Ethical Decision Making: Processes, Steps, and Principles

1. Ethical Decision Making

As you know, healthcare professionals often face complex ethical dilemmas that require careful consideration and decision making. Ethical decision making in healthcare involves evaluating the situation, considering the ethical principles involved, and determining the best course of action. In this lesson, you will explore the steps in the ethical decision-making process, examine real-life scenarios, and analyze the various factors that influence ethical decisions. By the end of this lesson, you should be able to determine appropriate steps in the ethical decision-making process in healthcare.

Ethical decision making is a process that involves assessing complex situations where moral principles, patient preferences, professional responsibilities, and legal requirements must be carefully balanced. Experts in the field of ethics developed a decision-making process that is widely used. This process helps decision makers to stay objective and remove emotions as much as possible. Following are the steps in the process with an explanation of what each step involves.

step by step

1. Identify the Ethical Dilemma:
a. The first step is to recognize that an ethical dilemma exists. This involves identifying the conflicting values, principles, or interests involved in the situation.
b. For example, a healthcare provider may face a dilemma when a patient refuses a life-saving treatment due to personal beliefs.

2. Gather Relevant Information:
a. Collect all the necessary information to understand the situation fully. This includes medical facts, patient preferences, legal considerations, and any relevant policies or guidelines.
b. For instance, understanding the patient's medical condition, prognosis, and reasons for refusing treatment is crucial.

3. Identify the Stakeholders:
a. Determine who is affected by the decision and who should be involved in the decision-making process. This includes the patient, family members, healthcare providers, and any other relevant parties.
b. In the case of a patient refusing treatment, stakeholders may include the patient, their family, the healthcare team, and possibly a legal representative.

4. Consider the Ethical Principles:
a. Evaluate the situation in light of the key ethical principles: autonomy, beneficence, non-maleficence, and justice. Consider how each principle applies to the dilemma and the potential conflicts between them.
b. For example, respecting the patient's autonomy may conflict with the principle of beneficence if refusing treatment leads to harm.

5. Explore the Options:
a. Identify the possible courses of action and evaluate the potential outcomes of each option. Consider the benefits, risks, and ethical implications of each choice.
b. In the case of a patient refusing treatment, options may include respecting the patient's decision, seeking a compromise, or involving an ethics committee.

6. Make a Decision:
a. Based on the analysis of the options and ethical principles, make a decision that aligns with the best ethical course of action. Ensure that the decision is well reasoned and justifiable.
b. For instance, the healthcare provider may decide to respect the patient's autonomy while ensuring that the patient fully understands the consequences of their decision.

7. Implement the Decision:
a. Put the chosen course of action into practice. Communicate the decision to all relevant parties and take the necessary steps to carry it out.
b. This may involve discussing the decision with the patient and their family, documenting the decision in the medical record, and coordinating with the healthcare team.

8. Evaluate the Outcome:
a. After implementing the decision, evaluate the outcome and reflect on the process. Consider whether the decision achieved the desired results and what could be improved in future ethical decision making.
b. For example, assess whether the patient's wishes were respected and whether the decision led to the best possible outcome for the patient.

IN CONTEXT

A 16-year-old patient with a severe infection requires a blood transfusion to survive. However, the patient's parents refuse the transfusion due to their religious beliefs. The healthcare team faces an ethical dilemma about whether to respect the parents' wishes or proceed with the transfusion to save the patient's life.

This scenario can be analyzed using the steps in the ethical decision-making process.

1. Identify the Ethical Dilemma:
a. The dilemma involves conflicting values: the parents' religious beliefs versus the patient's right to life and health.

2. Gather Relevant Information:
a. Understand the medical necessity of the transfusion, the patient's prognosis without it, and the parents' religious beliefs.

3. Identify the Stakeholders:
a. Stakeholders include the patient, parents, healthcare team, and possibly a legal representative.

4. Consider the Ethical Principles:
a. Autonomy: Respecting the parents' decision.
b. Beneficence: Acting in the best interest of the patient by providing the transfusion.
c. Non-maleficence: Avoiding harm by preventing the patient's death.
d. Justice: Ensuring fair treatment and considering legal obligations.

5. Explore the Options:
a. Respect the parents' decision and withhold the transfusion.
b. Seek a court order to proceed with the transfusion.
c. Engage in dialogue with the parents to find a compromise.

6. Make a Decision:
a. The healthcare team may decide to seek a court order to proceed with the transfusion, prioritizing the patient's right to life and health.

7. Implement the Decision:
a. Obtain the court order and proceed with the transfusion while communicating the decision to the parents and healthcare team.

8. Evaluate the Outcome:
a. Assess the patient's recovery and reflect on the decision-making process to identify areas for improvement.

2. Ethical Decision-Making Matrix

An ethical decision-making matrix is a tool used to guide individuals or groups through the complex ethical decision-making process by providing a structured way to assess and evaluate potential actions. It helps identify the ethical principles involved, weigh various options, and make decisions that align with ethical standards. The matrix can simplify decision making by ensuring that all relevant factors are considered in an organized manner.

Here's a simplified version of how the matrix might look when analyzing an ethical dilemma, such as deciding whether to administer an experimental treatment to a patient:

Advantages of using an ethical decision-making matrix are that it provides a clear, organized way to think through complex ethical issues, it forces the decision maker to consider multiple perspectives and factors, and it helps prioritize ethical principles and consider the consequences of each decision.

By using the ethical decision-making matrix, healthcare professionals can make more informed, balanced, and ethically sound decisions. It’s particularly helpful when faced with uncertainty or conflicting ethical principles.

term to know

Ethical Decision-Making Matrix

A tool used to guide individuals or groups through the complex ethical decision-making process by providing a structured way to assess and evaluate potential actions.

3. Role of Ethics Committees in Healthcare

Many healthcare institutions have ethics committees that play a critical role in supporting the ethical decision-making process. Ethics committees often have a diverse membership, including physicians, nurses, ethicists, social workers, and legal experts. They are tasked with:

• Consultation: Providing guidance in complex or controversial cases where ethical dilemmas arise.
• Policy Development: Assisting in the creation of institutional policies that promote ethical practices.
• Education: Offering training for healthcare professionals on ethical issues and best practices.
• Case Review: Reviewing specific cases to help resolve conflicts or dilemmas, especially when parties disagree about the best course of action for a patient.

big idea

Ethics committees generally don't make decisions for patients but offer a framework and advice to help ensure that decisions are made in a manner that respects the ethical standards of the healthcare institution.

watch

Every day in healthcare, professionals face decisions that test not just their knowledge, but their values. In this video, we’ll explore the steps in the ethical decision making process to help navigate these tough choices with compassion, integrity, and clarity.