see below ….

a fraMEWork for uNdErSTaNdING

aNd rESolvING MENTal hEalTh

–Marna S. Barrett, PhD
Clinical Associate Professor of Psychology in Psychiatry

University of Pennsylvania Perelman School of Medicine


Think about It!
• Ethical dilemmas are inherently troublesome, primarily because they involve at least two compet-

ing yet equally “right” choices rather than a right versus wrong choice.

• Distinct from other branches of medicine, psychiatry raises unique challenges for ethical decision-
making. Only in mental health are we asked to determine a person’s competence, restrict a per-
son’s right to self-determination, participate in legal decisions about a person’s culpability, and
engage with society in a reciprocal relationship of influence.

• Ethical principles such as autonomy, beneficence, nonmaleficence, fidelity, justice, and empathy
are ideals to which we strive. Although useful for understanding the complexities of a dilemma,
they are not sufficient for problem resolution.

• A framework for ethical decision-making is imperative for developing a consistent and effective
personal standard for resolving ethical dilemmas. Key elements of such a framework include identi-
fying and clarifying the issue, determining whether the situation is a “right versus wrong” or a “right
versus right” dilemma, evaluating the principles involved, creating a “trilemma,” weighing benefits
and burdens, consulting, considering possible outcomes, making document decisions, and review-
ing and reflecting on the process.

Ethical dilemmas are among the most difficult struggles we face. Whether in our professional or personal
lives, we are confronted with decisions about what is right, fair, kind, and just. Within medicine, ethical
dilemmas are more pronounced because of competing concerns such as benefit versus harm, the rights
of individuals versus the rights of others, patient competency, patient versus hospital obligations, or
truth versus kindness. In all ways, we are encouraged by our profession to strive toward the ideals of
“compassion and respect for the inherent dignity, worth, and uniqueness of every individual” (American
Nurses Association (ANA, 2001, para. 16). A formal code of ethics is what enables professionals to make
clear to society the ethical obligations and duties that can be expected from us.

Ulrich, C. M. (2012). Nursing ethics in everyday practice : A step-by-step guide. Sigma Theta Tau International.
Created from apollolib on 2023-01-10 05:55:03.



















18 Nursing Ethics in Everyday Practice


An integrated ethical
decision-making model
for nurses

Eun-Jun Park
Kyungwon University, Korea

The study reviewed 20 currently-available structured ethical decision-making models and developed an
integrated model consisting of six steps with useful questions and tools that help better performance
each step: (1) the identification of an ethical problem; (2) the collection of additional information to
identify the problem and develop solutions; (3) the development of alternatives for analysis and com-
parison; (4) the selection of the best alternatives and justification; (5) the development of diverse, prac-
tical ways to implement ethical decisions and actions; and (6) the evaluation of effects and development
of strategies to prevent a similar occurrence. From a pilot-test of the model, nursing students reported
positive experiences, including being satisfied with having access to a comprehensive review process of
the ethical aspects of decision making and becoming more confident in their decisions. There is a need
for the model to be further tested and refined in both the educational and practical environments.

decision making, ethics, ethical issues, nursing ethics, problem solving


Patients’ safety and well-being are dependent, to a large extent, on professionals’ ethical decisions.1

Regardless of his or her excellence in clinical knowledge and skills, a healthcare professional who has low

or non-existent ethical standards should be considered unfit to practice. For responsible healthcare, profes-

sionals have to be competent in ethical decision making.2 An ethical problem is ‘as [an ethical] matter or

issue that is difficult to deal with, solve, or overcome and which stands in need of a solution’ (p.94).3 Ethical

problems in a clinical setting are those we rarely confront in our daily lives, and ethical norms learned from

our parents or schools are not sufficient to resolve clinical ethical issues. There are concerns about profes-

sionals’ ethical competency. Health professionals often adopt an inconsistent decision-making process or

reach inconsistent ethical conclusions in attempts to resolve identical ethical problems.1,4,5 Moreover, they

tend to come to decisions of an ethical nature before reviewing all possible alternatives or going through a

systematic and comprehensive decision process.2 It is challenging for clinicians to make ethical decisions.

Health professionals attempt to achieve the best possible and morally-justifiable resolution while prior-

itizing a patient’s interest.6 Accordingly, the quality of ethical decision making should be evaluated in terms

not only of its conclusion but also the process of decision making. For example, whether all individuals

Corresponding author: Eun-Jun Park,

Reply 1


Reply 1 2

explain the ethical and legal issues with 
ONE (1) of the following topics:


· Genetic/genomic research



· Take a position on the topic and include evidence to support your position.

Explain why your group agrees or disagrees with the stance and 
provide citations or evidence to support it. Be constructive and professional in your responses. Remember to format in APA which avoids “I,” “we,” “you,” and similar pronouns. Recommend using terms like “the group” or “the nurses.” 

Part II:

and apply
the decision-making model you employed and the process used to arrive at your position.

Review the following resources from this week’s University Library Readings if you need additional information about ethical decision-making models:

· An Integrated Ethical Decision-Making Model for Nurses

Nursing Ethics in Everyday Practice: A Step-By-Step Guide, Ch. 2: Ethical Decision-Making

· 875-word paper