Paradigm (4 boxes)
A case-based approach to ethical decision-making
Adapted from AR Jonsen, M Siegler, W Winslade, Clinical Ethics, 7th edition. McGraw-Hill, 2010.
MEDICAL INDICATIONS
The Principles of Beneficence and Nonmaleficence
What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
What are the goals of treatment?
In what circumstances are medical treatments not indicated?
What are the probabilities of success of various treatment options?
In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
PATIENT PREFERENCES
The Principle of Respect for Autonomy
Has the patient been informed of benefits and risks, understood this information, and given consent?
Is the patient mentally capable and legally competent, and is there evidence of incapacity?
If mentally capable, what preferences about treatment is the patient stating?
If incapacitated, has the patient expressed prior preferences?
Who is the appropriate surrogate to make decisions for the incapacitated patient?
Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
QUALITY OF LIFE
The Principles of Beneficence, Nonmaleficence, and Respect for Autonomy
What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
What ethical issues arise concerning improving or enhancing a patient’s quality of life?
Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
What are plans and rationale to forgo life-sustaining treatment?
What is the legal and ethical status of suicide?
CONTEXTUAL FEATURES
The Principles of Justice and Fairness
Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
Are there financial factors that create conflicts of interest in clinical decisions?
Are there problems of allocation of scarce health resources that might affect clinical decisions?
Are there religious issues that might affect clinical decisions?
What are the legal issues that might affect clinical decisions?
Are there considerations of clinical research and education that might affect clinical decisions?
Are there issues of public health and safety that affect clinical decisions?
Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare?
Assignment: Ethical Issue/Case Study Final Paper
The following criteria will be used to evaluate the student work in the Final Paper
Introduced the topic and purpose of the paper in a clear, complete, and logical manner; in a half page length.
5 Points
Selected case study/ethical issue that is significant and relevant to patient care and/or nursing practice.
10 Points
Used current, evidence-based literature (a minimum of 6 references from relevant, peer
reviewed journals and/or text-books – at least
5 from sources outside course text).
10 Points
Summarized data in a clear, logical, and organized manner.
15 Points
Delineated relevant health care issues that impact the ethical issue within the context of current 1) professional, 2) political and 3) financial situation.
20 Points
Implementation of a method of ethical analysis (like 4-box) used, possible solution/outcome alternatives, and resolution / plan of care (what action or alternative did you choose and why). May include your opinion on the topic, however, balanced arguments are required.
20 Points
The conclusion clearly summarizes relevant points of the paper and provides adequate closure to the topic.
10 Points
Submits an 8-10-page typed paper (not including title page or reference pages) that is neat with no major spelling errors (APA 7th ed.). An abstract is not required.
5 Points
Strictly adhered to APA 7th edition guidelines, including a complete reference list with < 2 minor errors evident (e.g., incorrect punctuation in citation). Uses headings and citations properly. Title page and reference page are in the proper format.
5 Points
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