SCBC121

BIOMEDICAL ETHICS
Introduction to Decision-Making
Frameworks

Ms Grace Ijoma

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 Outcomes
At the end of this section you will be able to:

• Describe schematically the process of ethical inquiry

• Identify values and how it affects everyday living and prioritize
values (activity work book)
• Differentiate between subjectivity and objectivity (activity
work book)
• Evaluate precursor classic ethical dilemmas (activity work)
• Identify stakeholders and values (activity work)
• Apply decision-making model in reaching a decision on an
ethical issue (activity work)

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 Role of Ethicists in Society
• Ethicists serve as advisers to hospitals and other health
care institutions.
• They also have served as advisers to federal and state
legislatures in the writing of laws concerning:
– the treatment of human subjects in biomedical
experimentation,
– the decision to end life support,
– the use of genetic testing,
– physician-assisted suicide (euthanasia),
– the general conduct of clinical medicine
– life sciences research.
• Bioethics even has become part of the landscape in the
commercial world of science; as they work on the board
of most commercial biotechnology companies.
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 Problems associated with ethical
decision-making

• Individual disagreement on the content of some of

the specific approaches to decision-making
• Disagreements over sets of human and civil rights.
• Different approaches may not all answer the
question "What is ethical?" in the same way.

• Having a method for ethical decision making is

absolutely essential.

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The process of Ethical Inquiry

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 Step 1: Awareness (Question)
Be alert to the ethical components

Ensure that there are no conflicts of interests, that

will cause a bias in your judgement either on your
part or on the part of some of the decision-makers.
such as financial gains, relationship to one of the involved
parties and so on

Identify the stake holders (people involved and

affected).

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 Inputs: Content 1: Scientific
Background
Gather the facts and ensure you have adequate
background knowledge.

Identify areas in the background that you do not

understand and ensure you get clarity.

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 Inputs: Content 2: Ethical
Perspective
You must have a background knowledge of the
major ethical principles ad perspectives.
Seek to clarify the issue / dilemma by considering
the ethical principles which impact the issue.

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 Values
• Your personal values, social and cultural
expectation as well as potential value conflicts
must be identified and explored.

• This is important because individual values

and thought processing differ based on this.
 Contextual Features
 A necessary part of the decision-making framework
 It includes aspects such as:
financial implications of the decision,
cultural (the accepted norms in the environment in
question);
the legal requirement are considered to determine
compliance with existing laws and policies;
 the social and historical context.
 As the bioethicist you would need to ask yourself;
Why this decision is being made in a particular context at this
time?
Are there better contexts for making this decision?
Are the right decision-makers included?
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 Final Checklist for Step 1
 Define the problem
 State the decisions to be made.
 Identify the goals. (short, medium and long term
goals)
 List appropriate laws or regulations.
 List the ethical values at stake.
 Name all the stakeholders (persons who are likely
to be affected
 List what is at stake for each stakeholder.
 Take time to gather all necessary and additional
information.
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 Step 2: Reasoning analysis
 Utilise all information and knowledge available in your
thinking process before prescribing an action as to
what should be done.
 Determine what ethical approach best suits the
problem
 If necessary modify approaches based on available
information
 If you are a part of a committee, have brain-storming
sessions
 Test each of the viable options against the ethical
principles that have been agreed upon.
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 Aspects of Bioethics
• the boundaries of life (e.g. abortion,
euthanasia, cloning, genetic engineering),
• surrogacy,
• the allocation of scarce health care
resources (e.g. organ donation, health
care rationing)
• the right to refuse medical care for
religious or cultural reasons.

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 Final Checklist
 Review ethical questions.
for Step 2
 Demand proof when appropriate.
 Check your assumptions.
 State all possible options.
 List all solutions that have already surfaced
 Produce additional solutions by brainstorming with associates.
 Test each solution against agreed ethical principles and
perspectives
 Note how stakeholders can be affected (loss or gain) by each
solution
 Eliminate unethical options.
 Eliminate solutions that are clearly unethical.
 Eliminate solutions with short-term advantages but long-term
problems.
 Rank the remaining options according to how close they bring
you to your goal, and solve the problem.
 Commit to and implement the best ethical solution.
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 Step 3: Decision (Motivation and
Justification)
 The decisions arrived must be strongly motivated and
responsibility and ownership belongs to all participants.

 However there need to mechanisms put in place for review as

decisions may be revised in light of new evidence.

 It must be noted that that no decision is without its demerits

and as such an avenue must be created.

 This also means the cycle may be repeated.

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 Step 4: Outcome (Action and
Evaluation)
Ethical decisions are followed by implementation either
through Government policies and regulations.

Its initial use must be monitored and constantly tested

against new findings.

If it is found to have loopholes that affect the citizenry, it

may require a review and the cycle begins again.

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