The 7-Step Moral Reasoning Model

Scott Rae
Moral
Choices
Thursday 17 May 2012

MAKING
ETHICAL
DECISIONS
Chapter
Thursday 17 May 2012 4
A model for making moral
decisions
Rae suggests the following
procedure for making moral
decisions - within this his work is
not to get you to the “right” answer
but to help you ask the right
questions in your ethical
deliberation. Rae says his model is
free from cultural, ethnic and
religious background biases -
though it is consistent with the
bible and uses biblical principles, it
is not a distinctively “Christian
model”.
A model for making moral
decisions
It is oriented towards virtues and
principles with consideration of
consequences as a supporting role.
Many moral dilemmas or issues are
not addressed clearly, if at all, in
the Bible. So we apply principles
and virtues to each - the problem
then becomes which to apply and
how.
Often weighting needs to be given to
elements within a problem. There is
a danger of trying to oversimplify
things by claiming to be biblical.
What is an ethical dilemma?
(How would I know if I were facing
one?)
An ethical dilemma is
a conflict between two
or more value - or
virtue driven
interests.
You have to identify the parties in
the conflict, what their interests
are, and what virtues and values
underlie those interests.
There follows Rae’s list of elements
1. Gather the facts
The simplest way of clarifying an

ethical dilemma is to make sure
the facts are clear. Ask:
Do you have all the facts that
are necessary to make a good
decision?
What do we know?
What do we need to know?
In this light it might become clear
that the dilemma is not ethical
but about communication or
strategy.
2. Determine the ethical issues
Ethical interests are stated in terms of
legitimate competing interests or
goods. The competing interests are
what creates the dilemma. Moral values
and virtues must support the
competing interests in order for an
ethical dilemma to exist. If you cannot
identify the underlying values/virtues
then you do not have an ethical
dilemma. Often people hold these
positions strongly and with passion
because of the value / virtue beneath
them.
3. Determine what virtues / principles have a
bearing on the case
In an ethical dilemma certain

values and principles are central to
the competing positions. Identify
these. Determine if some should
be given more weight than others.
Ask what the source for the
principle is - constitution, culture,
natural law, religious tradition...
These supplement
biblical principles.
4. List the alternatives
Creatively determine possible

courses of action for your
dilemma. Some will almost
immediately be discarded but
generally the more you list
the greater potential for
coming up with a really good
one. It will also help you
come up with a broader
selection of ideas.

5. Compare the alternatives with the
virtues / principles
This step eliminates alternatives as
they are weighed by the moral
principles which have a bearing on the
case.
Potentially the issue will be resolved
here as all alternatives except one are
eliminated. Here you must satisfy all the
relevant virtues and values - so at least
some of the alternatives will be
eliminated (even if you still have to go
on to step 6). Often here you have to
weight principles and virtues - make
sure you have a good reason for each
6. Consider the consequences
If principles have not yielded

a clear decision consider the
consequences of your
alternatives. Take the
alternatives and work out
the positive and negative
consequences of each.
Estimate how beneficial each
+ve and -ve consequence is
- some might have greater
weight than others.

7. Make a decision
Ethical decisions rarely have

pain-free solutions - it might
be you have to choose the
solution with the least
number of problems / painful
consequences.
Even when making a
“good” decision you might
still lose sleep over it!

Applying the model: A case study
This has been adapted from Rae’s
original. It is about medical
ethics.
-67 year old Indian woman
diagnosed with a form of
cancer which is usually treated
by chemotherapy.
-at admission she is fully competent
and able to make her own
decisions
-she knows something is wrong with
her and appears fearful and anxious
about what getting well might
- she lives with her son and his
wife
- the family appear happy
-the son has taken responsibility
for her as her husband has died
-the son translates for her with
almost all information
needing translating
-the son does not want her to
know anything more than the
bare minimum about the
treatment as he fears she will give
up on life and resign herself to
dying
-the son is strongly motivated by
-The patient does not know her
full diagnosis or the full effects
of the chemotherapy
-she knows she is sick and
treatment will make her feel sick
to her stomach as well as losing
her hair
You are the doctor -
what would you do?
Follow the family’s wishes (based
on their culture)?
Decide the patient needs to know
what is happening - tell her even
if it increases her fear (and
alienates you from the family)
1.Gather the facts - go back
over the information given and
write down all the facts.
2.Determine ethical issues -
patient autonomy, including giving
consent for treatment versus what
a caring family think is best for the
patient.
In such a situation nurses are bound
by what the doctor decides - yet
still they have to solve the problem
of obedience to the doctor with
the patients integrity in being able
to give informed consent.
3. Determine what values /
principles have a bearing
on the case
- the right of the patient to give
informed consent -
chemotherapy is a very invasive
treatment. This is recognised by
law, the person has a right to
control what happens to their
body. Such dignity comes from
being made in the image of
God.

