A methodology for making ethical health care decisions.

Medical professionals have no alternative to using an ethical methodology in their practice if they are to retain public confidence and resist public pressure for more legal oversight of medical practice. The method presented here for making ethical decisions points toward objectivity, is rigorous, and aims at publicly defensible choices. It involves four major stages: Expository, descriptive phase. The decision maker investigates medical and human factors and then identifies the involved parties' interests and feelings. Rational, analytic phase. The professional identifies medical ethics categories, conceptual distinctions (e.g., direct and indirect killing), principles and moral guidelines, and legal decisions or professional codes, as they apply to the situation. Volitional, decisional phase. The person then turns to making a defensible decision. This involves ordering goods and values, choosing the governing principles, and finally making a decision that considers the effect on all concerned. Public, reflective phase. The professional defends choices by making assumptions explicit, correlating reasons and feelings, and organizing reasons for public communication.