Clinical Ethics Issues and Discussion and A Framework for Thinking Ethically, assignment help

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Instructions

Assignment
#4

The final project for this
course is an analysis of the legal and or ethical issues involved in the below
health care scenario
. See questions to be
answered at end of this factual scenario below. I have also provided, after the
formatting requirements for the paper, two articles that will aid you in your
analyzing the scenario and writing your paper.  

The
two articles to base the analysis of your paper are entitled:

Clinical Ethics Issues and
Discussion and

A Framework for Thinking
Ethically

This
is the final paper for the class and must be double spaced and be
approximately 4-5 pages in 12 point New Times Roman font.

NOTE:
For this paper it is unnecessary to do any research beyond the two articles I
furnished with this assignment. Both are after the specific paper requirements.
  To do internet research would only be wasting your valuable time.

Case Scenario

A
72 year old woman was admitted to the Neurological Intensive Care Unit
following a cerebral hemorrhage which left her with severe brain damage and
ventilator dependent. One year before this event, the patient and her husband
had drawn up “living wills” with an attorney. She was diagnosed by
her treating physician as being in a permanent unconscious condition. The
patient’s living will specified that the patient did not want ventilator support
or other artificial life support in the event of a permanent unconscious
condition or terminal condition.

The
patient’s husband is her legal next of kin and the person with surrogate
decision-making authority. When the living will was discussed with him, he
insisted that the patient had not intended for the document to be used in a
situation like the present one. Further discussion with him revealed that he
understood that the patient would not be able to recover any meaningful brain
function but he argued that the living will did not apply because her condition
was not imminently terminal. He further indicated that he did not consider his
wife to be in a permanent unconscious condition.  The immediate family
members (the couple’s adult children) disagreed with their father’s refusal to
withdraw life support.

The
treatment team allowed a week to pass to allow the husband more time to be
supported in his grief and to appreciate the gravity of his wife’s situation.
 Nevertheless, at the end of this time, the husband was unwilling to
authorize withdrawal of life support measures consistent with the patient’s
wishes as expressed in her living will. End of scenario.

You paper should have
3 major sections. Each is numbered 1, 2 and 3. Questions
to be discussed based on the facts above. You must weave into your
discussion the relevant facts from above scenario to support your discussion in
discussion areas 2 and 3 below. And for discussion area 3 you must weave into
your discussion the ethics philosophy you pick for each issue from the article
A Framework for Thinking Ethically. -5% penalty in grading rubric if
fail to use appropriate underlined headings in your paper. 

1.  Three Legal/Ethical Issues. Just list the three most important
legal/ethics issues in this scenario that you will discuss. They must be three separate, different and distinct issues. Pay
particular attention to the article I furnished with this assignment. No
explanation needed, just state them 1, 2, 3. 

2.  Discussion of Three Legal/Ethical Issues.Discuss the three most important
ethical/legal issues you listed above
. Must use the relevant facts
in the scenario to support your discussion of the legal/ethical issues.

     
    Must use underlined headings below. Headings
will be:

       
   Legal/Ethical issue 1
 [state the issue] then discussion

       
   Legal/Ethical issue 2
 [state the issue] then discussion

       
   Legal/Ethical issue 3
 [state the issue] then discussion

 
    For each legal/ethical issue above discuss

 
          a. Why each is a legal /ethical issue?

 
          b. Discuss each issue in the context of the
scenario facts and

 
          c. Define the concepts you use

3.  How I would Handle Each Issue.First, in this section
and for each issue, as a health care provider, how would you handle each
of the three issues discussed above and why? Must use the relevant
facts in the scenario to support your positions. Secondly for each
issue, using the article in these requirements, entitled “A Framework of
Thinking Ethically” fully discuss the specific ethics philosophy that
would epitomize your handling of each issue. Fully define the specific ethics
philosophy used and weave the ethics philosophy into your discussion. See
article below entitled A Framework for Thinking Ethically. 

