Table 1 Four topics approach to clinical ethics case analysis [2]
From: Ethical decision making in dental education: a preliminary study
Medical Indications | Patient Preferences |
• What is the patient’s medical problem? History?Diagnosis? Prognosis? | • Is the patient mentally capable and legally competent? Is there evidence of capacity? |
• Is the problem acute? Chronic? Critical? Emergent? Reversible? | • If competent, what is the patient stating about preferences for treatment? |
• What are the goals of treatment? | • Has the patient been informed of benefits and risks, understood this information, and given consent? |
• What are the probabilities of success? | • If incapacitated, who is the appropriate surrogate? Is the surrogate using appropriate standards for decision making? |
• What are the plans in case of therapeutic failure? | • Has the patient expressed prior preferences)? |
• In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided? | • Is the patient unwilling or unable to cooperate with medical treatment? If so, why? |
• In sum, is the patient’s right to choose being respected to the extent possible in ethics and law? | |
Quality Of Life | Contextual Features |
• What are the prospects, with or without treatment, for a return to normal life? | • Are there family issues that might influence treatment decisions? |
• What physical, mental, and social deficits is the patient likely to experience if treatment succeeds? | • Are there provider (physician, nurse) issues that might influence treatment decisions? |
• Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life? | • Are there financial and economic factors? |
• Is the patient’s present or future condition such that his or her continued life might be judged as undesirable? | • Are there religious or cultural factors? |
• Is there any plan and rationale to forgo treatment? | • Are there limits on confidentiality? |
• Are there plans for comfort and palliative care? | • Are there problems of allocation of resources? |
• How does the law affect treatment decisions? | |
• Is there any conflict of interest on the part of the providers or the institution? |