “safety agreements that are not kept.” Only a part of the moral dilemmas focus on the moral uncertainty or doubt of the case presenter. In quite a few cases, the formulation of the moral question was not open, but contained normative words. For example: “or should we keep muddling on?” Often one side of the dilemma mentioned details on how to act, while the other option only said to not do that action, to not speak up, to just let go, or continue work as normal. Dilemmas were often formulated with questions about continuing a non-ideal situation. Related formulations already seem to contain a normative conclusion (“this situation is not ideal”). In many of these cases, staff seem to be certain about what the right action is, but seem unsure about their ability to change practice and are therefore “cynical” about their impact in the organization. Such formulations express feelings of being “powerless,” e.g., by saying “it won’t make a difference” or “nothing is going to change.”

Reflective organization and dialogical ethics

We noticed how prison staff have a sense of “powerlessness” and/or feel restricted in their “freedom of action.” However, fruitful moral reflections, and mastering moral craftsmanship require a sense of being able to influence or impact the work environment. If MCD-participants experience cynicism about their influence and/or the impact of MCD, it becomes even more important to try to translate moral reflections and decisions from MCD-sessions into actions or improvements in practice. Feelings of cynicism and powerlessness, which some of the staff members experienced, might hinder a “moral craftsman” to blossom. A strong focus on “rule-based behavior” or “compliance strategies” can make it harder when one aims to work toward a more reflective organization in which staff need discretionary space to develop their moral craftsmanship (Karssing, 2000). Present influences of hierarchy and the many rules and procedures can prevent staff initiatives in the DCIA-organization (Van Houwelingen et al., 2015). To develop moral craftsmanship, it is necessary that prison staff are able to engage in joint dialogs and reflections, in teams but also in the entire organization. To build trust in this dialogue and joint reflection, prison staff need to experience impact of their participation, during and after the dialogue. Dialogical ethics is an approach that stresses the need for deliberation and dialogue as a way to come to joint interpretation of situations and joint improvement of these situations (Widdershoven, Abma et al., 2009). During a moral dialogue, both individual professionals and the team as a whole can learn from one situation for future occasions. A dialogical ethics approach to both the handling of moral dilemmas and the implementation of Ethics Support Services, such as MCD, can contribute to a safe learning environment for all prison staff, which in turn can strengthen the reflectivity of and within the organization (Weidema et al., 2016).

Strengths & limitations

Most literature about ethics of prison staff focuses on incidents and/or scandals as seen from the outside (e.g., by researchers or managers). This study is unique as it is based on 154 self-perceived and personally experienced moral dilemmas of multidisciplinary prison staff throughout all organizational levels. With the aim of working on improvement of their moral craftsmanship, prison staff were invited to express their daily doubts in MCD-sessions. To gain insight into the content of moral dilemmas from prison staff we first presented an overview of themes. In addition, we showed where in the organization such topics occur and how observations of the formulation and context of dilemmas can lead to new insights.

Although the mix of teams selected in this research creates a multidisciplinary overview of moral themes, a limitation in our research might be our decision to use team-based MCD-sessions. This decision may have led to fewer reported dilemmas related to multidisciplinary teamwork. The reason for team-based participation was to guarantee a safe space to talk freely, without potential influences of hierarchy during MCD. The MCD-facilitators were trained to support and create such a safe and open atmosphere.

We noticed in the evaluation forms that, compared to the MCD-facilitators, prison staff shared less detailed information about the moral dilemmas. This led to the exclusions of some sessions, however not that many. No systematic reasons were seen leading up to this type of exclusion of the data. Data provided by the MCD-facilitators were leading during the analysis, since case-details were often needed for a more in depth-interpretation for coding and categorization the dilemmas. Perhaps prison staff were less able to articulate on paper the moral dimensions of situations, since MCD was new to them. By contrast, the MCD-facilitators received a specific training on how to recognize and formulate a dilemma or moral question. A lack of time to fill out the evaluation forms might also be an explanation, since it was a noncompulsory task for participants, which had to be performed during working hours immediately after an MCD-session.

In our analysis every dilemma was assigned to only one main theme and subtheme. Arbitrary categorization could not always be avoided, as some cases fit in more than one theme. We deliberately did not quantify data, e.g., regarding the number of moral dilemmas occurring in one main theme or subtheme. Since we hope the weight of themes should be measured by the content itself and because challenging cases could be assigned to more than one theme. We discussed such challenging cases multiple times with at least three researchers. After consulting additional notes about observations regarding the formulations of dilemmas, with the three researchers (including one senior) we reached for consensus. Only with this consensus we made a final categorization. In some cases of those challenging cases, a lack of contextual information created doubt. We then chose the option closest to the dilemma formulation provided in the evaluation form.

There seems to be an overlap between two main themes: “complying” and “deviating” could be considered as two sides of one question. Separate main themes were justified since they show a difference in the positioning of dilemmas within the organization: a) “compliance” concerns hierarchical matters, showing only individual decisions toward superiors, while b) “deviation” is a subtheme focused on more action-oriented matters from daily practice, where cases show collective decision-making processes.

Recommendations

Morally challenging situations in prison will remain and therefore deserve ongoing attention, both at the level of facilitating reflection among support staff in order to deal with moral dilemmas, and on the content level regarding the specific moral themes. Continuation of MCD-sessions and building the expertise for facilitating these MCD-sessions within the prison itself is important for safeguarding the moral competency of both staff and organization. A follow-up after MCD-sessions is highly recommended to create impact that goes beyond a single MCD-session. To help deepen understanding of all moral themes and encourage further steps toward a reflective organization, it is important to develop a roadmap together with an internal multidisciplinary “working group” in which lessons-learned and future needs are monitored and fostered at the same time.

