Bioethical
 Decision
 Making
 Model
 

 

1. Define
 the
 dilemma:
 Use
 your
 own
 words
 to
 describe
 the
 problem.
 State
 it
 in
 a
 way
 
that
 others
 can
 quickly
 understand
 your
 dilemma.
 Review
 
 
 
 

 

2. Identify
 the
 medical
 facts:
 Describe
 the
 facts
 that
 are
 relevant
 to
 the
 dilemma.
 
 

 

3. Remember
 that
 the
 diagnosis
 and
 prognosis
 are
 medical
 facts.
 
 

 

4. Identify
 the
 non-­‐medical
 facts
 (patient
 and
 family,
 external
 influences):
 
 
a. Patient
 and
 family
 facts
 such
 as
 culture,
 religion,
 social,
 economic,
 the
 

existence
 of
 an
 Advance
 Healthcare
 Directive,
 verbal
 preferences
 made
 by
 
the
 patient,
 how
 the
 patient
 lived
 his/her
 life.
 
 

b. Those
 that
 you
 discuss
 should
 be
 relevant
 to
 the
 situation.
 
 

 

5. External
 influences
 include:
 organizational
 policies,
 federal
 and
 state
 laws,
 practice
 
acts,
 code
 of
 ethics.
 These
 should
 be
 relevant
 to
 the
 situation.
 
 
 

 

6. For
 both
 step
 2
 or
 3,
 separate
 the
 facts
 from
 the
 assumptions:
 Sometimes
 all
 
healthcare
 professionals
 allow
 assumptions
 to
 guide
 their
 decision-­‐making.
 These
 
must
 be
 identified
 so
 that
 these
 assumptions
 do
 not
 interfere
 with
 the
 process.
 
 

 

 

7. Identify
 items
 that
 need
 clarification.
 Your
 paper
 should
 identify
 facts
 that
 you
 need
 
to
 clarify.
 When
 initially
 discussing
 an
 ethical
 situation,
 it
 is
 not
 unusual
 to
 not
 have
 
all
 of
 the
 answers.
 
 

 

8. Identify
 the
 decision
 makers:
 Is
 the
 patient
 an
 adult
 competent
 to
 make
 their
 own
 
choices?
 Is
 the
 patient
 a
 child
 who
 is
 old
 enough
 to
 have
 a
 say
 in
 the
 decision.
 If
 the
 
patient
 cannot
 make
 their
 own
 decision,
 who
 is
 the
 decision
 maker?
 How
 was
 this
 
person
 selected?
 
 
 

 

 

9. Review
 the
 underlying
 ethical
 principles:
 Review
 which
 ones
 and
 why
 they
 apply
 t
 
this
 particular
 case:
 beneficence,
 nonmaleficience,
 veracity,
 fidelity,
 autonomy
 and
 
justice.
 

 

10. Define
 alternatives:
 One-­‐Way
 to
 proceed
 may
 be
 apparent
 at
 this
 point.
 However,
 
sometimes
 there
 are
 different
 choices.
 
 They
 should
 be
 addressed
 identifying
 the
 
benefits
 and
 burdens
 for
 doing
 one
 thing
 versus
 the
 other.
 

 
11. Follow-­‐up:
 
 Define
 the
 process
 to
 be
 used
 with
 the
 chosen
 alternative.
 
 

 

 

 
Reference
 Source:
 Levine-­‐Ariff,
 J.
 &
 Groh,
 D.H.
 (1990).
 Creating
 an
 Ethical
 Environment.
 
Nurse
 managers'
 bookshelf
 a
 quarterly
 series:
 2:1.
 Baltimore,
 Maryland:
 Williams
 &
 Wilkins.
 
41-­‐61.