Medical ethics: explain the values and reasoning behind a decision
Medical ethics asks how care and research should respect people and respond to competing responsibilities. Learning it involves more than attaching a principle to a case. A useful explanation identifies the decision, the people affected, the available evidence and the reasons that make an option defensible.
Establish what is known and what needs to be decided
Ethical discussions begin with an accurate depiction of the scenario. Facts, unknowns and assumptions should all be identified prior to assessing your choices. It is helpful to determine whose interests are represented and ultimately what decision must be reached. A disagreement may involve missing information regarding some of the options, differing priority levels assigned to various aspects of the issue or the practical consequences associated with choosing an option. Rather than hiding those issues under an umbrella term of "ethics," those disagreements deserve consideration.
Write the clinical question as well as the ethical issue separate from each other for a fictional care discussion. For instance, there is a difference between uncertainty regarding the probable advantage of an option versus the disagreement over which outcome is most important. Examine what additional information may change the conversation. This allows the reasoning to remain tied to the circumstances and avoid viewing a brief case summary as an adequate explanation of all the pertinent information.
Respect involves an understandable exchange of information
Individuals should receive relevant information about proposed care, possible advantages, disadvantages, alternative treatments and uncertainty. Individuals' preferences and inquiries should also be included in the communication process. The communication process should reflect each individual's needs and provide a means to verify understanding. While documents can facilitate the process, signing a document alone does not ensure that an individual understands the options and was given an adequate opportunity to engage in a discussion about them.
Identify the factors that contribute to a useful comparison between two fictional descriptions of an option. One provides technical details regarding an option; the second relates those technical details to the individual's concern and encourages inquiry. Describe what creates this latter form of exchange as more beneficial. The specific professional and legal requirements for obtaining consent vary depending upon the circumstance and jurisdiction. This page serves as an introduction to ethical reasoning rather than providing guidance concerning whether consent was legally obtained in a particular individual's case.
Consider who gains, who bears a burden and what is uncertain
Choices can have both positive and negative outcomes for the same individual (or for others). Reasoning ethically should expose these effects and assess whether burdens are equitably distributed among the parties. Evidence, along with limitations of evidence, matter. No amount of confidence regarding an advantageous effect can adequately settle the discussion if the outcome lacks sufficient evidence or if the individual prioritizes a different outcome.
In addition to describing the anticipated benefits, disadvantages and practical burdens of two fictional options in similar terms, identify which party may prioritize differently, and why. Do not assume that the technically easiest option is inherently equitable. Reasonable accounts will specify how the respective interests were assessed, as well as what degree of uncertainty continues to exist. Reasonable accounts do not merely name a desired outcome.
Honesty, privacy and review help sustain responsible practice
Professional duties include honesty, respectful treatment and appropriate protection of personal information. Decisions and their reasons need a record suited to the situation. Research has additional ethical requirements, including appropriate independent review and informed, voluntary participation.
Do not treat agreement to participate in clinical care as agreement to participate in a study. End a teaching case by identifying the justification for your decision, unresolved concerns related to your decision and plans for reviewing future developments or concerns. Identify when additional expertise or discussion would be required. Ethical principles assist with structuring your inquiry; however, actual cases also require current professional standards as well as applicable laws. An introductory guide cannot supplant professional standards or applicable laws, or resolve for disputes arising from multiple perspectives.
Check your understanding
A short quiz, with an explanation after each answer.
What should come before applying an ethical label?
Review the portion you found most difficult to understand. Attempt to explain the example provided without accessing this page. Once you have explained the example, check your response and attempt again. Developing ability to articulate the rationale for making a decision is far more valuable than simply recalling where a correct answer lies.