Recognizing an Ethical Issue
Ethical dilemmas frequently arise in health care. Signs of an ethical dilemma or issue include:
- The "yuck factor": an intuition that something isn't right, or a feeling of moral angst or distress
- You know the "right" thing to do in a situation, but various constraints make doing the right thing difficult.
- You wonder what a good person or professional should do in a given situation.
- Right vs. Right: Two or more values apply to a situation, but these values support diverging courses of action. How do you choose? (i.e., it is right to honor patient wishes, it is also right to protect patients from harm)
- Conflict or uncertainty regarding a patient's quality of life, treatment plan or goals of care
- Limited resources or existing hospital policies or practices make it difficult to satisfy the needs, values and preferences of a patient
Patients, families, trainees, staff and physicians make ethical decisions every day. Most times, they do not need help with these decisions. However, when assistance is needed in making difficult moral choices related to a patient's care, there is help available.
This assistance is provided by the Ethics Consultation Service of Hamilton Health Sciences. Any member of the health care team (including patients and families) may access the Ethics Consultation Service for support.
Ethics is the systematic examination of facts, beliefs, standards and values in determining the rightness or wrongness of decisions and actions. Ethics involves expanding our focus from what is good for me, to consider "the greater good." Ethics is not merely opinion or gut reaction, but involves reasoned deliberation to address the question: "What is the best thing to do, all things considered?"
Ethical decision-making involves reflection on how to make decisions about what should be done in a particular situation. Ethical decision-making usually involves four related questions:
- What should we do? (What options are good or right in this context?)
Why should we do it? (Exploring the values and reasons that support each option.)
- How should we do it? (What plan of action best aligns with these values and reasons?)
- Who should do it? (Who is responsible for making the final decision and enacting and communicating it?)
Clinical Ethics addresses ethical issues and dilemmas that arise in the care or treatment of individual patients. Health care professionals should consider the specific duties they have to these patients, such as those related to confidentiality, disclosure, consent, etc. Some examples of clinical ethics issues include:
- whether to withdraw or withhold treatments for a patient at end of life
- conflict between a team and family regarding the perceived safety of a discharge plan for a patient
- conflict between members of a healthcare team regarding whether to offer a fragile patient an innovative therapy
- uncertainty regarding whether a patient is competent to refuse needed treatment
Organizational Ethics addresses the ethical dimensions of decisions affecting groups of patients, as well as non-patient related issues such as human resources, policies and processes, and resource allocation decisions. Examples of organizational ethics issues include:
- the development of a policy to support organ donation after cardiac death
- the disclosure of a health risk to a cohort of affected patients
- the review of a perceived conflict of interest of a Board member
- the identification of reasonable criteria to inform resource allocation decisions
- the realignment of staff roles to support a new patient care process