The CCE has implemented a principle-based decision-making framework in all its affiliated hospitals (the YODA framework). (Adapted from Catholic Health Association of Canada Health Ethics Guide.)
The following principle based framework/process for ethical decision making is grounded in the Mission, Vision and Values of the institution.
Steps for Resolving Ethical Dilemmas:
YOU OBSERVE DELIBERATE ACT
- Identify the Problem
Name the problem clearly. Where is the conflict?
- Acknowledge Feelings
What are the “gut” reactions? biases? loyalties?
- Gather the Facts
What are the ethically relevant facts? Whose account of the facts counts? Have all the relevant perspectives been obtained? What do the institution’s policies or guidelines say? What does the relevant law say?** (**Legal information is not the same as legal advice, where legal advice is the application of law to an individual’s specific circumstances. We recommend that you consult a lawyer if you want professional legal advice in a subject area that is appropriate to your particular situation.)
- Facts in Biomedical Ethics Issues include:
- Quality of Life
- Patient /SDM Wishes
- Contextual Features – e.g. Religion, Culture, Psycho-social issues, Relationships
- Facts in Business/Organizational Ethics Issues include:
- Allocation/Rationing of Scarce Resources
- Conscientious Objection
- Employer/Employee Relationships
- Conflict of Interest
- Alternative Sources of Revenue
- Abuse of Care Providers
- Whistle blowing
- Consider Alternatives
What are the alternative courses of actions? What are the likely consequences?
- Examine Values
What are the preferences of the person receiving care? Are other values relevant? Which of the values conflict?
- Evaluate Alternatives
Identify appropriate decision makers. Rank all relevant values i.e., Values of the institution: human dignity, compassion, pride of achievement, community of service, social responsibility. These values are derived from and relate to the values as set out in the CHAC Health Ethics Guide: dignity of every human being and the interconnectedness of every human being. They also ground the ethical values of autonomy, beneficence/non-maleficence and justice. Justify ranking by appealing to principles as set out in the Catholic Health Association of Canada’s Health Ethics Guide. – i.e., principle of totality (a holistic perspective of the human person and or the institution), principle of double effect (cannot intentionally desire to cause harm in order to do good, principle that the benefits must be equal to or greater than burden/harm, principle of legitimate cooperation, (cannot intend to cooperate with immoral acts, principle of subsidiarity, (decisions should be taken as close to the grass roots as possible), principle of informed choice, principle of confidentiality. Evaluate the consequences in terms of principles. What alternatives are excluded?
- Articulate the Decision
Which alternative best reflects the ranking of values? Which alternative best balances more of the values? Have any other alternatives come to light?
- Implement the Plan
How should the decision be communicated? Who needs to know it? How best to document the process? Who needs to act?
- Concluding Review
What are the feelings of those involved?