 
     Must use underlined headings
below. Headings will be:

 Handling
of Legal/ethical issue #1 
[then discussion]

 Handling
of Legal/ethical issue #2 
[then discussion]

 Handling
of Legal/ethical issue #3
 
[then discussion]

[-5% in grading rubric fail to
use appropriate headings in your paper. ]

All you need to read to analyze
the questions for this paper are the two articles below entitled:

Clinical Ethics Issues and
Discussion and

A Framework for Thinking
Ethically

The
paper must be:

· 

Paper
must be in narrative format not outline or bullets. 

· 
Double spaced and be
4-5 pages in 12 point New Times Roman font. [No deduction if paper exceeds a
page or so.  Thus 3 and half page paper will be penalized.]

· 
Must cite to source of
all your  facts in the text of your paper in APA format. 

· 
You can cite directly
to the original source. Here are the links to the sources where the University
received copyright permissions for the materials:

· 
A Framework for
Ethical Decision Making: http://www.scu.edu/ethics/practicing/decision/framework.htmi

· 
Include a cover page
[not counted as a page] which should have student name and title of your paper
[Provide a short name for the legal responsibility the specific health care
organization has for one type of patient right in a specific setting ] 

· 
A the end of the paper
a list of references [not counted as a page]    

· 
Be prepared using
word-processing software and saved with a .doc, .docx, or .rtf extension. No
pdf.

Background articles to support
the issues you will discuss in the paper. 

Article One of Two

Clinical Ethics Issues and
Discussion Article

Relationships: I. clinical
ethics, law & risk management

1.  Definitions and sources of authority

In
the course of practicing medicine, a range of issues may arise that lead to
consultation with a medical ethicist, a lawyer, and/or a risk manager. The
following discussion will outline key distinctions between these roles.

· 
Clinical
ethics
 may be defined
as:  a discipline or methodology for considering the ethical implications
of medical technologies, policies, and treatments, with special attention to
determining what ought to be done (or not done) in the delivery of health care.

· 
Law may be defined as: established and
enforceable social rules for conduct or non-conduct; a violation of a legal
standard may create criminal or civil liability.

· 
Risk
Management
 may be defined
as: a method of reducing risk of liability through institutional
policies/practices.

Many
health care facilities have in-house or on-call trained ethicists to assist
health care practitioners, caregivers and patients with difficult issues arising
in medical care, and some facilities have formally constituted institutional
ethics committees. In the hospital setting, this ethics consultation or review
process dates back to at least 1992 with the formulation of accreditation
requirements that mandated that hospitals establish a “mechanism” to consider
clinical ethics issues.

Ethics
has been described as beginning where the law ends. The moral conscience is a
precursor to the development of legal rules for social order.  Ethics and
law thus share the goal of creating and maintaining social good and have a
symbiotic relationship as expressed in this quote:

[C]onscience is the
guardian in the individual of the rules which the community has evolved for its
own preservation. William Somerset Maugham

The
role of lawyers and risk managers are closely linked in many health care
facilities. Indeed, in some hospitals, the administrator with the title of Risk
Manager is an attorney with a clinical background. There are, however,
important distinctions between law and risk management. Risk management is
guided by legal parameters but has a broader institution-specific mission to
reduce liability risks. It is not uncommon for a hospital policy to go beyond
the minimum requirements set by a legal standard. When legal and risk
management issues arise in the delivery of health care, ethics issues may also
exist. Similarly, an issue originally identified as falling within the clinical
ethics domain may also raise legal and risk management concerns.

To
better understand the significant overlap among these disciplines in the health
care setting, consider the sources of authority and expression for each.

Ethical norms may be derived
from:

· 
Law

· 
Institutional
policies/practices

· 
Policies of
professional organizations

· 
Professional standards
of care, fiduciary obligations

Note:
If a health care facility is also a religious facility, it may adhere to
religious tenets. In general, however, clinical ethics is predominantly a
secular professional analytic approach to clinical issues and choices.