Cases are shown to be highly context-dependent, which means that discussing and resolving specific moral dilemmas is more fruitful than providing general guidance in training sessions or focusing solely on codes of conduct for prison staff. To ensure prison staff feel supported in dealing with the morally challenging situations, prison locations can work on further implementation of ethics support services, such as MCD. It would be beneficial to further research how these moral dilemmas effects prison staff, both personally and professionally. Our observations about how dilemmas were formulated showed that in future MCD-sessions a strong dialogical approach would be beneficial. It might be helpful to train internal MCD-facilitators for prison-locations, to immediately facilitate MCD in urgent cases and to make sure themes and MCD-sessions are followed up.

The collected moral dilemmas can be used as illustration during (further developments of) ethics training, and to stimulate dialogue about how to reflect upon such situations. In general, skills for moral reflection and having open dialogs about moral challenges require practice. Continuous implementation of appropriate reflection tools, such as MCD-sessions, might stimulate this ongoing practicing of joint dialogs and reflections.

This study took place in the context of a broader study about the role of MCD to strengthen moral craftsmanship of prison staff. Various MCD evaluation studies, mainly in health care, have shown that MCD can strengthen the moral competency of MCD-participants, the cooperation among multidisciplinary staff members, and the constructive handling of different viewpoints (Haan et al., 2018; De Snoo-Trimp et al., 2018). In the specific context of prisons, further research is needed to evaluate the MCD-sessions with prison staff and to see how MCD-sessions contribute to their moral craftsmanship and support them in dealing with the moral challenges of prison work.

Conclusion

This study provides a thematic analysis of 154 personally experienced moral dilemmas of Dutch prison staff from all professional disciplines. Our findings show an overview of the themes of moral dilemmas in the workplace of prison staff. Findings represent a wide variety of main themes, including “working with prisoners,” ‘good employment practices, “addressing work climate” and “deviating from protocols.” Moral dilemmas related to security, cooperation and deviating from procedures and the vision of superiors were most frequently experienced. Unexpectedly, moral dilemmas related to the rehabilitation-aim of prison work were underrepresented. Prison staff at all levels of the organization encounter moral dilemmas: apparently, moral dilemmas are inherent in all facets of prison work.

The formulation of dilemmas showed how many moral dilemmas arose out of feelings of frustration. Often dilemmas were not expressed as an open moral question for a moral inquiry but were formulated using normative comments. Prison work regularly puts staff in situations where they question whether current procedures or policies are adequate, or wonder how to still act morally right in non-ideal circumstances. Often prison staff expressed certainty about knowing what the right action should be but felt restricted in their “freedom of action.” In order to further strengthen moral craftsmanship of both prison staff and the organization as a whole, we recommend a dialogical ethics approach when implementing programs for dealing with these moral dilemmas and themes.

Author contributions

AS, WL, MS and AM participated in the local Steering Committees and organized supervision meetings for the involved MCD-facilitators. AS and WL collected the data, and with the help of research-assistants processed all evaluation forms into our dataset. AS, WL, MS and AM coded a pilot of cases. AS and WL coded the database of cases, with additional reflections by MS. AS, WL and MS participated in the analysis of the mind map, which AM and HV reviewed and approved. AS was responsible for drafting and revising the manuscript. MS, AM and HV participated in discussions about the analysis and results, contributed to writing and provided detailed feedback on the manuscript, and approved the final version.

Acknowledgments

We would like to thank all participants and MCD-facilitators involved in this research project for their openness and willingness to contribute, as well as the management teams of the selected research locations, the whole DCIA-organization, and their Training Institute for all their constructive cooperation. Furthermore, we thank the local project-coordinators of the DCIA-locations and our research-assistants for their crucial role in helping to process the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Dutch Custodial Institutions Agency of the Ministry of Justice and Security in the Netherlands.

Notes

1. Stolper M., Molewijk B., Widdershoven G. (2016). Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation. BMC Med Ethics, Jul 22; 17(1):45. DOI: 10.1186/s12910-016-0125-1.

2. For DCIA we made a slight adjustment in this dilemma method. Together with the facilitators we decided to mainly focus on the formulation of a dilemma, instead of as well including a “moral question”.

Appendix.

Moral Case Deliberation; the dilemma method¹

1. Introduction

Introducing moral case deliberation and its methodical approach, and discussing the objectives, expectations and confidentiality of the session.

• (2) Presentation of the case

Providing a description of the case by the case owner, specifically at the moment the moral question is most prominent.

• (3) Formulation of the dilemma and the underlying moral question

Identifying and formulating the two sides of the dilemma including the negative consequences, and the underlying moral question² or moral theme.

• (4) Empathizing through elucidative questions

Asking elucidative questions in order to empathize with the situation and to gain a clear picture of the situation.

• (5) Perspectives, values and norms

Collecting the values and norms of relevant stakeholders involved and with respect to the dilemma.

• (6) Alternatives

Free brainstorm focused on realistic and unrealistic options to deal with the dilemma.

• (7) Individually argued consideration

Making individually a choice in the dilemma, how one would act in the specific situation of the case. Formulating the value that support one’s choice and the negative consequences of one’s action(s). Including formulating how to limit negative consequences. Finally, attention for “needs” that help to accomplish the choice made.

• (8) Dialogue about similarities and differences

Examining the similarities and differences in individual choices, argumentations and/or considerations.

• (9) Conclusions and actions

Formulating conclusions with concrete actions or agreements regarding the discussed dilemma.

• (10) Wrapping up and evaluation

Evaluating the MCD session, with the focus on the usefulness of MCD and what to organize differently next time (e.g., steps of the method, selected day and timeframe, groups dynamics, facilitator etc.).