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ETHICAL DECISION-MAKING MAP
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| 1. ISSUE |
2. PERSPECTIVES OF THOSE INVOLVED |
3. LOCUS OF DECISION |
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What is the situation or dilemma?
(Outline briefly)
- basic medical problem
- medical indications for treatment
- what decision needs to be made?
- what are the patient/family preferences?
- what are the preferences of healthcare providers?
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Patient's/family's concerns
- adequate disclosure
- capacity to choose
- ability to refuse therapy
- coercion, duress or abandonment
- advanced directives
- surrogate decision makers
- pt health vs family finances
- religion, values & culture
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Who has authority to act?
- does physician have authority to force care on pt
- does pt have authority to refuse or demand care
- does family have authority to refuse or demand care
- authority lies with other agent
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Who does what to whom and under what circumstances?
- who is involved in the situation?
- what actions are planned?
- what information is being given & withheld?
- who will experience consequences?
- how will the decision be achieved?
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The Healthcare Providers' concerns
- professional codes
- standard of care
- awareness of community norms
- trust and professional reputation
- diagnosis & prognosis
- goals of therapy
- efficacy/inefficacy
- futility/utility
- loyalty issues
- communication with family/pt
- institutional concerns & financial constraints
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How was the decision actually made in terms of power?
(who had the final say?)
- doctor
- family
- patient
- nurse
- administration
- other
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Is there a conflict of values?
- between healthcare provider and patient/family
- among healthcare providers
- between healthcare provider(s) and organization
- between the family and patient
- between patient and 3rd party payer
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Contextual/systemic, & quality of life issues
- relevance of benefits, harms and rights of others
- interests of others
- protection of others
- cost of care
- allocation of resources
- legal obligations
- effects on community and the medical practice relations?
- life expectancy
- potential for disability & suffering
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What ethical principles inform the situation? (Examples)
Autonomy:
- does the patient have the right to refuse care?
- is patient informed enough to refuse care?
- does the family have a right to know?
Competency:
- does the patient/family understand the diagnosis and treatment?
Truth-telling
- how much information should the healthcare providers provide?
Harm:
- will not telling cause harm?
- will telling cause harm?
- will forcing care cause harm?
- will not forcing care cause harm?
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