Law may be derived from:

· 
Federal and state
constitutions (fundamental laws of a nation or state establishing the role of
government in relation to the governed)

· 
Federal and state
statutes (laws written or enacted by elected officials in legislative bodies,
and in some states, such as Washington and California, laws created by a
majority of voters through an initiative process)  

· 
Federal and state
regulations (written by government agencies as permitted by statutory
delegation, having the force and effect of law consistent with the enabling
legislation)

· 
Federal and state case
law (written published opinions of appellate-level courts regarding decisions
in individual lawsuits)

· 
City or town
ordinances, when relevant

Risk Management may be derived
from
 law,
professional standards and individual institution’s mission and public
relations strategies and is expressed through institutional policies and
practices.

1.  Conceptual Models 

Another way to consider the
relationship among the three disciplines is through conceptual models:

1.  Linear

2.  Distinctions

3.  Interconnectedness

4.  Orientation to law for non-lawyers

5.  Potential legal actions against health care
providers

There are two primary
types of potential civil actions against health care providers for injuries
resulting from health care:  (1) lack of informed consent,
and (2) violation of the standard of care. Medical treatment
and malpractice laws are specific to each state.

1.  Informed Consent. Before a health care
provider delivers care, ethical and legal standards require that the patient
provide informed consent. If the patient cannot provide informed consent, then,
for most treatments, a legally authorized surrogate decision-maker may do so.
 In an emergency situation when the patient is not legally competent to
give informed consent and no surrogate decision-maker is readily available, the
law implies consent on behalf of the patient, assuming that the patient would
consent to treatment if he or she were capable of doing so. 

Information
that must be conveyed to and consented to by the patient includes: the
treatment’s nature and character and anticipated results, alternative
treatments (including non-treatment), and the potential risks and benefits of
treatment and alternatives. The information must be presented in a form that
the patient can comprehend (i.e., in a language and at a level which the
patient can understand) and that the consent must be voluntary given. An
injured patient may bring an informed consent action against a provider who
fails to obtain the patient’s informed consent in accordance with state law.

From a clinical ethics
perspective, informed consent is a communication process, and should not simply be treated as a
required form for the patient’s signature. Similarly, the
legal concept of informed consent refers to a state of mind, i.e.,
understanding the information provided to make an informed choice.  Health
care facilities and providers use consent forms to document the communication
process. From a provider’s perspective, a signed consent form can be valuable
evidence the communication occurred and legal protection in defending against a
patient’s claim of a lack of informed consent.  Initiatives at the federal
level (i.e., the Affordable Care Act) and state level (e.g., Revised Code of
Washington § 7.70.060)  reflect approaches that support shared
decision-making and the use of patient decision aids in order to ensure the
provision of complete information for medical decision-making.

2.  Failure to follow standard of care. A
patient who is injured during medical treatment may also be able to bring a
successful claim against a health care provider if the patient can prove that
the injury resulted from the provider’s failure to follow the accepted standard
of care. The duty of care generally requires that the provider use reasonably
expected knowledge and judgment in the treatment of the patient, and typically
would also require the adept use of the facilities at hand and options for
treatment.  The standard of care emerges from a variety of sources,
including professional publications, interactions of professional leaders,
presentations and exchanges at professional meetings, and among networks of
colleagues. Experts are hired by the litigating parties to assist the court in
determining the applicable standard of care.

Many states measure
the provider’s actions against a national standard of care (rather than a local
one) but with accommodation for practice limitations, such as the reasonable
availability of medical facilities, services, equipment and the like. States
may also apply different standards to specialists and to general practitioners.
As an example of a statutory description of the standard of care, Washington
State currently specifies that a health care provider must “exercise that
degree of care, skill, and learning expected of a reasonably prudent health
care provider at that time in the profession or class to which he belongs, in
the State of Washington, acting in the same or similar circumstances.” 

 
III. Common clinical ethics issues: medical decision-making and
provider-patient communication

There
are a number of common ethical issues that also implicate legal and risk
management issues. Briefly discussed below are common issues that concern
medical decision-making and provider-patient communication.

