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Ethical Decision Making Model

Ethical Decision Making Model

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The health care environment is an increasing complex set up. Many decisions have to be made in line with financial, political and welfare implications in mind. Some of these decisions are not so obvious thouh, and conflicts of interests are common. For this reason, health care facilities are governed by a set of principles, laws and values that have to be upheld by moral agents in making any resolutions that may appear contentious (Asser, & Rita, 1998). For instance, a competent patient may for his reasons refuse a medically approved treatment even if the prognosis of such a decision is poor. By law, the practitioner involved in such a case is only permitted to explain to the patient the consequences of such decision but is not allowed to impose any treatment that is objected.

Background Information

In the United States of America, the Supreme Court recognizes parental moral authority over their minors (Kolarik, Walker, & Arnold, 2006). These rights also include making medical decisions concerning what treatments, based on religious grounds are most suitable for their children. The right is, however, limited to cases whereby mental and physical health is not threatened. It is also quite evident that, in most medical cases, mental and physical health is always at stake, and other decision-making criteria are needed by the state to accomplish its mandate of protecting its citizens over their minors (Kolarik, Walker, & Arnold, 2006).. These decisions should be arrived at without infringing individual’s rights as provided for in the First Amendment to the U.S. Constitution (Cummings, & Mercurio n.d.).. Decision-making process health care is the process of choosing the best medical alternative achieving individual and state objectives based on set legislative and ethical principles.

Ethical dilemma in health care settings is a common occurrence. Caregivers are often confronted with cases of conflict of interests involving surrogate decision especially when the patient is incompetent to make informed decisions (Asser, & Rita, 1998). A good example is a case involving a 6-year-old child who has been diagnosed with an acute case of meningitis. The child’s parents are separated, but she lives with her foster mother as primary custodian. Despite the physician's request for an initiation of medical treatment, the mother for religious reasons insists that no medical treatments should be given. Meanwhile, the biological father of the child is also contacted from a different state. He maintains that treatment should begin straight away.

Decision-Making Model

The American Academy of Pediatrics provides guidelines and policies to be followed while making such crucial ethical decisions to make sure that the rights and obligations of individuals are kept in mind. Several decision-making models also exist in literature and have also been outlined in various medical facilities to facilitate this process (Guo, 2008). The approaches may be different, but the essential components remain unaltered. This paper describes a five steps decision-making approach that is most suited for the case described above. The method requires the definition of the problem involved, establishing the criteria and objectives of one’s action plan, considering the available alternatives and choosing the best option. This process is often followed by an evaluation of the chosen action plan to assess its suitability (Guo, 2008).

Problem statement

The child in our case study has been determined to have meningitis that is a potentially killer disease if not treated properly. The child is also likely to develop future complications such as deafness, mental incapacity or abnormal development if the condition is not addressed before it metastasizes to critical levels. Medical attention is therefore urgently needed if this life is to be saved. The non-biological mother is of the opinion that no medical treatment whatsoever should be given. As a practitioner, one is left in a dilemma as to whether or not one should override the mother’s religious beliefs and provide the much-needed lifesaving treatment.

Establishing criteria

Medical profession just like any other is governed by a set of rules, policies, and codes of conduct. The most used are,however, the principles of bioethics; some of these principles are even enshrined in the Hippocratic Oath for everyone concerned to uphold (Lawrence, 2007). The principle of respect for autonomy, for instance, demands the right for an individual to make his or her choices. This principle requires the patient to give informed consent to any medical procedure, a condition that requires competence, comprehension, and voluntariness. Autonomy justifies letting a competent adult reject a medical treatment for themselves for religious reasons but is limited when making such decisions for others (Lawrence, 2007). In a similar manner, the principle of beneficence requires moral agents to act in the best interests of their patients, his family and society in mind. While nurses spend most the time with patients in the hospital, they can never claim to know their patients better than their family and loved ones do. Presumably then, close relations are prioritized to know what is best for their sick ones, especially in cases where competence is highly questioned or while comatose (Asser, & Rita, 1998). Closely related to this is the principle of non-maleficence. This law demands no harm for others as much as possible when administering medical procedures. Withholding proven treatment, even with the consent of the beneficiary, is likely to cause harm and is considered a violation of this principle though it goes against autonomy (Lawrence, 2007). Lastly, principlism entitles everyone to fair and equal access to medical care.

