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Table 1 Summary of the Decision-making framework

From: A bioethical framework to guide the decision-making process in the care of seriously ill patients

Step# and guiding ethical principle

Main focus

Goals

Method

Practical objectives

1st step: Ethics of Accuracy

The body and its biology: the diseases and treatment options

To be accurate in diagnosis, prognosis, and success and failure rates of possible treatments.

Evidence-based practice, probabilistic and scientific reasoning

To Present:

a) A correct diagnosis and the phase of the disease.

b) A probable prognosis, i.e., how the majority of patients with that phase of the disease will evolve over time.

c) The absolute risk reduction, the relative risk reduction, the number needed to treat.

The potential adverse effects as well as costs and inconveniences of treatments. Uncertainty is addressed through estimation of confidence intervals and the disclosure of the potential limitations of generalization of evidence in that specific case.

2nd step: Ethics of comprehension

The person and biography: patient’s values and views of suffering.

To comprehend and be empathetic to the patient’s suffering, respecting the other as an end in itself. The emphasis here is to listen, to be present and to learn about biography, not to act, to change or to fix it.

Empathic communication

To learn about the patient’s understanding, views, life values, perceptions of suffering and treatment preferences.

3rd step: Ethics of situational awareness

The healthcare multidisciplinary team

To apply the scientific evidence developed in populations to the specific situation of the patient, conciliating evidence based treatments with the patient’s values and biography.

Clinical judgement and effective team communication

A team proposal of which would be considered:

a) the acceptable evidence based treatment, taking on consideration the scientific view only

b) The best or recommended treatment following both the scientific evidence while also respecting the patient’s biography and wishes.

c) The potentially inappropriate treatments following scientific evidence and the patient’s biography and wishes.

d) The futile or unacceptable treatments, considering exclusively the scientific basis.

4th step: an ethics of deliberation

The patient-provider relationship

Establishing rapport and building consensual patient-provider goals of care, ensuring that the patient’s values will be respected and scientifically acceptable practices will be used.

Deliberation and person-centered communication

To have and honest and empathic communication about diagnosis, prognosis and then, to establish consensual goals of care for the best and worst scenario. After the setting of GOC, specific treatments within the Step#3 proposal are deliberated between patient and physician, reaching a new consensus about which treatments might or might not be employed to reach the desired goals.