If
a patient is capable of providing informed consent, then the patient’s choices
about treatment, including non-treatment, should be followed. This is an
established and enforceable legal standard and also consistent with the ethical
principle of respecting the autonomy of the patient. The next two sections
(Surrogate decision-making; Advance directives) discuss how this principle is
respected from a legal perspective if a patient lacks capacity, temporarily or
permanently, to make medical decisions. The third section briefly introduces
the issue of provider-patient communication, and highlights a contemporary dilemma
raised in decisions regarding the disclosure of medical error to patients.

1.  Surrogate decision-making

The determination as
to whether a patient has the capacity to
provide informed consent is generally a professional judgment made and
documented by the treating health care provider. The provider can make a
determination of temporary or permanent incapacity, and that determination
should be linked to a specific decision. The legal term competency (or incompetency) may be
used to describe a judicial determination of decision-making capacity. The
designation of a specific surrogate decision-maker may
either be authorized by court order or is specified in state statutes.

If
a court has determined that a patient is incompetent, a health care provider
must obtain informed consent from the court-appointed decision-maker. For
example, where a guardian has been appointed by the court in a guardianship
action, a health care provider would seek the informed consent of the guardian,
provided that the relevant court order covers personal or health care
decision-making.

If, however, a
physician determines that a patient lacks the capacity to provide informed
consent, for example, due to dementia or lack of consciousness, or because the
patient is a minor and the minor is legally proscribed from consenting, then a
legally authorized surrogate decision-maker may be able to provide consent on
the patient’s behalf.  Most states have specific laws that delineate, in
order of priority, who can be a legally authorized surrogate decision-maker for
another person. While these laws may vary, they generally assume that legal
relatives are the most appropriate surrogate decision-makers. If, however, a
patient has previously, while capable of consenting, selected a person to act
as her decision-maker and executed a legal document known as a durable power of attorney for health care or health care proxy, then that designated
individual should provide informed consent.

In Washington State, a
statute specifies the order of priority of authorized decision-makers as
follows: guardian, holder of durable power of attorney; spouse or state
registered partner; adult children; parents; and adult brothers and sisters. If
the patient is a minor, other consent provisions may apply, such as: court
authorization for a person with whom the child is in out-of-home placement; the
person(s) that the child’s parent(s) have given a signed authorization to
provide consent; or, a competent adult who represents that s/he is a relative
responsible for the child’s care and signs a sworn declaration stating
so.  Health care providers are required to make reasonable efforts to
locate a person in the highest possible category to provide informed consent.
If there are two or more persons in the same category, e.g., adult children,
then the medical treatment decision must be unanimous among those persons.
 A surrogate decision-maker is required to make the choice she believes
the patient would have wanted, which may not be the choice the decision-maker
would have chosen for herself in the same circumstance. This decision-making
standard is known as substituted judgment. If
the surrogate is unable to ascertain what the patient would have wanted, then
the surrogate may consent to medical treatment or non-treatment based on what
is in the patient’s best interest.

Laws on surrogate
decision-making are slowly catching up with social changes. Non-married couples
(whether heterosexual or same sex) have not traditionally been recognized in
state law as legally authorized surrogate decision-makers. This lack of
recognition has left providers in a difficult legal position, encouraging them
to defer to the decision-making of a distant relative over a spouse-equivalent
unless the relative concurs. Washington law, for example, now recognizes
spouses and domestic partners registered with the state as having the same
priority status. 

Parental decision-making and
minor children.
 A parent may not
be permitted in certain situations to consent to non-treatment of his or her
minor child, particularly where the decision would significantly impact and
perhaps result in death if the minor child did not receive treatment. Examples
include parents who refuse medical treatment on behalf of their minor children
because of the parents’ social or religious views, such as Jehovah’s Witnesses
and Christian Scientists.  The decision-making standard that generally
applies to minor patients in such cases is known as the best interest standard.  The substituted
judgment standard may not apply because the minor patient never had
decision-making capacity and therefore substituted judgment based on the
minor’s informed choices is not able to be determined. It is important to note
that minors may have greater authority to direct their own care depending on
their age, maturity, nature of medical treatment or non-treatment, and may have
authority to consent to specific types of treatment. For example, in Washington
State, a minor may provide his or her own informed consent for treatment of
mental health conditions, sexually transmitted diseases, and birth control,
among others. Depending on the specific facts, a health care provider working
with the provider’s institutional representatives could potentially legally
provide treatment of a minor under implied consent for emergency with
documentation of that determination, assume
temporary protective custody of the child under child neglect laws, or if the
situation is non-urgent, the provider could seek a court order to authorize
treatment.

