Carolina RN to BSN Online
Conceptual Bases of Professional Nursing Practice
Ethical Decision Making

Activity 1
Ethical Dilemma

Activity 2
Ethical Code

Activity 3
NC Statutes

Living Wills

Activity 4
Applying Your Knowledge

Activity 5
Peer Relationships

Summary and Conclusion

Activity 6
Ethics Committee




An Ethical Decision Making Model

Now that you have made some important ethical decisions (EOL care and supporting/reporting peers), let's look a model for that deliberation.

Why now??

It is my firm belief that decision-making models serve to outline critical "elements" to consider. Models are not meant to be followed in such a strict way that they limit either thought-processes or creativity. Hence, I wanted your own creative method of processing to evolve. I would predict that you considered most of the 7 elements in Leah Curtin's (1978) classic model described below; but, just in case, review the model. If you skipped any of the elements, consider how including them might have altered your decision.

1. Detail the background information. Gather all the facts. Often simply clarifying the facts of a case resolves some conflicts of opinion. The facts include:

  • Medical (with risk and benefit considerations)
  • Personal (with consideration of patient and family values, beliefs, and wishes)
  • Economic (with cost and benefit review)

2. Describe the conflicts. Clarify what is at issue by asking:

  • Is there a conflict in values and views? Who is involved in the conflict? Who "counts"?(see #3, below)
  • Is there a conflict between the nurses' duties/roles and his/her values?

3. Identify the ethical agents involved. Many people are often involved in an ethical dilemma - patient, family members, doctor, nurse, administrator, risk manager, and so on. It is important to identify all of the people who could have some stake in the decision at hand and what their stake is. It is most important, however, to identify who has prime responsibility for the decision that must be made. In other words, be clear about whose decision it really is. (e.g. nurse can decide the best treatment for a decubiti and not the patient; but patient may be the one who rightly decides if they want any treatment at all)

4. List all alternatives/solutions with their potential consequences. This element is a reminder that there is often more than one way to answer a question, although we all tend to get stuck on a limited set of alternatives. It is important to take some time to think through all the possible ways a situation could be handled. (You may wish to "brainstorm" with others on this element.) Then, it is important to think of potential consequences that can reasonably be associated with each alternative.

5. Apply principles/theories to the alternatives and solutions. This element reminds you to look at each potential solution to the dilemma and think about whether or not that solution violates an important moral principle (such as "do no harm") or theory (such as treat no person simply as a means to someone else's end). Thus you can eliminate any solutions that violate principles, theories and/or deeply held values. Then any conflicting values could be prioritized using data and logical argumentation. For example, when the duty to do no harm conflicts with the duty to tell the truth, you must use logic and facts to decide which, in the long run, would produce the greater valued good.

6. Choose a solution. After reflecting on alternatives, choose a solution and be sure you have a clear rationale for your choice (one you could defend to others - say, like, your mother, or your faculty, or even the "supreme being" herself.) It is also helpful to think about what the strongest objection is that could be made to the rationale behind your choice and how you would refute that objection. This element also suggests that you should consider and describe the legal mandates that may impinge upon your ethical choice.

7. Act. This element conveys the importance of actually following through and implementing what you think would be the good, right, and/or fair thing to do - sometimes at some personal risk.

Remember, the model is NOT recommended to be used step-by-step: 1 then 2, then 3, etc. Rather, when you are involved in ethical deliberation, let your thoughts, arguments and data flow -just be sure that you have covered the first 6 "elements" before you actually do the 7th - acting.

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