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Handout 5 Ethical Decision-Making: (Substituted or Surrogate Judgment) Want? (Best Interest)

The document outlines a five step process for ethical decision making. The steps are: 1) gather relevant information such as clinical facts, patient preferences, quality of life, and external factors. 2) identify the type of ethical problem. 3) determine the ethics approach such as deontology or utilitarianism. 4) explore practical alternatives. 5) complete the action by implementing a strategy to address the problem. The process is meant to help health professionals systematically evaluate an ethical situation and decide on a course of action.

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Kate Camacho
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65 views2 pages

Handout 5 Ethical Decision-Making: (Substituted or Surrogate Judgment) Want? (Best Interest)

The document outlines a five step process for ethical decision making. The steps are: 1) gather relevant information such as clinical facts, patient preferences, quality of life, and external factors. 2) identify the type of ethical problem. 3) determine the ethics approach such as deontology or utilitarianism. 4) explore practical alternatives. 5) complete the action by implementing a strategy to address the problem. The process is meant to help health professionals systematically evaluate an ethical situation and decide on a course of action.

Uploaded by

Kate Camacho
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Handout 5

ETHICAL DECISION-MAKING

FIVE STEPS PROCESS OF ETHICAL DECISION-MAKING


1. Gather relevant information
o relevant facts include
 clinical indications
- Is the illness or condition reversible?
- Is the life saving treatment medically useless?
- What is the usual treatment for this type of condition in the community?
- What is needed to relieve suffering and provide comfort?
- Is the patient brain dead or in persistent vegetative state?
 patient preferences
- Is the patient informed?
- Is the patient competent?
- If the patient is not competent, how can I discern what this patient would want?
(substituted or surrogate judgment)
- If the patient is not competent, how can I discern what this type person would
want? (best interest)
 quality of life
- What is the patient’s judgment?
- What is the health professional’s judgment?
- Is there any hope for improvement from present quality of life?
 external factors
- Costs? Reimbursement issues?
- What policies are there? Hospital, judicial opinions, professional societies, etc.
- What are the legal implications? (court cases, statutes)
- Is allocation of beds, other resources an issue?
2. Identify the type of ethical problem
o simultaneous with the initial fact-finding and sorting of information, the health
professional can begin to determine the type of ethical problem he is facing
o as he observes, asks questions, and reflects, he can begin to decipher where his initial
observations were correct and where they were not until he arrives at a point where he
has as clear a picture of the situation as he is able to put together
3. Determine the ethics approach to be used
o if the moral agent is a deontologist his thinking will be guided by the duties and/or
rights that are in conflict
 he will spend a lot of time weighing the two duties in dilemma and will probably
decide that the weightier or more compelling duty is to the patient
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o if the moral agent is a utilitarian, he will spend less time thinking about the duties
and will be guided by his desire to bring about the over-all best consequences in the
situation
 the over-all best consequences might well be to leave well enough alone, not to
make waves with the patient
4. Explore the practical alternatives
o the health professional has to explore the actual strategies and options open to him
o these alternatives should be duty-bound and would produce the desired outcome
5. Complete the action
o the final and necessary step in moral judgment and action
o without the necessary attention to a strategy for carrying out the plan, the entire
process, steps 1 to 4, is just an intellectual exercise
o the health professional must assume that he is prepared to accept the consequences
of his actions, and that he has the motivation to go beyond mere identification of the
problem
o in order to see the benefits of his own struggle he must now proceed to action
o to do this, he needs the character traits of compassion, a sense of responsibility, and
the courage to go ahead

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