1.   Advance directives

The term advance directive refers to several different
types of legal documents that may be used by a patient while competent to
record future wishes in the event the patient lacks decision-making capacity.
 The choice and meaning of specific advance directive terminology is
dependent on state law. Generally, a living will expresses
a person’s desires concerning medical treatment in the event of incapacity due
to terminal illness or permanent unconsciousness. A durable power of attorney for health care or health care proxy appoints a legal decision- maker
for health care decisions in the event of incapacity. An advance health care directive or health care directive may combine the functions of
a living will and durable power of attorney for health care into one document
in one state, but may be equivalent to a living will in
another state. The Physician Orders for Life
Sustaining Treatment 
(POLST) form is
a document that is signed by a physician and patient which summarizes the
patient’s wishes concerning medical treatment at the end of life, such as
resuscitation, antibiotics, other medical interventions and artificial feeding,
and translates them into medical orders that follow patients regardless of care
setting. It is especially helpful in effectuating a patient’s wishes outside
the hospital setting, for example, in a nursing care facility or emergency
medical response context.  This relatively new approach is available in
about a dozen states, although the programs may operate under different names:
POST (Physician Orders for Scope of Treatment), MOST (Medical Orders for Scope
of Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), and COLST
(Clinician Orders for Life-Sustaining Treatment).  The simple one page
treatment orders follow patients regardless of care setting. Thus it differs
from an advance directive because it is written up by the clinician in
consultation with the patient and is a portable, actionable medical order.
 The POLST form is intended to complement other forms of advance
directives. For example, Washington State recognizes the following types of
advance directives: the health care directive (living will), the durable power
of attorney for health care, and the POLST form. Washington also recognizes
another legal document known as a mental health advance directive,
which can be prepared by individuals with mental illness who fluctuate between
capacity and incapacity for use during times when they are incapacitated.

State
laws may also differ on the conditions that can be covered by an individual in
an advance directive, the procedural requirements to ensure that the document
is effective (such as the number of required witnesses) and the conditions
under which it can be implemented (such as invalidity during pregnancy).

Advance
directives can be very helpful in choosing appropriate treatment based upon the
patient’s expressed wishes. There are situations, however, in which the advance
directive’s veracity is questioned or in which a legally authorized surrogate
believes the advance directive does not apply to the particular care decision
at issue. Such conflicts implicate clinical ethics, law and risk management.

1.  Provider-patient communications: disclosing
medical error

Honest
communication to patients by health care providers is an ethical imperative.
Excellent communication eliminates or reduces the likelihood of
misunderstandings and conflict in the health care setting, and also may affect
the likelihood that a patient will sue.

One
of the more contentious issues that has arisen in the context of communication
is whether providers should disclose medical errors to patients, and if so, how
and when to do so. Disclosure of medical error creates a potential conflict
among clinical ethics, law and risk management. Despite a professional ethical
commitment to honest communication, providers cite a fear of litigation as a
reason for non-disclosure. Specifically, the fear is that those statements will
stimulate malpractice lawsuits or otherwise be used in support of a claim
against the provider.  An increase in malpractice claims could then
negatively affect the provider’s claims history and malpractice insurance
coverage.  

There
is some evidence in closed systems (one institution, one state with one
malpractice insurer) that an apology coupled with disclosure and prompt payment
may decrease either the likelihood or amount of legal claim.  In addition,
a number of state legislatures have recently acted to protect provider
apologies, or provider apologies coupled with disclosures, from being used by a
patient as evidence of a provider’s liability in any ensuing malpractice
litigation. It is currently too early to know whether these legal protections
will have any impact on the size or frequency of medical malpractice claims.
For this reason and others, it is advisable to involve risk management and
legal counsel in decision-making regarding error disclosure.  

