Patient Participation in Moral Case Deliberation: Evaluating the Dynamics of Shared Reflection in a Mental Healthcare Setting in Türkiye.

Clinical ethics support services (CESS) have traditionally centered on healthcare professionals (HCPs), leaving the patient participation (PP) as a subject of controversy. This paper evaluates the practical and dialogical dynamics of a patient-participatory moral case deliberation (MCD). We analyze a MCD session conducted in a Turkish psychiatric hospital using the Dilemma Method. The group-comprising the facilitator, the case presenter (a senior psychiatrist), seven mental health professionals including a nurse and a clinical psychologist, and the patient herself-deliberated on a complex moral dilemma: whether to disclose a long-held family secret regarding the patient's biological motherhood to her adult son, balancing potential psychological harms against truth-telling and rights. The patient's active presence shifted the team's focus from clinical-prognostic routines to the core moral question, fostered shared agency, and prompted the attending physician to re-evaluate his professional priorities. Emotional expressions during the session added human dimension, while providing the patient with a reflective distance to process her own narrative within a supportive, non-paternalistic environment. Direct PP in MCD can enhance contextual understanding, dissolve paternalistic barriers, and foster shared ownership of concrete action plans. To avoid symbolic participation or potential harm, CESS providers must ensure preliminary scoping, maintain psychological safety, and guard against patient instrumentalization.