The document discusses a four component model for ethical analysis of clinical cases. It outlines the four components as medical indications, patient preferences, quality of life considerations, and contextual features surrounding the case. It then describes a five step ethical decision making process involving collecting data, stating the dilemma, considering choices of action, analyzing the pros and cons, and making a decision. The goal is to help nurses make ethical decisions in situations without clear answers.

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2. 2

3. • Objective
• Rationale for the Model
• Four Component Model for Ethical Analysis of Clinical
Cases
• The Ethical Decision Making Process in Ethics
• Summery
• Reference
• Acknowledgment
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4. Objectives:
• Discuss the four components model of clinical
analysis of clinical cases.
• Use the model for ethical decision making and case
analysis in any ethical dilemma.
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5. • Ethics is not added to a clinical case by injecting
into it new facts, but is arises out of the facts
and values imbedded in the case itself.
• Ethical aspects are seen in the medical
benefits, the preference of the patient, the
quality of the patient’s life, and the relation
between care of the patient, family, social,
economic, and legal circumstances surrounding
the case.
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6. Components are;
• Medical Indications.
• Patient Preferences.
• Quality of life considerations.
• Contextual/related/ features surrounding the
case.
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7. • Patient history:- diagnosis of the patient,
treatment of the patient, pathologic condition,
prognosis, e.t.c.
• What are the goals of those interventions?
• What are the possible benefits of intervention-
realistic? Probability of success?
• Moral dimension-Beneficence and non-
maleficence. 7Habtemariam & Tingrt

8. • A clear view of the possible benefit of
intervention is the first step in assessing
the ethical aspect of the care.
• “I will use treatment to help the sick
according to my ability and judgment
but never to injury and wrong doing”-
Hippocrates.
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9. • Other Hippocrates imperatives;
•“Be of benefit and do no harm”.
•“Risks should be balanced by benefit”.
• In sum, how can this patient be
benefited by medical or nursing care
and how can harm be balanced?
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10. • Based on the patient own values and personal
assessment of benefits and burdens are ethically
relevant.
• What are the patient’s goals?
• What does the patient want?
• Has the pt. get enough information?
• Does the pt. comprehend? Is the pt. consenting
voluntarily (with out coerce from external body like
family, health professional, religious leader, e.t.c.)?
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11. • Moral dimensions- arising within this
component is consideration of
respect for the principle of
autonomy.
• Don’t start with moral dimension
which cause confusion but with the
story of the patient. 11Habtemariam & Tingrt

12. • Has the patient been informed of
benefits, risks, understood this
information and given consent?
• Is the patient mentally capable and
legal competent? Is there an
evidence that show capacity of the
patient? 12Habtemariam & Tingrt

13. • If competent, what is the patient stating
about the preference for treatment?
• If incapacitated, who is the appropriate
surrogate?
• Is the surrogate using appropriate
standards for decision making?
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14. • Is the patient unwilling or unable to
cooperate with medical treatment? If
so why?
• In sum, is the patient right to choose
being respected to the extent
possible in ethics and law?
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15. • Any injury or illness threatens persons with
actual or potential reduced quality of life,
manifested in the s/s of their disease.
• The objective of the medical intervention is to
restore, maintain or improve quality of life.
• The topic quality of life must be raised. Quality of
life (it is personal)? Principle of beneficence and
non-maleficence and respect for autonomy.
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16. • Are there biases that might prejudice
the providers evaluation of the patient
quality of life?
• Is there any plan and rationale to
forgo treatment?
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17. • External factors.
• Persons, institutions, financial, and social
arrangements have positive or negative influence on
the patient care/interest of others.
• These decisions have psychological, emotional, legal,
financial, scientific, educational, religious impact on
others.
• Moral dimension- Justice and rights of various
participants- Dax’s case.
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18. • Are there financial and economic factor?
• Is there any conflict of interest on the part of
providers?
• Are there family issues?
• Are there religious factor?
• Are there problems of resource allocation?
• How does the law affect the decision?
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19. • Method of analysis begins not with
principles and rules but with the
actual feature of the case.
• Refer to relevant principles and rules
as they arise in the discussion of the
topic.
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20. 20Habtemariam & Tingrt

