Framework for Clinical Ethical Decision-Making

Buy ready-to-submit essays. No Plagiarism Guarantee

Note: Every paper is crafted by human writers to ensure authenticity and originality.

Framework for Clinical Ethical Decision-Making

[Adapted from Clinical Ethics (7th ed.) Jonsen, Siegler & Winslade; McGraw-Hill: 2010]

1. Medical (Treatment) Indications
   1. Underlying principles: beneficence, nonmaleficence
   2. What is the health problem? Diagnosis? Prognosis?
   3. What is the range of treatment options? Are any legally forbidden? Are any morally/ethically repugnant?
   4. What is the goal of each treatment option?
   5. Common problems: Who judges futility? Who determines “benefit”?

1. Patient Preferences
   1. Underlying principle: respect for autonomy
   2. What are the patient’s preferences regarding the treatment options identified above?
   3. Is the patient’s decision-making capacity in question?
   4. If the patient is unable to communicate preferences at this time, is there verbal or written evidence of what his/her preferences might have been (e.g., living will or conversations with others)?
   5. If no written or verbal evidence of the patient’s preferences exist a) have all potential sources been exhausted, and b) is there “relational” evidence based on how the patient lived his/her life and prior health care choices?
   6. With minors, patient preferences are “held in trust”. What are the parents’ views of what is in the minor’s best interests.
   7. Common problems: Are we questioning the quality of the informed consent? The quality of the capacity for consent? Or our view of the quality of the preference expressed?

1. Quality of life
   1. Underlying principles: beneficence, nonmaleficence, and respect for autonomy
   2. If possible, the patient’s view of his/her quality of life is respected. If the patient’s view is unknowable, whose standards do we use to judge quality of life?
   3. What are the clinical facts devoid of judgments of worth? Consider ability to communicate in any way, mobility, sensory perceptions, pain, etc.
   4. Do care providers, family members or others have biases that influence their evaluation of the patient’s quality of life? How do their unique perspectives differ?
   5. Suggestion: Compare quality of life for each treatment option outlined in step one based on the clinical facts in the case rather than on subjective judgments.
2. Contextual Features
   1. Underlying principle: Justice (fairness), fidelity, etc.
   2. Who is the primary beneficiary of treatment? (Patient? Family? MD? RNs?)
   3. Are there family issues that might influence treatment decisions? Provider issues?
   4. Is there conflict between any of the involved parties (MDs, RNs, family)?
   5. Are there religious or cultural issues?
   6. Are there problems of allocation of resources?
   7. How does the law affect treatment decisions?
   8. Is there a conflict of interest on the part of the providers or institution?