Ethical Decision-Making
Framework
Workbook
EVIDENCE INFORMED
PRACTICE TOOL
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FRAMEWORK
ETHICAL DECISION-MAKING PROCESS
I. CLARIFYING THE PROBLEM
1. IDENTIFY THE UNCERTAINTY
2. ANALYZE YOUR BIASES
3. CLARIFY THE QUESTION
4. LIST THE MAJOR STAKEHOLDERS
II. DESCRIBING THE ETHICAL CONSIDERATIONS
5. CLINICAL/MEDICAL ISSUES*
a. Clinical/Medical Indications
b. Preferences
c. Quality of Life
III.
IV.
6. CONTEXT
7. LIST THE RISKS AND CONSEQUENCES
8. CONSIDER APPLICABLE RULES AND DUTIES
9. LIST THE ETHICAL PRINCIPLES INVOLVED
CHOOSING A SOLUTION
10.LIST OPTIONS
11.CONSIDER ALL RELATIONSHIPS
12.MAKE A CHOICE AND JUSTIFY IT
IMPLEMENTING AND EVALUATING
13.MAKE AN ACTION PLAN
14.HOW DO YOU AND OTHERS FEEL?
15.WHAT HAVE I LEARNED?
16.IS THERE ANY MORAL DISTRESS OR RESIDUE?
17.ARE THERE IMPLICATIONS FOR POLICY?
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* Adapted from Jonsen, Seigler & Winslade (2010). Clinical Ethics
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Ethical Decision-Making Process
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ETHICAL DECISION-MAKING
WORKSHEET
I. CLARIFYING THE PROBLEM
1. IDENTIFY THE UNCERTAINTY
What is the main problem?
Why is it a problem? What worries you about the situation?
Why are you worried?
What do you know for sure about it? What are the facts?
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What information is missing?
2. ANALYZE YOUR BIASES
What are your biases?
What are your gut feelings? What assumptions are you making?
Where are these feelings/assumptions coming from?
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Ethical Decision-Making Process
What is your role?
~5~
What are your expectations and goals?
3. CLARIFY THE QUESTION
Revisit the facts: what you know, what you need to find out.
What are the most important issues?
What do you need in order to move forward?
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What is the key question to be answered?
What values are involved? How much weight should they have in the final decision?
4. LIST THE MAJOR STAKEHOLDERS
Stakeholder
Value
Rank/Weight
Who will ultimately make the final decision?
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Ethical Decision-Making Process
Who will be affected by the decision?
~7~
What information about the perspectives of these stakeholders needs to be considered?
How are the various perspectives (including yours) similar?
How are the perspectives different?
How does this affect the problem being considered?
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Who else should be included in the discussion? What is their role?
II. DESCRIBING THE ETHICAL CONSIDERATIONS
5. CLINICAL/MEDICAL ISSUES10
Medical Indications
Patient/Client/Resident Preferences
Quality of Life
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Ethical Decision-Making Process
6. CONTEXT
~9~
Context
7. CONSIDER ALL RELATIONSHIPS
Relationships
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8. LIST THE RISKS AND CONSEQUENCES
Risks/Harms/Negative Outcomes
Benefits/Advantages/Positive Outcomes
9. CONSIDER APPLICABLE RULES AND DUTIES
Rules/Duties/Obligations
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Ethical Decision-Making Process
10. LIST THE ETHICAL PRINCIPLES INVOLVED (SEE APPENDIX B FOR DEFINITIONS)
List the principles involved
Whose are they?
~ 11 ~
Rank principles from most
important to least important
III. CHOOSING A SOLUTION
11. LIST OPTIONS
Viable Options
Rank – Most preferable to
least preferable
12. MAKE A CHOICE AND JUSTIFY IT
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IV. IMPLEMENTING AND EVALUATING
13. MAKE AN ACTION PLAN
Implementation Plan
Who is responsible?
Communication Plan
14. HOW DO YOU AND OTHERS FEEL?
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Ethical Decision-Making Process
15.WHAT HAVE I LEARNED?
~ 13 ~
16.IS THERE ANY MORAL DISTRESS OR RESIDUE?
17.ARE THERE IMPLICATIONS FOR POLICY?
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