The American Academy of Pediatrics Committee suggests that if the parents makes a decision that is not in their child’s best interest, then it is the pediatrician’s duty to override such a decision even it involves a court’s intervention (Guo, 2008.. The Constitution of United States also recognizes the rights to religion and requires the government not to interfere with religious practices or endorse any particular religion. Though this guarantee for freedom of association does not permit children to be harmed through religious practices, nor can it be used as a legal defense for child negligence or harm. As the Supreme Court has it, ‘parent can make martyrs of them, but not of their children who are too young to have consented to embrace the faith (Asser, & Rita, 1998).

Considering the Available Alternatives and Choosing the Best

The most obvious alternatives here is whether to or not override the mother’s decision. Going with the mother’s decision would mean death or serious physical and harm to the child. Another alternative would be to refer this case to another physician or health facility and save oneself the agony of such a conflict. This is however an escapist decision and one which is against religious, cultural and professional values. From these alternatives it is obvious that the best decision and one that is the best interest of the patient is to effect treatment as soon as possible.

Developing and Implementing a Plan of Action

Due to the gravity of the ethical conflict involved in this study, it is paramount that thorough caution is observed by the health care manager involved. Since the minor is not competent to be involved in decision making, and no amicable resolution expected from the talk with the mother, the practitioner will consider consulting the hospitals ethics’ council or legal counsel for directions as provided for by the U.S. National Ethics Committee (Cummings, &Mercurio, n.d.). It is also useful to inform both the developmental child and parents a simply as possible the diagnosis and prognosis of this condition to help them with decision making and why you have to make a particular decision as a moral agent.

Monitoring and Evaluation

This last phase of this model, though not very helpful in this case since the decision is irrevocable once made, requires revisiting and assessing the effectiveness of the action taken to help with revisions.


The Constitution recognizes the role of religion in spiritual, personal and social wellbeing. Health professionals are therefore encouraged to make collaborative decision making to avoid conflicts of interests between caregivers and other stakeholders in medical care. This agreement will never always be achieved in all case, conflicts abound, and medical official are tasked with making the right decisions based on medical principles, laws and codes of conducts.


Asser, S. & Rita S. 1998. Child fatalities from religion-motivated medical neglect. Pediatrics 101(4): 625–29. Cummings, C. & Mercurio, M. (n.d.). American academy of pediatrics bioethics: Exploring the ethical principles in pediatrics. Pediatrics. Guo, K. (2008). A Decision making model for more effective decision making by health care Managers. Lippincott Nursing Center, 27(2) Kolarik, R. C., Walker, G., & Arnold, R. M. (2006). Pediatric resident education in palliative care: a needs assessment. Pediatrics, 117(6), 1949-1954. Lawrence, D. J. (2007). The four principles of biomedical ethics: A foundation for current bioethical debate. Journal of Chiropractic Humanities, 14, 34-40.


Below is the suggested line of conversation between the ailing child and the health official. Me: Ahem… good afternoon (greetings subject to time of the day), Mr. Smith and Ms. Cathy. (Hypothetical names)

Parent: Good afternoon

Me: I am sure the past few days have not been easy for both you and poor Casey (referring the kid); sorry I didn’t make it any easier for you. Frankly, Casey’s condition does not look good from our diagnosis. I appreciate your well-intended inputs into this matter and totally respect your beliefs and values. I also know you both love Casey and want the best for her, though the gravity of this sickness requires that urgent medical attention be given or Casey is likely to suffer dire consequences or even face untimely death, God forbid. My professional, personal values and cannot just allow me to do nothing and let the child suffer, for we are both held directly accountable for any decision we make here. My decision in consultation with the facilities management and legal counsel is to effect treatment. Sorry but it is the decision I can live with, thank you for your understanding.

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