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A six-step process should guide ethical decision making in healthcare.
No one would deny clinical and administrative healthcare professionals regularly encounter ethical challenges. For clinicians, the challenges may relate to a conflict regarding withholding or withdrawing lifesustaining interventions or breaching patient confidentiality. For the executive, the conflict may involve a decision concerning a needed service that is a financial drain on the organization or the abusive behavior of a highly productive administrator.
What is the same for clinician and executive decision makers is the potential for an ethical conflict or controversy. All ethical conflicts are characterized by a number of common components. An ethical conflict occurs when an uncertainty, a question or a controversy arises regarding competing ethical principles, personal values, or organizational and professional ethical standards of practice. Examples of such standards include the American College of Physicians' Ethics Manual or the American College of Healthcare Executives' Code of Ethics.
Once an ethical conflict is identified, the challenge becomes how healthcare leaders and other staff involved in the situation should respond. The use of a systematic process can enhance the analysis leading to a response that is ethically justifiable. For the clinician, executive or ethics committee member, applying a systematic process can diminish the possibility of making quick decisions lacking thoughtful reflection and sound ethical reasoning.
The Importance of a Standard Process for Resolution A little over a decade ago, I was changing positions. Because I talked frequently about the importance of systematic ethical reasoning, during a farewell gathering, I was given a small poster that hangs in my office today. It reads, "Ethics, schemethics; flip the damn coin." The cynicism serves as a constant reminder of the need for the opposite-to always apply a carefully developed process to address ethics conflicts. The process will take time and effort, yet it can lead to ethically defensible decisions rather than convey the general attitude, "Because I said so." The process can foster a focused application of ethical principles, institutional values and policies to ethical conflicts. It promotes thoughtful and, hopefully, respectful dialogue between the parties involved in the ethical conflict.
Unlike some decision-making models, the application of a uniform systematic process for addressing both clinical and administrative issues is a subtle-but-important distinction. It emphasizes...