Bioethical Decision Making Model
1. Define the dilemma: Use your own words to describe the problem. State it in a way
that others can quickly understand your dilemma. Review
2. Identify the medical facts: Describe the facts that are relevant to the dilemma.
3. Remember that the diagnosis and prognosis are medical facts.
4. Identify the non-‐medical facts (patient and family, external influences):
a. Patient and family facts such as culture, religion, social, economic, the
existence of an Advance Healthcare Directive, verbal preferences made by
the patient, how the patient lived his/her life.
b. Those that you discuss should be relevant to the situation.
5. External influences include: organizational policies, federal and state laws, practice
acts, code of ethics. These should be relevant to the situation.
6. For both step 2 or 3, separate the facts from the assumptions: Sometimes all
healthcare professionals allow assumptions to guide their decision-‐making. These
must be identified so that these assumptions do not interfere with the process.
7. Identify items that need clarification. Your paper should identify facts that you need
to clarify. When initially discussing an ethical situation, it is not unusual to not have
all of the answers.
8. Identify the decision makers: Is the patient an adult competent to make their own
choices? Is the patient a child who is old enough to have a say in the decision. If the
patient cannot make their own decision, who is the decision maker? How was this
person selected?
9. Review the underlying ethical principles: Review which ones and why they apply t
this particular case: beneficence, nonmaleficience, veracity, fidelity, autonomy and
justice.
10. Define alternatives: One-‐Way to proceed may be apparent at this point. However,
sometimes there are different choices. They should be addressed identifying the
benefits and burdens for doing one thing versus the other.
11. Follow-‐up: Define the process to be used with the chosen alternative.
Reference Source: Levine-‐Ariff, J. & Groh, D.H. (1990). Creating an Ethical Environment.
Nurse managers’ bookshelf a quarterly series: 2:1. Baltimore, Maryland: Williams & Wilkins.
41-‐61.
