Bioethical Decision-Making Model: Define The Dilemma

Bioethical Decision Making Model1 Define The Dilemma

Describe the problem using your own words, ensuring others can quickly understand the dilemma. Identify relevant medical facts, including diagnosis and prognosis. Recognize non-medical facts such as patient and family details (culture, religion, social and economic factors, Advance Healthcare Directive, verbal preferences, lifestyle). Include external influences like organizational policies, laws, practice acts, and ethical codes. Separate facts from assumptions during your analysis. Identify facts that require clarification, acknowledging that initial discussions may not provide all answers. Determine who the decision makers are—whether the patient is competent, a child capable of participating, or someone else authorized to decide—and explain how they were selected. Review applicable ethical principles such as beneficence, nonmaleficence, veracity, fidelity, autonomy, and justice, explaining their relevance. Outline possible alternatives to proceed, weighing benefits and burdens. Define the follow-up process for the chosen option, referring to the source: Levine-Ariff, J. & Groh, D.H. (1990). Creating an Ethical Environment. Nurse managers' bookshelf, 2(1), 41-61.

Paper For Above instruction

The process of bioethical decision making is complex and multi-faceted, centered on thoroughly understanding the dilemma and applying ethical principles to guide appropriate action. At the core of this process is the clear definition of the dilemma. For instance, consider a scenario where a patient with a terminal illness refuses life-sustaining treatment; the dilemma involves respecting the patient's autonomy versus the healthcare provider's duty to beneficence. Articulating this in straightforward language ensures clarity for all parties involved, including family members, colleagues, and legal entities.

Once the dilemma is established, gathering relevant medical facts becomes paramount. Diagnoses, prognosis, and treatment options constitute objective data that inform decision-making. For example, understanding the disease trajectory and the likely outcomes of proposed interventions helps define the scope of possible choices. Equally essential is distinguishing these facts from assumptions; healthcare providers sometimes rely on assumptions due to incomplete data, which must be identified and scrutinized to prevent bias.

Beyond medical facts, non-medical factors significantly influence ethical decisions. These encompass patient and family values, cultural beliefs, religious considerations, social circumstances, and economic constraints. For example, a patient's cultural background may influence their preferences for end-of-life care or decision-making authority. An Advance Healthcare Directive might specify wishes that override other considerations. Verbal preferences expressed by the patient in conversations should also be documented, reflecting their lived experience and personal values.

External influences, including organizational policies, legal statutes, practice acts, and ethical codes, shape the decision-making context. Healthcare providers must be familiar with relevant laws, such as consent laws or withholding treatments, and organizational policies that may restrict or guide certain actions. For instance, institutional policies might require ethics committee consultation in specific cases, emphasizing the importance of aligning decisions with both legal and ethical standards.

When analyzing facts, it is crucial to separate verified data from assumptions. For example, a healthcare team might assume a patient’s cultural beliefs based on ethnicity, but it’s vital to confirm these beliefs directly from the patient or family to avoid stereotyping. Clarification is often necessary; gaps in understanding can hinder ethical resolution. Identifying these uncertainties allows for targeted information gathering and enhances decision accuracy.

Identifying who holds decision-making authority is another key component. An adult patient deemed competent has the primary right to choose; if incompetent, a legally authorized surrogate or family member often assumes this role. In pediatric cases, age and maturity determine involvement. The rationale for selecting decision-makers should be transparent and documented, respecting legal and ethical standards concerning autonomy and guardianship.

Reviewing fundamental ethical principles offers a structured framework for analyzing the dilemma. Beneficence and nonmaleficence guide providers to promote the patient's well-being while avoiding harm. Respect for autonomy emphasizes honoring patient choices. Veracity relates to honesty in communication, whereas fidelity underscores maintaining trustworthiness. Justice involves fairness in distributing healthcare resources. For example, in deciding whether to honor a patient's refusal of treatment, autonomy and beneficence might conflict, requiring careful balancing informed by these principles.

After understanding the context and principles, alternative courses of action can be considered. Each option should be evaluated for potential benefits and burdens. For instance, imposing treatment against a patient's wishes might benefit physical health but cause psychological harm or violate rights. Conversely, respecting refusal preserves autonomy but may lead to earlier death or perceived neglect of beneficence. Clearly articulating these trade-offs informs ethically sound decisions.

The final step involves defining the follow-up process for implementing the chosen alternative. This includes documenting decisions, communicating clearly with all stakeholders, and arranging ongoing support or reassessment. Continuous evaluation ensures that actions remain aligned with ethical principles and patient preferences, and adjustments can be made when new information emerges.

References

• Levine-Ariff, J., & Groh, D.H. (1990). Creating an Ethical Environment. Nurse Managers’ Bookshelf, 2(1), 41-61.
• Beauchamp, T.L., & Childress, J.F. (2013). Principles of Biomedical Ethics (7th ed.). Oxford University Press.
• Jonsen, A.R., Siegler, M., & Winslade, W.J. (2010). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (7th ed.). McGraw-Hill Education.
• Sulmasy, D.P. (Ed.). (2010). Methods in Medical Ethics. Georgetown University Press.
• Gillon, R. (1994). Medical ethics: four principles plus attention to scope. BMJ, 309(6948), 184-188.
• Beauchamp, T.L. (2001). The 'Four Principles' Approach and the Logic of Justification. The Journal of Medicine and Philosophy, 26(1), 31-43.
• Kalaitzidis, E., & O'Connor, M. (2019). Ethical Decision-Making Frameworks for Healthcare Professionals. Nursing Standard, 34(12), 50-55.
• Shaw, D. (2017). Ethical Issues in Healthcare. Routledge.
• Cholbi, M., & Massa, M. (2019). Ethics in Medical Practice: The Bioethics Landscape. Journal of Medical Ethics, 45(4), 245-250.
• Pesut, B., & Thorne, S. (2012). Perspective on Ethical Decision-Making in Nursing. Journal of Ethics in Healthcare, 3(2), 1-8.