Table 1 Modified “SME model” with supportive questions
What is the ethical dilemma? | What are the facts in this case and what laws and guidelines are relevant? | Who are the involved parties? | What does the relevant ethical positions, values and norms say about the dilemma? | What are the possible ways of action? |
|---|---|---|---|---|
Specify, what makes the situation difficult? Clarify, what is at stake and what the ethical challenge is? | What relevant information is available? Is relevant information missing? What laws and guidelines are relevant? Are there any special elements to consider? Is the ethical challenge well-known in clinical practice? What is the usual way of handling the ethical challenge? What is the treatment plan and what is it the intention to obtain with it? | Who are affected? Who can/must make a choice? Identify – if possible – what the involved parties knows and what their values, wishes and intentions are. What consequences does the outcome have for the involved parties? Can we build up or maintain a relationship of trust? How is this ethical challenges related to the core values of Danish psychiatry: respect, professional competency and responsibility? | Autonomy • Has the patient been informed and asked? • Is the patient in a state where he can evaluate the consequence of his choice? Is the patient consistent? • Is the patient under pressure? What would be to the best of the patient? • How are the wishes and values of the patient respected? • How is integrity, dignity, vulnerability of the patient respected? • How is the level of confidence? How do we avoid causing harm? • Does the good we do outweigh the potential harm - to the patient, to others affected, and to the overall use of resources? Consequentialism • What will benefit the most and harm the fewest? Deontology • Are there decisions which can be generalised? • Consider the patient as a goal by itself, not only as a means to obtain something else. Virtue ethics. • What is a good doctor in this situation? • What virtues/values are relevant and how are they to be expressed? | What are the options of action in this situation? What arguments are there for and against? Is there a risk stigmatizing? What are the consequences of the actions on both in both short and long term? |