Analyzing an Ethical Decision.

SUMMARY OF THE STEPS OF THE
ETHICAL DECISION MAKING PROCESS
1. Gather the facts
2. Define the ethical issues
3. Identify the affected parties (stakeholders)
4. Identify the consequences
5. Identify the obligations (principles, rights, justice)
6. Consider your character and integrity
7. Think creatively about potential actions
8. Check your gut
9. Decide on the proper ethical action and be prepared to
deal with opposing arguments.
1 – GATHER THE FACTS
 Don’t jump to conclusions without the facts
 Questions to ask: Who, what, where, when, how, and
why.
 However, facts may be difficult to find because of the
uncertainty often found around ethical issues
 Some facts are not available
 Assemble as many facts as possible before proceeding
 Clarify what assumptions you are making! Analyzing an Ethical Decision.

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2 – DEFINE THE ETHICAL ISSUE(S)
 Don’t jump to solutions without first identifying the ethical
issue(s) in the situation.
 Define the ethical basis for the issue you want to focus on.
 There may be multiple ethical issues – focus on one major
one at a time. Analyzing an Ethical Decision.
3 – IDENTIFY THE AFFECTED PARTIES
 Identify all of the stakeholders
 Who are the primary or direct stakeholders?
 Who are the secondary or indirect stakeholders?
 Why are they stakeholders for the issue?
 Perspective-taking — Try to see things through the eyes
of those individuals affected
4 – IDENTIFY THE CONSEQUENCES
 Think about potential positive and negative consequences for affected
parties by the decision (Focus on primary stakeholders to simplify
analysis until you become comfortable with the process).
 What are the magnitude of the consequences and the probability that
the consequences will happen.
 Short term vs. Long term consequences – will decision be valid over
time.
 Broader systemic consequences – tied to symbolic and secrecy
 Symbolic consequences – Each decision sends a message.
 Secrecy consequences – What are the consequences if the decision
or action becomes public?
 Did you consider relevant cognitive barriers/biases?
 Consider what your decision would be based only on consequences –
then move on and see if it is similar given other considerations. Analyzing an Ethical Decision.
5 – IDENTIFY THE RELEVANT PRINCIPLES,
RIGHTS, AND JUSTICE ISSUES
 Obligations should be thought of in terms of principles and rights involved
 A) What obligations are created because of particular ethical principles
you might use in the situation?
 Examples: Do no harm; Do unto others as you would have them do
unto you; Do what you would have anyone in your shoes do in the
given context.
 B) What obligations are created because of the specific rights of the
stakeholders?
 What rights are more basic vs. secondary in nature? Which help protect
an individual’s basic autonomy?
 What types of rights are involved – negative or positive?
 C) What concepts of justice (fairness) are relevant – distributive or
procedural justice?
 Did you consider any relevant cognitive barriers/biases?
 Formulate the appropriate decision or action based solely on the above
analysis of these obligations. Analyzing an Ethical Decision.
6 – CONSIDER YOUR CHARACTER &
INTEGRITY
 Consider what your relevant community members would
consider to be the kind of decision that an individual of
integrity would make in this situation.
 What specific virtues are relevant in the situation?
 Disclosure rule – what would you do if the New York Times
reported your action and everyone was to read it.
 Think about how your decision will be remembered when
you are gone.
 Did you consider any relevant cognitive biases/barriers?
 What decision would you come to based solely on
character considerations? Analyzing an Ethical Decision.

7 – THINK CREATIVELY ABOUT POTENTIAL
ACTIONS
 Be sure you have not been unnecessarily forced into a
corner
 You may have some choices or alternatives that have not
been considered
 If you have come up with solutions “a” and “b,” try to
brainstorm and come up with a “c” solution that might
satisfy the interests of the primary parties involved in the
situation. Analyzing an Ethical Decision.
8 – CHECK YOUR GUT
 Even though the prior steps have argued for a highly
rational process, it is always good to “check your gut.”
 Intuition is gaining credibility as a source for good
decision making – knowing something is not “right.”
• Particularly relevant if you have a lot of experience in
the area – expert decision-making. Analyzing an Ethical Decision.
9 – DECIDE ON YOUR COURSE OF ACTION AND PREPARE
RESPONSES TO THOSE WHO MAY OPPOSE YOUR POSITION
 Consider potential actions based on the consequences,
obligations, and character approaches.
 Do you come up with similar answers from the different
perspectives?
 Do the obligation and character help you “check” the
consequentialist preferred action?
 How can you protect the rights of those involved (or your
own character) while still maximizing the overall good for
all of the stakeholders?
 What arguments are most compelling to you to justify the
action ethically? How will you respond to those with
opposing viewpoints? Analyzing an Ethical Decision.