21. • Nurses by definition are problem solver.
• One of the important problem solving
tool is the nursing process.
• The goal of ethical decision making
process is to enable nurses to determine
right or wrong in situations without clear
demarcation. 21Habtemariam & Tingrt

22. Step One- Collect, Analyze, and
Interpret the data.
Patient and family wishes, extent of
physical and emotional problems
causing the dilemma.
• Understand how mentally competent
the pt. is to make a decision.
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23. • Example
• Whether or not to resuscitate a hospital pt with terminal
illness/disease?
• What the pt desires are? and what the family thinks
about the situation?
• Institution policy related to no resuscitation.
• Issues how mentally competent the patient to make no
resuscitation decision.
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24. Step Two-State the dilemma.
Reduce the dilemma into a statement
of one or two that resolves around the
key ethical issues.
Patient wish is unequivocal (clear).
Patient wishes is the first.
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25. If patient is unresponsive- followed by
family’s decision.
Question if family wish conflict with
patient.
It involves a question of conflicting
rights or basic ethical principles.
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26. Step Three- Consider the Choices of
Action.
• List all possible courses of action that
can resolve the dilemma without
considering their consequences.
• Brainstorming activity in which all
possible course of action are considered. 26Habtemariam & Tingrt

27. • Example;
•Avoid dealing with the situation.
•No resuscitating the patient at all.
•Resuscitate the patient by the nurse
despite the physician regimen.
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28. • Options;
• Report the problem to the supervisor.
• Attempting to clarify the question with the
family.
• Attempting to clarify the question to the patient.
• Confronting the physician about the question.
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29. Step 4- Analyze the advantage (pros) and
disadvantages (cons) of each course of
action.
Step 5- Make decision – the most difficult
part.
No every one will be pleased with the 29Habtemariam & Tingrt

30. • Ethical dilemmas produce different
opinions.
• The best decision is based on sound
ethical decision making process.
• Patient’s wishes will always
supersede independent decisions.
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31. • Collaborative decision-making is
the ideal and tends to produce fewer
complications on the long-term
resolution that involves patient,
physician, nurse and family.
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32. The goal of ethical decision making process is to enable
nurses to determine right or wrong in situations without
clear demarcation.
The Ethical Decision Making Nursing Process in Ethics:
Step One- Collect, Analyze, and Interpret the data.
Step Two-State the dilemma.
Step Three- Consider the Choices of Action.
Step 4- Analyze the advantage (pros) and disadvantages
(cons) of each course of action.
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33. •Questions
•Comments
•Enhancement
Habtemariam & Tingrt 33
Don’t be shy

34.  Schumann JH, Alfandre D. Clinical ethical decision making: the four topics approach. Semin
Med Pract
2008;11:36–42. Available at www.turner-white.com
 Schumann JH, Alfandre D. Clinical ethical decision making: the four topics approach. Semin
Med Pract
2008;11:36–42. Available at www.turner-white.com
 Alexander, L., & Moore, M. (2015). Deontological ethics. In E. N. Zalta (Ed.), The
Stanford Encyclopedia of Philosophy. Stanford, CA: Stanford University.
http://plato.stanford.edu/archives/spr2015/entries/ethics-deontological
 Woody, R. H. (2013). Legal self-defense for mental health practitioners. New York, NY:
Springer
 Kirsch NR. Ethical decision making: application of a problem-solving model. Top Geriatr
Rehabil 2009; 25(4): 282–91.
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35. • First we would like to express our heartfelt gratitude to
WU CMHS for giving us this chance to enhance our
knowledge and in promotion of our ongoing profession.
• Secondly we would like to thank our instructor Dr.
Caridad Sanchez Olis for sharing us her deep
knowledge, experience and expertise.
• Last but not least we would like to thank our family and
friends in helping us in idea and material during our entire
work.
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36. 36Habtemariam & Tingrt