Module 1: Professional Accountability and Prescribing

Lesson 6

Clinical ethics: The four topic approach

RNs and NPs are taught to approach a case in a systematic, logical manner regardless of the case’s complexity.

First, we identify the chief complaint, and then progress through the history of current health practices, past medical history, social history, review of systems, physical findings, and laboratory tests to come up with a diagnosis.  Based on the diagnosis, treatment goals are developed and implemented, patients are educated, and plans for follow-up developed.

However, this framework does not include ethical decision-making processes. The potential for ethical issues to arise in the provision of psychoactive drugs underscores the need for the health care provider to be skilled in using an ethical decision-making framework.

The four topics approach is a practical process to sort out facts and values and facilitate a discussion and resolution of an ethical dilemma.  The four topics – medical indications, patient preferences, quality of life, and contextual features – provide a framework that can be used with any case. It allows the provider to approach a clinical case systematically, integrating ethical principles and clinical circumstances. This framework will be applied to the case of SM to show how it can be used to systematically identify, analyze and resolve unique ethical problems in clinical practice.