- the obligation of the medical
team to act in the patients best
interest. They should do good
for the patient whenever they
can - to act with compassion
(the family will also claim to be
acting in compassion)

-respect for the family’s wishes
and culture. Humility is the virtue
which says the doctors must
realise not all they think is best.
How heavily do they respect
family / cultural values? The
family may think they are taking
some of the burden for their
mother by making the decisions
and not telling her everything -
this caring is highly valued by
them
-also the law regarding informed
consent must be applied, and
nursing staffs obedience to
doctors
4. List the alternatives
-attempt to convince the
family of the seriousness of the
treatment and why she needs
to know
-call an ethics committee
conference to discus the case
and try to convince the
family to tell her
These two options should be
discussed prior to any
further treatment.
-override the family’s wishes
and tell the patient of her
condition and the treatment
-continue to follow the family’s
wishes, the son continues to
translate and she knows
nothing more
-wait for the patient to ask
questions about treatment
and then encourage her to
ask very direct questions of
her family and doctor
(another translator is required
here)
-bring in another translator
and ask the woman if she
wants to know the details of
all that is happening - likely to
cause cultural offense to the
5. Compare the
alternatives with the
virtues / principles
-initially try to pursue all
possibilities of talking with the
family and the doctors trying
to get them to disclose the
information themselves
-if above is unsuccessful you can
either withhold or disclose
information to the patient
-use another translator and tell
the patient (or ask if she
wants to know full details of
what is going on - this
alternative respects her
-she can make it clear at this
time she wants her son to make
the decisions for her - this
would satisfy most important
principles / virtues
-if she chooses to know then it
is her who is challenging the
culture, yet she retains her
dignity and has full
information
-if nurses are unhappy with
what is happening the most
viable option is probably
for them to be requested
to be removed from the
6. Consider
the
consequences
If you disclose the
information directly
possible consequences
include;
-family feel alienated,
cultural values have been
violated
-family may take patient
to another hospital
- patient may “give up”
-patient might be happy
they are finally being
If you continue withholding
information possible
consequences include;
-patient continues to be fearful
and anxious about the
treatment
-patient finds out somehow
and trust is compromised
-family are happy cultural
values are being respected

If you ask the patient if she wants
to know through another
translator, possible consequences
include;
-family are unhappy at
disrespect for their
cultural values
-patient gets to speak for herself
and make own decisions
-she can choose to let her son
continue making the decisions,
both law and culture are
satisfied here
-patient will be relieved as she
knows her wishes have been
respected
7. Make a decision
-we have had to think through our
ideas of respect for family and
culture
-how far should we go in respecting
this cultural approach, is the patients
best interest compromised, is her
dignity as an individual respected?
Rae suggests, “Here it seems the
alternative that involves asking
the patient if she wants to know
the details of her situation
satisfies most of the virtues and
values a t stake and produces the
best balance of consequences

The 7-Step Moral Reasoning Model

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The 7-Step Moral Reasoning Model

Uploaded by

Copyright:

Available Formats

Scott Rae

Thursday 17 May 2012

The simplest way of clarifying an

In an ethical dilemma certain

Creatively determine possible

Thursday 17 May 2012

If principles have not yielded

Thursday 17 May 2012

Ethical decisions rarely have

Thursday 17 May 2012

Thursday 17 May 2012

Thursday 17 May 2012

Thursday 17 May 2012

You might also like