Adapted from: Jonsen AR, Sieger M, Winslade WJ. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 8th ed. New York, NY: McGraw-Hills; 2015.
Beneficence and Nonmaleficence
1.What is the patient’s medical problem?
2.Is the problem acute? Chronic? Critical? Reversible? Emergent?
Terminal?
3.Where the goals of treatment?
4.In what circumstances are medical treatments not indicated?
5.How can the patient benefit from medical and nursing care, avoid
harm?
6.Do critical military mission considerations dictate that the need
for preferential care?
7.Conscience clause: is there an indication for intervention/patient
preference that does not align with physician willingness to treat?
1.Has the patient been informed of benefits and risks of
recommendations, understood, and given consent?
2.Does the patient have capacity?
Yes: What preferences are they stating?
No: Have they expressed prior preferences?
3.Who is the appropriate surrogate to make decisions for
an incapacitated patient?
4.What standards should govern the surrogate’s
decisions?
5.Is the patient unwilling or unable to cooperate with
medical treatment question if so, why?
Beneficence, Nonmaleficence, & Autonomy
1.What are the prospects, with or without treatment, for a return to
an acceptable quality of life (QOL) and what physical, mental,
and social deficits might the patient experience even if treatment
succeeds?
2.On what grounds can anyone judge that some QOL would be
undesirable for a patient who cannot make or express such
judgement?
3.Are there biases that might prejudice the provider’s evaluation of
the patient’s QOL?
4.What ethical issues arise concerning improving or enhancing a
patient’s QOL?
5.Do QOL assessments raise any questions that might contribute to
a change of treatment plan, such as forgoing life-sustaining
treatment?
6.Are there plans to provide pain relief/comfort after a decision has
been made to forgo life-sustaining interventions?
Principles: Justice and Fairness
1.Are there professional, interprofessional, or business
interests that might create conflicts of interest in the
clinical treatment of patients?
2.Are there parties outside clinician/patient such as
family members who have a legitimate interest in
decisions?
3.Are there limits imposed on pt confidentiality by the
legitimate interests of third parties?
4.Are there financial factors that create conflicts of
interest in clinical decisions?
5.Are there religious factors that might influence clinical
decisions? Legal issues?
6.Are there considerations of clinical research and
medical education that affect clinical decisions?
7.Are there considerations of public health and safety
that influence clinical decisions?
8.Does institutional affiliation create conflicts of interest
that might influence clinical decisions?