Article Two of Two

A Framework for Thinking
Ethically Article

This
document is designed as an introduction to thinking ethically. We all have an
image of our better selves-of how we are when we act ethically or are “at
our best.” We probably also have an image of what an ethical community, an
ethical business, an ethical government, or an ethical society should be.
Ethics really has to do with all these levels-acting ethically as individuals,
creating ethical organizations and governments, and making our society as a
whole ethical in the way it treats everyone.

What is Ethics?

Simply
stated, ethics refers to standards of behavior that tell us how human beings
ought to act in the many situations in which they find themselves-as friends,
parents, children, citizens, businesspeople, teachers, professionals, and so
on.

It
is helpful to identify what ethics is NOT:

· 
• Ethics is not the
same as feelings. Feelings provide important information for our ethical
choices. Some people have highly developed habits that make them feel bad when
they do something wrong, but many people feel good even though they are doing
something wrong. And often our feelings will tell us it is uncomfortable to do
the right thing if it is hard.

· 
• Ethics is not
religion. Many people are not religious, but ethics applies to everyone. Most
religions do advocate high ethical standards but sometimes do not address all
the types of problems we face.

· 
• Ethics is not
following the law. A good system of law does incorporate many ethical
standards, but law can deviate from what is ethical. Law can become ethically
corrupt, as some totalitarian regimes have made it. Law can be a function of
power alone and designed to serve the interests of narrow groups. Law may have
a difficult time designing or enforcing standards in some important areas, and
may be slow to address new problems.

· 
• Ethics is not
following culturally accepted norms. Some cultures are quite ethical, but
others become corrupt -or blind to certain ethical concerns (as the United
States was to slavery before the Civil War). “When in Rome, do as the
Romans do” is not a satisfactory ethical standard.

· 
• Ethics is not
science. Social and natural science can provide important data to help us make
better ethical choices. But science alone does not tell us what we ought to do.
Science may provide an explanation for what humans are like. But ethics
provides reasons for how humans ought to act. And just because something is
scientifically or technologically possible, it may not be ethical to do it.

Why Identifying Ethical
Standards is Hard

There
are two fundamental problems in identifying the ethical standards we are to
follow: 
1. On what do we base our ethical standards?
2. How do those standards get applied to specific situations we face?

If
our ethics are not based on feelings, religion, law, accepted social practice,
or science, what are they based on? Many philosophers and ethicists have helped
us answer this critical question. They have suggested at least five different
sources of ethical standards we should use.

Five Sources of Ethical
Standards

The Utilitarian Approach
Some ethicists emphasize that the ethical action is the one that provides the
most good or does the least harm, or, to put it another way, produces the
greatest balance of good over harm. The ethical corporate action, then, is the
one that produces the greatest good and does the least harm for all who are
affected-customers, employees, shareholders, the community, and the
environment. Ethical warfare balances the good achieved in ending terrorism
with the harm done to all parties through death, injuries, and destruction. The
utilitarian approach deals with consequences; it tries both to increase the
good done and to reduce the harm done.

The Rights Approach
Other philosophers and ethicists suggest that the ethical action is the one
that best protects and respects the moral rights of those affected. This
approach starts from the belief that humans have a dignity based on their human
nature per se or on their ability to choose freely what they do with their
lives. On the basis of such dignity, they have a right to be treated as ends
and not merely as means to other ends. The list of moral rights -including the
rights to make one’s own choices about what kind of life to lead, to be told
the truth, not to be injured, to a degree of privacy, and so on-is widely
debated; some now argue that non-humans have rights, too. Also, it is often said
that rights imply duties-in particular, the duty to respect others’ rights.

