 GUIDES FOR ETHICAL DECISION MAKING

1. Gather data and identify conflicting moral claims

a) What makes this situation and ethical problem? Are there conflicting
obligations, duties, principles, rights, loyalties, values, or beliefs?
b) What are the issues?
c) What facts seem most important?
d) What emotions have impact?
e) What are the gaps in information at this time?
2. Identify Key Participants
a) Who is legitimately empowered to make this decision?
b) Who is affected and how?
c) What is the level of competence of the person most affected in relation to the
decision to be made?
d) What are the rights, duties, authority, context and capabilities of participants?
3. Determine moral perspective and phase of moral development of key participants
a) Do participants think in terms of duties or rights?
b) Of the parties involved exhibit similar or different moral perspectives?
c) Where is the common ground? The differences?
d) What moral principles are important to each person involved?
e) What emotions are evident within the interaction and each person involved?
f) What is the level of moral development of the participants?
4. Determine the desired Outcomes
a) How does each party describe the circumstances of each outcome?
b) What are the consequences of the desired outcomes?
c) What outcomes are unacceptable to one or all involved?
5. Identify Options
a) What options emerge through the assessment process?
b) How do alternatives fit the lifestyle and values of the persons affected?
c) What are the legal considerations of the various options?
d) What alternatives are unacceptable to one or all involved?
e) How are alternatives weighed, ranked, and prioritized?
6. Act on the Choice
a) Be empowered to make difficult decisions
b) Give yourself permission to set aside less acceptable alternatives.
c) Be attentive to the emotions involved in this process.
7. Evaluate Outcomes and actions
a) Has the ethical dilemma been resolved?
b) Have other dilemmas emerged related to the action?
c) Are further actions required?

 PRINCIPLES OF BIOETHICS
1. Respect for Autonomy:
Put most simply, autonomy affirms that we ought to be the authors of our own
fate, the captain of our own ship. Autonomy emphasizes the personal responsibility we
have for our own lives; the right to choose who we wish to be, to make our own decisions
and to control what is done to ourselves. Autonomy includes the capacity to deliberate
about a proposed course of action as well as the ability to actualize or carry it out.

2. Nonmaleficence: 
Nonmaleficence derives from one of the most traditional of medical guidelines
that goes back to the time of the Hippocratic oath: First of all, do no harm. The principle
of nonmaleficence imposes the obligation not to harm someone intentionally or directly.
Clearly there are many instances in the field of healthcare where individuals are exposed
to risks of harm, such as radiation or chemotherapy treatment. The principle of
nonmaleficence is not necessarily violated if a proper balance of benefits exists; that is, if
the harm is not directly intended but is rather an unfortunate side effect of attempts to
improve a person's health or, at the very least, to provide relief from the burden of pain.

3. Beneficence: 
Beneficence may be described as the positive expression of nonmaleficence. This
principle highlights that we have a positive obligation to advance the healthcare interests
and welfare of others, to assist others in their choices to live life to the fullest.
Beauchamp and Childress have described beneficence as a way of ensuring reciprocity in
our relationships; i.e. we have a responsibility to help others because we have ourselves
received benefits. The risk of harm to oneself represents a legitimate limit to our
obligation to be beneficent.
4. Justice: 
In relation to healthcare, justice may be described as the allocation of healthcare
resources according to a just standard. There are two basic types of justice. Comparative
justice involves balancing the competing claims of people for the same health care
resources. It is only necessary because of the fact that health funding is not unlimited if
there was plenty of everything, there would be no need to allocate or prioritize resources.
In comparative justice what one receives is determined by one's particular condition and
needs. Distributive justice, on the other hand, determines the distribution of health care
resources by a standard that is independent of the claims of particular people. For this
reason it may also be called 'noncomparative' justice. Distribution is determined
according to principles rather than individual or group need.

5. Double effect:
is a set of ethical criteria for evaluating the permissibility of acting when one's
otherwise legitimate act (for example, relieving a terminally ill patient's pain) will also
 cause an effect one would normally be obliged to avoid (for example, the patient's
death.) 

This set of criteria states that an action having foreseen harmful effects practically
inseparable from the good effect is justifiable if upon satisfaction of the following:

 the nature of the act is itself good, or at least morally neutral;

 the agent intends the good effect and not the bad either as a means to the good or as an
end itself;
 the good effect outweighs the bad effect in circumstances sufficiently grave to justify
causing the bad effect and the agent exercises due diligence to minimize the harm.

6. Veracity:
Principle of telling the truth from both the patient and the health care practitioner
7. Role of fidelity:
Related to the concept of faithfulness and the practice of keeping promises
8. Totality:
An individual can not dispose of their organs or destroy their capacity unless it is
for the greater good of the entire body 
9. Stewardship:
The Principle of stewardship explains that God is the creator of the earth and our
Human body;we our made to take care of them therefore we dont have the right to
destroy or used it for our immoral act...we must be morally responsible for God's creation
for we our just the caretaker of it

10. Confidentiality:
Binds the HCP to hold on strict secrecy those things learned about the client in the
course of health practice

 INFORMED CONSENT

Informed consent is the process by which a fully informed patient can participate
in choices about her health care. It originates from the legal and ethical right the patient
has to direct what happens to her body and from the ethical duty of the physician to
involve the patient in her health care.

 ELEMENTS OF INFORMED CONSENT

 1. Disclosure – nature of the condition, the various options, potential risks, the
professionals recommendation, and the nature of the consent as an act of
authorization
2. Understanding- HCP should provide information at the level that a hypothetical and
reasonable patient would understand
3. Voluntariness- no efforts towards coercion, manipulation or constraints are allowed.
The patient must be in the position to practice self-determination
4. Competence- decisions in regard to competence usually take into account experience,
maturity, responsibility, and independence of judgment.
5. Consent- consent is the autonomous authorization of the medical intervention.

 CLASSIFICATIONS OF CONSENT

o Oral consent- consent by words of mouth but binding as written consent since
there is no legal rule that consent must be provided in written form

o Implied consent- used in cases in which immediate action is required to save a

patient from death or permanent impairment of health

o Written consent- preferred form of consent; provides a legal, visible proof of the
patient’s intentions in the matter

o General consent- are worded in such a way as to permit the health care providers
to perform almost any medical or surgical or procedure that is deemed medically
necessary in the patient’s best interest. However, they are not designed and do not
provide authorization for specific high risk procedures or treatments

o Special consent- consent for high risk procedures or treatments that expose the
patient to an unusual risk

RIGHTS OF PATIENTS
1. Right to appropriate medical care and humane treatment
2. Right to informed consent
3. Right to privacy and confidentiality
4. Right to information
5. Right to choose HCP and facility
6. Right to self-determination
7. Right to religious belief
8. Right to medical records
9. Right to leave a hospital or health care institutions
10. Right to refuse participation in medical research
 11. Right to correspondence and to receive visitors
12. Right to express grievances
13. Right to informed of his rights and obligations as a patient

OBLIGATIONS OF THE PATIENT

1. Know rights
2. Provide accurate and complete information
3. Report unexpected health changes
4. Understand the purpose and cost of the treatment
5. Accept consequences of own informed consent
6. Settle financial obligations
7. Relation to others
8. Exhaust grievances mechanisms