by Michael McDonald
1.1.
Be alert; be sensitive to morally charged situations. Look behind
the technical requirements of your job to see the moral dimensions. Use
your ethical resources to determine relevant moral standards [see Part
III]. Use your moral intuition.
1.2.
Gather information, and don't jump to conclusions. While accuracy is
important, there can be a trade-off between gathering more information
and letting morally significant options disappear. Sometimes you may
have to make supplementary assumptions because there is insufficient
information and no time to gather more information.
1.3.
State the case briefly with as many of the relevant facts and
circumstances as you can gather within the decision time available.
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What
decisions have to be made? There may be more than one decision
to be made.
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By
whom? Remember that there may be more than one decision-maker
and that their interactions can be important. Be alert to
actual or potential conflict of interest situations. Be
alert to actual or potential conflict of interest situations.
A conflict of interest is "a situation in which a person, such
as a public official, an employee, or a professional, has a private
or personal interest sufficient to appear to a reasonable person to
influence the objective exercise of his or her official duties.
" These include financial and financial conflicts of interest
(e.g., favouritism to a friend or relative). If you have a conflict
of interest, you should declare the conflict openly. In a conflict
of interest case, it is often appropriate to also let others make
the decision without your input or direction.
1.4.
Consider the context of decision-making. Ask yourself why this
decision is being made in this context at this time? Are there
better contexts for making this decision? Are the right decision-makers
included?
TOP
State
the live options at each stage of decision-making for each
decision-maker. You then should ask what the likely consequences are of
various decisions. Here, you should remember to take into account good
or bad consequences not just for yourself, your profession, organisation
or patients, but for all affected persons. Be honest about
your own stake in particular outcomes and encourage others to do the
same.
TOP
3.1.
Principles. These are principles that are widely accepted in one
form or another in the common moralities of many communities and
organizations.
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Respect
autonomy. Would I be exploiting others, treating them
paternalistically, or otherwise affecting them without their free
and informed consent? Have promises been made? Are there legitimate
expectations on the part of others because I am a professional
person or family member?
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Don't
harm. Would I be harming someone to whom I have a general or
specific obligation as a professional or as a human being?
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Do
good. Should I be preventing harm, removing harm, or even
providing positive benefits to others?
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Be
fair.
3.2.
Moral models. Sometimes you will get moral insight from modelling
your behaviour on a person of great moral integrity.
3.3.
Use ethically informed sources. Policies and other source materials,
professional norms such as company policy, legal precedents, and wisdom
from your religious or cultural traditions.
3.4.
Context. Contextual features of the case that seem important such as
the past history of relationships with various parties.
3.5.
Personal judgements. Your judgements, your associates, and trusted
friends or advisors can be invaluable. Of course in talking a tough
decision over with others you have to respect client and employer
confidentiality. Discussion with others is particularly important when
other decision-makers are involved, such as, your employer, co-workers,
clients, or partners. Your professional or health care association may
provide confidential advice. Experienced co-workers can be helpful. Many
forward-looking health care institutions or employers have ethics
committees or ombudsmen to provide advice. Discussion with a good friend
or advisor can also help you by listening and offering their good
advice.
TOP
4.1.
Perform a sensitivity analysis. Consider your choice critically:
which factors would have to change to get you to alter your decision?
4.2.
Impact on the ethical performance of others? Think about the effect
of each choice upon the choices of other responsible parties. Are you
making it easier or harder for them to do the right thing? Are you
setting a good example?
4.3.
Would a good person do this? Ask yourself what would a virtuous
professional-- one with integrity and experience – do in these
circumstances?
4.4.
What if everyone in these circumstances did this? Formulate your
choice as a general maxim for all similar cases?
4.5.
Will this maintain trust relationships with others? If others
are in my care or otherwise dependent on me, it is important that I
continue to deserve their trust.
4.6.
Does it still seem right? Are you still satisfied with your choice?
If you are still satisfied, then go with your choice. If not, consider
the factors that make you uncomfortable with a view to coming up with a
new general rule with which you are satisfied.
TOP
5.1.
Live with it.
5.2.
Learn from it.
This
means accepting responsibility for your choice. It also means accepting
the possibility that you might be wrong or that you will make a less
than optimal decision. The object is to make a good choice with the
information available, not to make a perfect choice. Learn from your
failures and successes.
TOP
Feel
free to share this framework with others. If you reprint or distribute
it, please let the author know. Comments are welcomed. All substantive
comments and requests to the author at: mcdonald@ethics.ubc.ca.
This
framework is also posted on the Centre for Applied Ethics web page: http://www.ethics.ubc.ca/
Dr. Michael McDonald is Director of the UBC Centre for
Applied Ethics.
This page is administered by Bryn Williams-Jones (brynw@ethics.ubc.ca)
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