Module 1: Professional Accountability and Prescribing
Four topics approach to clinical ethics
Adapted from Jonsen, Siegler, and Winslade Clinical Ethics (7th ed.), McGraw Hill, 2010)
- What is patient’s medical status? History? Diagnosis? Prognosis? What assessment of the patient has been done and how recently?
- Have changes occurred that affect the goals of care?
- What are current goals of care/treatment?
- What are the probable outcomes?
- What are plans in case of therapeutic failure? What options have been considered?
- In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Principles of Beneficence and Nonmaleficence
- What preferences for treatment has the patient expressed?
- Have patient and family been informed of benefits and risks, understood, and given consent?
- What assessment of patient’s decision making capability has been completed?
- Has patient expressed prior preferences, e.g., advance directives, medical power of attorney?
- If incapacitated, who is appropriate surrogate? Is the surrogate using appropriate standards?
- Is patient unwilling or unable to cooperate with medical treatment? If so, why?
- In sum, is patient’s right to choose being respected to extent possible in ethics and law?
Principle of Respect for Autonomy
- What are the prospects, with or without treatment, for continuing the patient’s normal life?
- Are there biases that might prejudice provider’s view of quality of life?
- What physical, mental, and social deficits is patient likely to experience if treatment succeeds?
- Is patient’s present or future condition such that continued life might be judged undesirable by them?
- Any plan and rationale to forgo treatment?
- What plans for comfort and palliative care?
Principles of Beneficence, Nonmaleficence and Respect for Autonomy
- Are there family issues that might influence treatment decisions?
- Are there provider issues that might influence treatment decisions?
- Any financial or economic factors?
- Are there religious or, cultural factors?
- Is there any justification to breach confidentiality?
- Any problems with allocation of resources?
- What are the legal implications of treatment decisions?
- Is clinical research or teaching involved?
- Any provider or institutional conflict of interest?
Principle of Justice and Fairness