Ethical Reasoning

Original Editor - Andrea Sturm

Top Contributors - Wendy Walker, Rachael Lowe, Kim Jackson, Robin Tacchetti, Amanda Ager and Jess Bell  

Introduction

The ability to effectively address ethical dilemmas is an essential component of health care. The emphasis in ethical reasoning is on a sensible progression from the facts of the situation to a morally sound decision.

An ethics “workup” (this one or a similar version) may be used by a variety of health care professionals at both the organizational and individual clinical level. Health executives, physicians, nurses, physical therapists, and other health professionals use similar techniques to assess ethical dilemmas with the goal of gaining a shared sense of what is morally acceptable. With some adjustments, it may also be used by lay-persons.

The Ethics Workup

Using the five principal steps of the ethics workup, health professionals holding a variety of philosophical and religious positions regarding ethics can share a basic framework for thinking about and discussing morally troubling cases.

What are the Facts

It is vitally important to clarify the facts of any situation in order to anchor the decision. These facts relate to the organizational, medical, and social circumstances of the case. For example, at the bedside both an estimate of prognosis and an understanding of the patient's wishes are relevant to an ethical decision about what is in the patient’s best interest.

Resource allocation may be ethically relevant at the organizational level, but should provide a subsidiary influence at the bedside.

5 Step Evaluation

1. Who
2. What
3. Where
4. When
5. Why