ETHICAL DECISION-MAKING (part 1)
[These reflections were first drafted 1997 when I prepared -- in collaboration with Fidelma Rigby, MD, a Maternal-Fetal Medicine specialist at LSU’s School of Medicine – a response to an invitation from the American College of Obstetricians and Gynecologists’ Technical Bulletin Committee to submit a revision of the committee’s 1989 bulletin entitled ‘Ethical Decision-making in Obstetrics and Gynecology’. I have subsequently used these reflections in numerous didactic sessions with physicians (in training) and with nurses.]
Values, Morals, and Ethics
Each individual forms a personal sense as to what is of ultimate value and what is of lesser value. These core values serve as a prism through which information is interpreted before being applied to life’s decisions. Certain relationships, experiences, circumstances, and objects are thus regarded to be of such importance to an individual that s/he is prepared to suffer great loss rather than to violate them.
Morals are common ideas about what is right or wrong, about what ought or ought not to be done. Such views are taken for granted in daily activities and can usually be acted upon safely without much conflict. However, some situations require a collective judgment from a number of individuals with competing goals or divergent viewpoints. In order to avoid a harmful abuse of power (e.g., a physician attempting to manipulate the transfer of information in order to steer a patient into agreement or a patient threatening a lawsuit), a reflective approach to decision-making -- i.e., ethics -- is necessary.
Ethics has to do with serious reflection on and the determination of what ought to be done in a given situation, all things considered. Some differences in judgment can be traced to variations in reasoning patterns. For instance, one person may be very logical, deductive, abstract. Another person may be more intuitive, pragmatic, affective. Other differences in judgment can be traced to variations in what is taken into consideration and the value given to what is taken into consideration. For instance, one physician may support a woman in her desire to obtain treatment for her infertility, while another physician -- the “gate-keeper” for the patient’s health maintenance organization -- may be most concerned with providing cost-effective primary care for a large number of patients. Before a thorough analysis of options can be undertaken, the participants in the decision-making process must respect (L., to look again) each other enough to listen carefully in order to recognize and understand these differences.
An ethical dilemma arises when compelling value-based justifications exist for two or more conflicting courses of action. On initial examination, the possible choices may appear equally strong. For example, a physician caring for a patient who is refusing surgical treatment of a large pelvic mass may be torn between promoting what appear to be the patient’s best medical interests and respecting the patient’s personal choice to refuse therapy.
Ethics, as a discipline within medicine, involves three steps. First, a framework is established for analyzing differing points of view. Second, a determination is made as to whose interests are most critical in the situation. Third, a course of action is adopted that promotes those interests with the least imposition of compromise or harm on those affected by the decision.
[These reflections were first drafted 1997 when I prepared -- in collaboration with Fidelma Rigby, MD, a Maternal-Fetal Medicine specialist at LSU’s School of Medicine – a response to an invitation from the American College of Obstetricians and Gynecologists’ Technical Bulletin Committee to submit a revision of the committee’s 1989 bulletin entitled ‘Ethical Decision-making in Obstetrics and Gynecology’. I have subsequently used these reflections in numerous didactic sessions with physicians (in training) and with nurses.]
Values, Morals, and Ethics
Each individual forms a personal sense as to what is of ultimate value and what is of lesser value. These core values serve as a prism through which information is interpreted before being applied to life’s decisions. Certain relationships, experiences, circumstances, and objects are thus regarded to be of such importance to an individual that s/he is prepared to suffer great loss rather than to violate them.
Morals are common ideas about what is right or wrong, about what ought or ought not to be done. Such views are taken for granted in daily activities and can usually be acted upon safely without much conflict. However, some situations require a collective judgment from a number of individuals with competing goals or divergent viewpoints. In order to avoid a harmful abuse of power (e.g., a physician attempting to manipulate the transfer of information in order to steer a patient into agreement or a patient threatening a lawsuit), a reflective approach to decision-making -- i.e., ethics -- is necessary.
Ethics has to do with serious reflection on and the determination of what ought to be done in a given situation, all things considered. Some differences in judgment can be traced to variations in reasoning patterns. For instance, one person may be very logical, deductive, abstract. Another person may be more intuitive, pragmatic, affective. Other differences in judgment can be traced to variations in what is taken into consideration and the value given to what is taken into consideration. For instance, one physician may support a woman in her desire to obtain treatment for her infertility, while another physician -- the “gate-keeper” for the patient’s health maintenance organization -- may be most concerned with providing cost-effective primary care for a large number of patients. Before a thorough analysis of options can be undertaken, the participants in the decision-making process must respect (L., to look again) each other enough to listen carefully in order to recognize and understand these differences.
An ethical dilemma arises when compelling value-based justifications exist for two or more conflicting courses of action. On initial examination, the possible choices may appear equally strong. For example, a physician caring for a patient who is refusing surgical treatment of a large pelvic mass may be torn between promoting what appear to be the patient’s best medical interests and respecting the patient’s personal choice to refuse therapy.
Ethics, as a discipline within medicine, involves three steps. First, a framework is established for analyzing differing points of view. Second, a determination is made as to whose interests are most critical in the situation. Third, a course of action is adopted that promotes those interests with the least imposition of compromise or harm on those affected by the decision.