A Clinician's Approach to Clinical Ethical Reasoning

Physicians can be more confident in their approach to ethical challenges in patient care if they adopt a systematic approach to address the issues. The authors recognize that a problem which initially appears to be ethical in nature may be more related to insufficient communication, interpersonal conflict or incomplete awareness of existing medical options and information. Six actions are recommended as a way of supporting the decision-making process when ethical issues surface. A case study is used to illustrate the systematic approach in which a physician recommends a course of treatment for a patient who is incapable of expressing her preferences, and the patient's family disagrees with the physician's plan. The strategy suggests a plain statement of the initial problem, careful gathering of data, a diagnostic assessment of the issue, and articulation and confirmation of a justified course of action. The approach taken enables the ethical basis of a difficult decision to become apparent, which in turn makes communication of a particular course of action easier. This strategy pays special attention to the goals of medical care, because reaching a satisfactory decision may depend so much on whether the physician and patient, or the patient's caregivers, share the same objectives.