"Ethical workup" guides clinical decision making.

Abstract

Shared decision making, along with an explosion in costs and the alternatives associated with the technological revolution in medicine, has moved medical ethics from the status of a professional etiquette to that of a rigorous new discipline. A model for an "ethical workup," which medical professionals can use in healthcare setting, has four phases: expository, rational, volitional, and public. The expository phase includes medical factors, which are the most important for determining the right or wrong thing to do for a patient; ethical factors, which involve the interests, intuitions, and feelings of all those involved in a case; and socioeconomic factors, in which costs that create burdens on others become important, and in some cases decisive, considerations. The rational phase includes medical ethics categories, which determine the type of case one is facing; principles and moral guidelines, which justify decisions; and legal decisions and professional codes, which synthesize accepted wisdom about appropriate ethical behavior. The volitional phase includes ordering goods and values, which involves establishing priorities and weighing certain factors; ordering the principles, which reflect personal or institutional character and is influenced by religious and philosophical beliefs; and decision making, in which professionals consider a decision's impact on their profession, their facility, and themselves. The public phase includes making assumptions explicit, which means professionals should try to recognize underlying beliefs, admit their influence on preferred positions, and be sensitive to other perspectives and preferences; correlating initial feelings about right and wrong with the reasons supporting a decision; and organizing reasons for public communication.