Table 1 Some common methods for ethical reflection

CME (Centre for Medical Ethics) 6-step model: This is a sequential structure for ethical deliberation about actual clinical dilemmas in which the facts of the case, ethical problems, stakeholder interests, relevant ethical features and laws, and available courses of action are identified and discussed [27].

Other discourse ethics models: E.g., “yes” or “no” as responses to the ethical question are written on each flipchart/blackboard, as are stakeholders and their interests, values and norms. The reflection process involves an assessment of the advantages and disadvantages of the two sides.

Ethics cards: Cards presenting statements, questions, pictures, or short descriptions of situations that contain ethical challenges are taken as point of departure for group discussions.

“Fish bowl” method: A sequential conversation, where participants sit in a circle and respond in turn by referring to the previous statements: “When you say…, (looking at one participant), I think …, (turning to the next participant)”, handing the statement to the next person in the ring.

“Traffic light” method: Red, green and yellow “traffic lights” are markers to signal that you agree (green), disagree (red) or are uncertain (yellow) about the ethical question and the proposed solution.