The Fairness or Justice
Approach

Aristotle and other Greek philosophers have contributed the idea that all
equals should be treated equally. Today we use this idea to say that ethical
actions treat all human beings equally-or if unequally, then fairly based on
some standard that is defensible. We pay people more based on their harder work
or the greater amount that they contribute to an organization, and say that is
fair. But there is a debate over CEO salaries that are hundreds of times larger
than the pay of others; many ask whether the huge disparity is based on a
defensible standard or whether it is the result of an imbalance of power and
hence is unfair.

The Common Good Approach
The Greek philosophers have also contributed the notion that life in community
is a good in itself and our actions should contribute to that life. This
approach suggests that the interlocking relationships of society are the basis
of ethical reasoning and that respect and compassion for all others-especially
the vulnerable-are requirements of such reasoning. This approach also calls
attention to the common conditions that are important to the welfare of
everyone. This may be a system of laws, effective police and fire departments,
health care, a public educational system, or even public recreational areas.

The Virtue Approach
A very ancient approach to ethics is that ethical actions ought to be
consistent with certain ideal virtues that provide for the full development of
our humanity. These virtues are dispositions and habits that enable us to act
according to the highest potential of our character and on behalf of values
like truth and beauty. Honesty, courage, compassion, generosity, tolerance, love,
fidelity, integrity, fairness, self-control, and prudence are all examples of
virtues. Virtue ethics asks of any action, “What kind of person will I
become if I do this?” or “Is this action consistent with my acting at
my best?”

Putting the Approaches Together

Each
of the approaches helps us determine what standards of behavior can be
considered ethical. There are still problems to be solved, however.

The
first problem is that we may not agree on the content of some of these specific
approaches. We may not all agree to the same set of human and civil rights.

We
may not agree on what constitutes the common good. We may not even agree on
what is a good and what is a harm.

The
second problem is that the different approaches may not all answer the question
“What is ethical?” in the same way. Nonetheless, each approach gives
us important information with which to determine what is ethical in a
particular circumstance. And much more often than not, the different approaches
do lead to similar answers.

Making Decisions

Making
good ethical decisions requires a trained sensitivity to ethical issues and a
practiced method for exploring the ethical aspects of a decision and weighing
the considerations that should impact our choice of a course of action. Having
a method for ethical decision making is absolutely essential. When practiced
regularly, the method becomes so familiar that we work through it automatically
without consulting the specific steps.

The
more novel and difficult the ethical choice we face, the more we need to rely
on discussion and dialogue with others about the dilemma. Only by careful
exploration of the problem, aided by the insights and different perspectives of
others, can we make good ethical choices in such situations.

We
have found the following framework for ethical decision making a useful method
for exploring ethical dilemmas and identifying ethical courses of action.

A
Framework for Ethical Decision Making

Recognize an Ethical Issue

1.  Could this decision or situation be damaging
to someone or to some group? Does this decision involve a choice between a good
and bad alternative, or perhaps between two “goods” or between two
“bads”?

2.  Is this issue about more than what is legal or
what is most efficient? If so, how?

Get the Facts

1.  What are the relevant facts of the case? What
facts are not known? Can I learn more about the situation? Do I know enough to
make a decision?

2.  What individuals and groups have an important
stake in the outcome? Are some concerns more important? Why?

3.  What are the options for acting? Have all the
relevant persons and groups been consulted? Have I identified creative options?

Evaluate Alternative Actions

1.  Evaluate the options by asking the following
questions:

· 
Which option will
produce the most good and do the least harm? (The Utilitarian Approach)

· 
Which option best
respects the rights of all who have a stake? (The Rights Approach)

· 
Which option treats
people equally or proportionately? (The Justice Approach)

· 
Which option best
serves the community 
as a whole, not just some members? 
(The Common Good Approach)

· 
Which option leads me
to act as the sort of person I want to be? (The Virtue Approach)

Make a Decision and Test It

1.  Considering all these approaches, which option
best addresses the situation?

2.  If I told someone I respect-or told a
television audience-which option I have chosen, what would they say?

Act and Reflect on the Outcome

1.  How can my decision be implemented with the
greatest care and attention to the concerns of all stakeholders?

2.  How did my decision turn out and what have I
learned from this specific situation?

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