ETHICAL DECISION-MAKING

FRAMEWORK
PHILOS 2D03
 Key Bioethical Principles
Autonomy:

Individual capacity of self-determination, informed decision-making,

and informed consent

Dignity-granting, demands respect

Cannot infringe on or restrict autonomy without good reason;

paternalism-> overriding another’s decision making for their own
good; weak paternalism may be compatible with weak agency

Nonmale cence:

Prohibition on intentionally harming another; the main good reason

for restricting autonomy

Due care: within reason, to observe our responsibility to avoid,

minimize or mitigate against harming another
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 Key Bioethical Principles
Bene cence:

Not merely to not harm others, but to provide bene t; advance welfare by
observing due care

Active promotion of well-being obligatory or supererogatory?

Utility:

Balance of nonmale cence and bene cence when in con ict

Do what will realize the greatest bene t and the least harm

Justice:

Fairness, impartiality, reciprocity, equality -> equals should be treated

equally

Distributive justice -> (in healthcare) who gets what and why?
Libertarianism and/or Egalitarianism; desert and distribution
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EDMF: Identifying the Problem
Identify all relevant facts of the case

What is the state of a airs - what has happened, is happening, will continue to happen?

Who are the principle actors - what is their relationship?

What is the cause of this state of a airs - presence/absence of structures, personnel, procedures?

Establish as much evidence for each of the above as possible, being transparent with the quantity
and quality of this evidence

Who are the stakeholders?

Identify classes of stakeholder (e.g. children, caregivers, family-members, racial status, economic
status, gender, sexuality)

Identify moral signi cance of each stakeholder, noting especially their vulnerability to harm
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 EDMF: Identifying the Problem
Identify all relevant ethical principles and values the case involves

List as many as you can

Identify the most relevant from the list

Rank them in importance (e.g. 5 = essential; 3 = signi cant; 1 = minor)

Identify which principles/values are in tension and why

Typical tensions include, but are not limited to:

Bene cence and nonmale cence

Utility and justice

Autonomy and privacy

Privacy and vulnerability

Consent and care

Rank the importance of resolving these tensions from greatest to least

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EDMF: Creating a Solution
Questioning

Revisit the list of principles in tension and pose some questions; e.g.:

Who stands to bene t from a proposed decision? What are those bene ts?
What is the moral value of these bene ts?

Who is harmed from any given decision? What are those harms? What is
the moral value of these harms?

What is the most important value and how will it best be promoted/
protected?

Who is the most vulnerable stakeholder and how might we protect them
from harm?
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EDMF: Creating a Solution
Recommendation

Identify again which principles/values should overriding consideration

-> Simple method:

Does X respect Y? Does X promote Y? Does X safeguard against Y?

Does X make provision for Y? -> -> Subject to following rubric: YES |
NO | MAYBE | ONLY IF

Identify how those principles/values that cannot be given priority

should still be promoted as much as possible

Articulate a recommendation for action based on above considerations