Ethical decision-making record

Most ethical failures are not the result of bad intentions; they are the result of a decision that seemed reasonable in isolation, made alone, under pressure, without consultation. A structured model slows the decision down and — crucially — creates a record showing that you reasoned rather than reacted.

1. 1Identify the problem, and separate the ethical question from the clinical and practical ones.
2. 2Identify who is affected and what each stakeholder’s interests are.
3. 3Consult the relevant ethics code, statute, regulation and professional guidance — specifically, by section.
4. 4Identify which principles are in tension: beneficence, non-maleficence, autonomy, justice, fidelity.
5. 5Generate at least three courses of action, including the one you are avoiding.
6. 6Consider consequences for each, for every stakeholder.
7. 7Consult. Always. Both because it improves the decision and because it evidences diligence.
8. 8Decide, act, document, and set a point at which you will review the outcome.