Application of Principles

Question 1

What is an ethical dilemma?

Answer 1

A situation that requires a moral choice between mutually exclusive courses of action

Question 2

What is the principled approach? (Four values, in order)

Answer 2

Autonomy
Non-maleficence
Beneficence
Justice

Question 3

What is the structured approach to gathering data?

Answer 3

Collect info well
ID key questions
ID guiding values
Brainstorm alternatives
Judge each option according to values
Make a decision
Live with it, learn from it

Question 4

What are the four main topics of the structured approach?

Answer 4

Clinical issues/medical indications
Patient preferences
Quality of life/death
Contextual features

Question 5

What are some clinical issues/medical indications to take into consideration with a structured approach?

Answer 5

Diagnosis
Treatment available
Prognosis for each treatment/non-treatment
Risk/benefit of each treatment/non-treatment
Uncertainties attached to outcomes
What is the best clinical judgement

Question 6

What are some considerations related to patient preference when using the structured approach?

Answer 6

What does the patient want?
Unencumbered/encumbered
Do the wishes reflect principles of informed consent?
Who is the alternative decision maker?
Is the alternative decision maker competent?
What does the health care professional want?

Question 7

What are some considerations related to quality of life/death when using the structured approach?

Answer 7

Quality of life as determined by the patient
What kind of life/death with/without treatment?
Care giver views of quality of life
How do we rate the quality of life/death
Is the quality of life “less than minimal”

Question 8

What are some contextual features to take into consideration when using the structured approach?

Answer 8

Whose other interest are affected?
What costs are involved?
Is there research/teaching influence?
Social support?
Social, legal & institutional circumstances influencing the decision

Question 9

What are some aspects of casuistry involved in the structured approach?

Answer 9

Application of biomedical principles to moral questions in order to resolve ethical dilemmas.
Includes drawing a comparison between similar cases.
Moral knowledge is acquired over time through the analysis of concrete cases.
Ex. Jonsen/seigler/winslade model

Question 10

What are the three steps of casuistry?

Answer 10

1. Complete description of case with possible maxims using the 4 topics:
   - Clinical issues
   - Patient preference
   - Quality of life/death
   - Contextual features
2. Identify relevant/similar cases
   - Determine if the best course of action was clear from the other relevant situations
   - Use this knowledge to guide the decision
3. Make a decision based on the outcome of step 1 & 2
   - Live with the results of the decision
   - Learn from the experience

Question 11

What is the narrative approach?

Answer 11

Tell the story of the situation.
Come to know what to do by telling the story.
Ex. Rodney, Storch, and Starzomski