Analyzing an Ethical Decision

Summarize the moral/ethical issue in the article.

Bipeta (2019) explores the ethical aspects presented in the Mental Healthcare Act of 2017 (MHCA 2017). It identifies the rights of patients with mental illness (PWMI), as well as the ethical and legal responsibilities of medical personnel offering these patients care. It specifically notes that although the rights of PWMI match those of other members of the society, PWMI are a unique group since their mental conditions identify them as vulnerable thus requiring special attention. Analyzing an Ethical Decision. The diminished mental capacity of PWMI make them potential medico-legal cases and care must be taken to avoid such cases. Besides that, the article notes that PWMI require special attention at every encounter with medical personnel to include medical evaluation, treatment and participation in research. At every encounter, there is a need to ensure that the fundamental rights are translated into respect for the principles of autonomy, non-maleficence, beneficence, justice, confidentiality, boundary violations, and informed consent. Overall, the article concedes that although every encounter between medical personnel and PWMI could be a potential medico-legal case, it possible to avoid such cases by balancing idealism and pragmatism in providing ethically sound care (Bipeta, 2019). Analyzing an Ethical Decision.

Describe the moral and ethical dilemmas surrounding the issue.

The ethical dilemma surrounding the issue discussed in Bipeta (2019) is the diminished cognitive capacity of PWMI that makes it difficult for them to participate in decision making so that they are likely to be ignored. Besides that, psychiatric disorders carry significant biases, myths and stigma with ethical implications. The cause of psychiatric disorders has varied beliefs presented as explanatory models of the illness. Analyzing an Ethical Decision.Some of the models include the psychosocial stress model, medical model, supernatural/magical model, religious model, and moral model. Each of these models has different implications for the rights of the patient. This is especially so when applied in diagnosis, an activity that largely relies in observations and symptomatology without laboratory and investigation markers thereby making the diagnosis imprecise. The diagnosis presents a label that could have psychological and social consequences to the PWMI, such as stigma, discrimination, danger, exclusion, secrecy, blame and shame, leading to rejection and isolation (Jain et al., 2015). The set of circumstances describes indicate that there is a need for ethical guidelines to help in maintaining accountability and transparency in providing care to PWMI. Analyzing an Ethical Decision.

Analyze the ethical issue and compare them to the state health laws and regulations in your state (Maryland State).

The ethical issue presented by Bipeta (2019) is the rights of PWMI. The Maryland Department of Health recognizes these concerns and has presented regulations offered as a Code of Ethics. Firstly, the code presents a requirement for professional competence among medical personnel to include education, training, supervised and professional competence as indicators of the capacity to provide the required care. Secondly, the code identifies ethical responsibility in terms of what medical personnel can and cannot do. Fourthly, the code defines the counseling relationship in terms of PWMI welfare, rights and information that should be provided to them. It requires that medical personnel inform PWMI about the purpose, goals, techniques, procedures, limitations, potential risks and benefits of medical services provided. Fifthly, the code talks of confidentiality and informed consent, noting that privacy and confidentiality of a PWMI must be maintained. Records can only be released with the consent of the PWMI or as permitted by the practice code and standards (Maryland Division of State Documents, 2020). Analyzing an Ethical Decision.

Outline the process of ethical decision making you would use to address this ethical dilemma.

The ethical decision making process outlined by Kaplan (2017) would be appropriate. The first step is getting an understanding of the case and the nature of the ethical dilemma in terms of the available courses of action. The second step is exploring the relevant code of ethics and matching them to the deconstructed decisions and options. The third step is examining evidence in terms of what is known that could contribute to the decision. The final step is making the best decision with the least ethical concern (Kaplan, 2017). Analyzing an Ethical Decision.