Decison Making and Basic Principles of Ethics

Engineering Model - Health care provider acts as a scientist who deals only with facts. The health care provider gathers information, explains the material to the patient, and then divorces himself from the decision.  Th patient is allowed to make the decision and follow the choice made. This model allows for a high level of patient autonomy and permits no professional determinism. The practitioner would not be allowed to exercise personal values, and if called upon would perform duties that might possibly be personally abhorrent.

Priest Model - Highly paternalistic model, where the health care provider operates from the moral position of knowing what is best for the patient. The patient is led to believe that their opinion is not of the same value as the health care provider. This form of paternalism goes beyond paternalism based on the concept of beneficence, and is more a matter or personal control.

Collegial Model - Health care provider and patient see themselves as colleagues solving the common problem of eliminating illness. Mutual trust and confidence drive the model as the two work toward a common goal in a collegial, harmonious, atmosphere of equality.

Contractual Model - Shared decision-making model where patient is allowed to make decisions and to have control over their own life whenever significant decisions are to be made. Once the decisions are made, the patient relies on the technical experience and skills of the health care providers for most of the decisions in regard to care. Both the health care provider and the patient may reopen the contract and leave the relationship if decisions run contrary to one's value system or are abhorrent to the other.

1. Identify the problem or issue presented in the situation.
2. Identify the individuals involved.
3. Identify the criteria, that is, the ethical principle(s) or rule(s) that apply.
4. Identify who should make the decisions (self or other).
5. Identify the role of the practitioner.
6. Consider the options and alternatives for possible action (to include the short-term and long-term consequences).
7. Make the decision (to include the decision "not to act" which has its own set of potential consequences).
8. Follow the decision to observe its outcomes.

Disclosure: The nature of the condition, the various options, potential risks, the profesional's recommendation, and the nature of consent as an act of authorization.

Understanding: In the U.S., most states require that the physician provide information at a level that a hypothetical reasonable patient would understand.

Voluntariness: No efforts toward coercion, manipulation, or constraint are allowed. The patient must be in a position to practice self-determination.

Competence: Decisions in regard to competence usually take into account experience, maturity, responsibility, and independence of judgment.

Consent: An autonomous authorization of the medical intervention.

• The wrongdoing in question is grave and has created, or is likely to create, serious harm.
• The professional who is contemplating blowing the whistle has appropriate information and is competent to make a judgment about the wrongdoing.
• The professional has consulted others to confirm their information and judgment.
• All other internal resources to resolve the problem have been exhausted.
• There is a good likelihood that the whistle-blowing will serve a useful purpose.
• The harm created by the whistle-blowing is less than the harm doen by a continuation of the wrongdoing.

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References:

Edge, Raymond S. (1994). The Ethics of Health Care: A Guide for Clinical Practice. Delmar Publishers, Inc.

Veatch, Robert (1981). Theory of Medical Ethics. Masik Books Inc.

St. Hill, Halcyon (1997). Notes from lecture "Ethical Applications in Professional Practice"