Bioethical
Decision
Making
Model
1. Define
the
dilemma:
Use
your
own
words
to
describe
the
problem.
State
it
in
a
way
that
others
can
quickly
understand
your
dilemma.
Review
2. Identify
the
medical
facts:
Describe
the
facts
that
are
relevant
to
the
dilemma.
3. Remember
that
the
diagnosis
and
prognosis
are
medical
facts.
4. Identify
the
non-‐medical
facts
(patient
and
family,
external
influences):
a. Patient
and
family
facts
such
as
culture,
religion,
social,
economic,
the
existence
of
an
Advance
Healthcare
Directive,
verbal
preferences
made
by
the
patient,
how
the
patient
lived
his/her
life.
b. Those
that
you
discuss
should
be
relevant
to
the
situation.
5. External
influences
include:
organizational
policies,
federal
and
state
laws,
practice
acts,
code
of
ethics.
These
should
be
relevant
to
the
situation.
6. For
both
step
2
or
3,
separate
the
facts
from
the
assumptions:
Sometimes
all
healthcare
professionals
allow
assumptions
to
guide
their
decision-‐making.
These
must
be
identified
so
that
these
assumptions
do
not
interfere
with
the
process.
7. Identify
items
that
need
clarification.
Your
paper
should
identify
facts
that
you
need
to
clarify.
When
initially
discussing
an
ethical
situation,
it
is
not
unusual
to
not
have
all
of
the
answers.
8. Identify
the
decision
makers:
Is
the
patient
an
adult
competent
to
make
their
own
choices?
Is
the
patient
a
child
who
is
old
enough
to
have
a
say
in
the
decision.
If
the
patient
cannot
make
their
own
decision,
who
is
the
decision
maker?
How
was
this
person
selected?
9. Review
the
underlying
ethical
principles:
Review
which
ones
and
why
they
apply
t
this
particular
case:
beneficence,
nonmaleficience,
veracity,
fidelity,
autonomy
and
justice.
10. Define
alternatives:
One-‐Way
to
proceed
may
be
apparent
at
this
point.
However,
sometimes
there
are
different
choices.
They
should
be
addressed
identifying
the
benefits
and
burdens
for
doing
one
thing
versus
the
other.
11. Follow-‐up:
Define
the
process
to
be
used
with
the
chosen
alternative.
Reference
Source:
Levine-‐Ariff,
J.
&
Groh,
D.H.
(1990).
Creating
an
Ethical
Environment.
Nurse
managers'
bookshelf
a
quarterly
series:
2:1.
Baltimore,
Maryland:
Williams
&
Wilkins.
41-‐61.