A Method of Case Analysis & Justification

Facts (Case Description): Describe the scenario that leads to the dilemma for the
clinician, providing all relevant factual information.
Stakeholders: Identify the key persons likely to be affected by the decision, and
state what matters most to them. Note that stakeholders may include institutions
and the wider community.
Though information about the stakeholders could be included in the Facts
section, this step invites fuller consideration of the concerns and beliefs of
persons who may be affected by the decision.
Ethically Relevant Factors: Identify specific significant factors of the case toward
which the clinician ought to be sensitive in determining the ethically right and
virtuous way to respond. Can include:
specific goods or harms (in relation to the various stakeholders)
possibilities of specific goods or harms.
Specific ethical rights (such as the right of a patient not to be deceived)
Examples:
Mr. Jones (the patients) goal of _____ or desire/ preference/wish for ______
the patients wifes desire/concern that _______
the burden of_______ on Mr. Jones from _______ treatment
the burden of ______ on the patients wife
the possibility that ____ treatment will enable Mr. Jones to live another two
years (the value staying alive)
the treatments inability to restore Mr. Jones capacity to _______
the significance of avoiding wrongfully playing God (The author would need
to explain what is meant by playing God in this case.)
Dr. Smiths desire to continue Mr. Jones treatment
The possibility that in confronting Dr. Smith with her concerns, Sarah (the
nurse) will threaten the good working relationship she has with Dr. Smith
Mr. Jones right to know the full truth about his condition (The author would
need to explain what is meant by right and why Mr. Jones has such a right.)
Sometimes ERFs reflect uncertainties (about a prognosis, advance directive,
institutional policy, religious directive, etc.) Examples:

The probability Jane will never recover consciousness.

The possibility, however small, that Jane will recover consciousness.
The possibility Janes comment about never wanting to live like a
vegetable meant ___.
The possibility Janes comment about never wanting to live like a
vegetable meant ___[something other than the meaning mentioned
above] .
The possibility ERD #__ means X, and that removing Janes feeding tube
would violate Catholic teaching.

The possibility ERD #__ means Y and that removing Janes feeding tube
would not violate Catholic teaching.

Ethical Conflicts: Identify how some ERFs invite the clinician to consider one
(general) course of action, while other ERFs invite the clinician to consider an
opposing course (or opposing courses) of action.
This step elucidates the reason or reasons the case presents a dilemma to
the clinician.
Example: (The case is about patient suffering acute respiratory failure. He
seems to express a desire to have his ventilator removed.)
Several factors invite Dr. Stephens to agree to remove the ventilator from
Charlie. They include:

Charlies apparent decision to be removed from the ventilator

Roses desire to honor her husbands recently expressed wish to be

removed from the ventilator

the discomfort the ventilator may be causing Charlie

On the other hand, several factors invite Ms. Stephens (the NP) to agree to
keep Charlie on the ventilator. They include:

the possibility Charlies recently stated wish to have the ventilator

removed may not reflect his deep-seated goals or adequate
understanding about his prognosis

the likelihood that short term mechanical ventilation will help

Charlie to recover what he views as an acceptable quality of life

the significance of Charlie having more time to live (the value of

staying alive)

Weighing Ethically Relevant Factors: Determine which ethically relevant factors

take precedence, and provide (to the extent possible) reasons for weighing the
factors as you do.
While all ethically relevant factors deserve consideration, some of them
should have greater influence in determining which courses of action are
ethically appropriate. Sometimes a single factor stands out as most
important.
General Recommendation: In light of how you weigh the ethically relevant factors
in the previous step, explain which general course of action the clinician ought to
take in order to respond to the most important factor(s). Consider all justifiable
options, and if more than one good option exists, explain (either here or in the
following section) why the option you recommend is preferred among others.
Sensitivity (and Refined Recommendation): Acknowledge how the proposed
recommendation may risk showing some insensitivity toward other ethically
relevant factors, and explain what, if anything, the clinician can do to manifest
sensitivity toward these factors.