The patient’s previous request must be given weight and, when the benefits, burdens and risks are finely balanced, will usually be the deciding factor. In working towards a consensus, you should take into account the different decision-making roles and authority of those you consult, and the legal framework for resolving disagreements. On this page, we aim to acknowledge existing knowledge, and provide additional information and key considerations for ethical decision-making, to help support Macmillan professionals and the wider cancer workforce during this time. The doctor may recommend a particular option which they believe would provide overall benefit for the patient. Furthermore, encourage others to use organizational resources to address challenging ethical issues. In circumstances in which there is no legal proxy with authority to make a particular decision for the patient, and the doctor is responsible for making the decision, the doctor must consult with members of the healthcare team and those close to the patient (as far as it is practical and appropriate to do so) before reaching a decision. As the following case in Zambia illustrates, the Rapid Ethical Decisionmaking Model, long used in emergency medicine, is a useful tool in such circumstances. Ethical Decision-Making Model Ethical decision-making at an individual level and one’s ethical behavior can be viewed in three primary steps using an ethical decision-making model. The Practitioner's Guide to Ethical Decision Making. November 2016 (revised). In these circumstances you will have legal authority to make decisions about treatment, under the Adults with Incapacity (Scotland) Act 2000 (subject to issuing a certificate of incapacity), or the Mental Capacity Act 2005(England and Wales), or the common law in Northern Ireland. Utilizing the ethical principles of autonomy, beneficence, nonmaleficence, fidelity, justice, and paternalism as outlined by the American Nurses Association (ANA) provides us with a firm foundation for ethical decision making. Making good ethical decisions requires a trained sensitivity to ethical issues and a practiced method for exploring the ethical aspects of a decision and weighing the considerations that should impact our choice of a course of action. The positive differences our work had on stakeholders last year. February 1997 (revised) Create a culture that fosters ethical clinical and administrative practices and ethical decision making. The most convenient way to get support. Written and verbal advance refusals of treatment that are not legally binding, should be taken into account as evidence of the person’s wishes when you are assessing whether a particular treatment would be of overall benefit to them. August 1993 If disagreement arises between you and the patient’s legal proxy, those close to the patient, or members of the healthcare team, about what would be of overall benefit, you must take steps to resolve the disagreement (see paragraphs 47 - 48). In this way, Step Seven reinforces the importance of ethical discernment before, during, and after the decision-making process and fosters the ability of leaders to make well-reasoned decisions in a consistent manner. The doctor explains the options to the patient, setting out the potential benefits, burdens and risks of each option. You should explain how decisions about the overall benefit of the treatment would be influenced by the patient’s current wishes if they lose capacity (see the model in paragraph 16). Ethical frameworks are analytical tools that are designed to assist physicians and other involved healthcare workers in complex moral decision-making situations. If the patient has made an advance decision or directive refusing a particular treatment, the doctor must make a judgement about its validity and its applicability to the current circumstances. The factors you should consider are different in the four UK countries, reflecting differences in the legal framework (see the legal annex). Ethical decision making models for professional counselors. HTA started in the 1970s with the primary interest of ensuring the effectiveness and safety of new health technologi… It is incumbent upon healthcare executives to lead in a manner that sets an ethical tone and models ethical behavior for their organizations. A valid advance refusal that is clearly applicable to the patient’s present circumstances will be legally binding in England and Wales24 (unless it relates to life-prolonging treatment, in which case further legal criteria must be met). An explanatory case study is provided along with sample dilemmas to illustrate how an ethical decision-making model might be used within the school setting. If a patient has lost capacity to decide, you must provide any treatment you assess to be of overall benefit to the patient. November 2007 (revised) Making Decisions. Most frameworks are step-by-step plans that can be followed chronologically during moral case deliberations. In such cases, you should start from a presumption that the patient had capacity when the decision was made, unless there are grounds to believe otherwise. To this end, healthcare executives should: Approved by the Board of Governors of the American College of Healthcare Executives on November 14, 2016. 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