Module 1: Professional Accountability and Prescribing

Lesson 6

Four topics approach to clinical ethics

Adapted from Jonsen, Siegler, and Winslade Clinical Ethics (7th ed.), McGraw Hill, 2010)

  1. What is patient’s medical status? History? Diagnosis? Prognosis? What assessment of the patient has been done and how recently?
  2. Have changes occurred that affect the goals of care?
  3. What are current goals of care/treatment?
  4. What are the probable outcomes?
  5. What are plans in case of therapeutic failure? What options have been considered?
  6. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

Principles of Beneficence and Nonmaleficence

  1. What preferences for treatment has the patient expressed?
  2. Have patient and family been informed of benefits and risks, understood, and given consent?
  3. What assessment of patient’s decision making capability has been completed?
  4. Has patient expressed prior preferences, e.g., advance directives, medical power of attorney?
  5. If incapacitated, who is appropriate surrogate? Is the surrogate using appropriate standards?
  6. Is patient unwilling or unable to cooperate with medical treatment? If so, why?
  7. In sum, is patient’s right to choose being respected to extent possible in ethics and law?

Principle of Respect for Autonomy

  1. What are the prospects, with or without treatment, for continuing the patient’s normal life?
  2. Are there biases that might prejudice provider’s view of quality of life?
  3. What physical, mental, and social deficits is patient likely to experience if treatment succeeds?
  4. Is patient’s present or future condition such that continued life might be judged undesirable by them?
  5. Any plan and rationale to forgo treatment?
  6. What plans for comfort and palliative care?

Principles of Beneficence, Nonmaleficence and Respect for Autonomy

  1. Are there family issues that might influence treatment decisions?
  2. Are there provider issues that might influence treatment decisions?
  3. Any financial or economic factors?
  4. Are there religious or, cultural factors?
  5. Is there any justification to breach confidentiality?
  6. Any problems with allocation of resources?
  7. What are the legal implications of treatment decisions?
  8. Is clinical research or teaching involved?
  9. Any provider or institutional conflict of interest?

Principle of Justice and Fairness