A Treatise Concerning Ethical Decision-Making

An understanding of ethical decision-making requires an examination of morality. Although ethical decisions have been pondered for centuries, a separate discipline for ethical decision-making, bioethics has only been recognized since 1970. These decisions include, informed consent, abortion, research on human subjects, right to health care, and many more areas. In the

1980’s a ten-step model of ethical decision-making was created and is still the basic standard used today. This model incorporates collecting data, utilizing ethical resources, proposing and testing resolutions, and, ultimately, making the decision. This process is very valuable in nursing judgments and is fundamental to bioethical nursing. Because decisions will always be made whether ethics, virtues or cultures are considered, the consistent use of this model will result in better outcomes for all involved.

To fully understand the process of making an ethical decision, there must be an understanding of human morality. Ethics and morality began with the caveman. For instance, cavemen would often hit other cavemen in the

head with their clubs; eventually, the injured caveman asked the aggressor, “Why did you do that?” and thus morality had its foundation and would become a pre-occupation of mankind for millennia. Ronald Dunlop pointed out that “both Piaget and Kohlberg considered the ability to see things from another person’s perspective, or role-taking, a pivotal concept in their theories of moral development” (Dunlop, 3) This concept establishes the importance of other people’s perspectives in making good ethical decisions and is a distinguishing characteristic of moral maturity. Ethical decisions have been made for centuries; however, according to Husted & Husted (2001), it was not recognized as a separate discipline in the medical field until recently: “Bioethics—ethics as it relates to the health care profession—came into existence as an independent discipline about 1970” (p. 4). Bioethics deals with matters such as informed consent, abortion, research on human subjects, compassionate treatment of the dying, and the right to health care. In the 1980’s a process of ethical decision-making was prepared. The basis of this model is moral reasoning—a critical inquiry into the ethical dimensions of health care with the awareness that one may agree or disagree with others during the process. This process has ten steps and includes all of the tiers in the framework of ethical decision-making used today.

Foulger, Davis, Measuring Complex Ethical Decision Making. Retrieved April 3, 2003 from

To make an ethical decision, a person must be familiar with the difference between law and ethics. An ethical decision does not need to be addressed if the issue at hand is a legal problem. Although laws are not by definition always necessarily ethical, consequences of disobeying the law can often prove catastrophic. However, the decision-maker in a healthcare situation must be current on all patient rights, code of ethics, the Nuremberg code, and all other ethical documents that outline proper and improper behavior. A nurse is held responsible for upholding these documents even if they are unaware of their existence. After consulting these sources the nurse may begin the process of decision-making. The first step is to determine the ethical problem at hand. There are four types of moral problems: moral uncertainty, moral dilemma, moral distress, and moral outrage. Moral uncertainty occurs when there is a moral problem, and one is unsure of the morally correct action. When this is the problem, the ethical decision-making process is not the immediate response to resolve the problem. How can a proper decision be made if the problem is not well defined? First, one must pinpoint what is wrong with this particular situation. On the other hand, if the problem is moral dilemma, distress, or outrage, then the process of ethical decision-making must be consulted. Many times in moral outrage the best choice may involve whistle blowing to stop a given behavior from inflicting harm on others. The framework of ethical decision-making should be used as a “guide rather than a recipe” to better utilize the process (McDonald, 2001, para. 20).

Some topics in this essay:
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