Values-Based Decision-Making ToolkitFind the complete ethical decision-making toolkit here

Ethics Decision-Making ProcessMAKING GOOD DECISIONSThe following decision-making process can help you make sure appropriate questions are being asked and steps are being taken to address an ethical issue:

1 Clarify the key question

Identify the central issue needing to be addressed

2Identify facts & stakeholders

Collect relevant facts and identify what you need but don't have If it is a clinical issue, collect information about the medical diagnosis o

r prognosis, quality of life described in patient’s terms, patient’s preferences and contextual features

Are there any organizational policies or guidelines addressing the question?

What guidance do relevant laws give? Which individuals are relevant to this issue and who should be part of t

he discussion and decision?

3Identify values and prioritize

What are the key values? What is the central conflict in values? How do you prioritize these values against each other? What do you think is most important and why?

4 Identify options

Identify all potential courses of action, even ones that don't immediately appear suitable

5Make a decision & evaluate

Assess each option against the values that you determined to be of priority in the step 3 above

Make a decision consistent with identified key values Once the decision is made, follow up and evaluate so you can learn fr

om this for next time

FURTHER INFORMATIONFor more resources, including the process toolkit, visit the Clinical Ethics page.

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Questions1. What question are we trying to answer?

The Key Question, that if answered will provide the team appropriate direction for how to move forward…

2. Identify the facts

Collect the relevant facts and identify anything missing that is critical to the decision.

What we know for sure: about the patient/client/resident’s identity, what is important to them, and their understanding of the context:

What we know for sure: about the person’s medical condition, treatment options, etc.

What we know for sure: about the person’s sources of funding/

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resources/supports, where they live, what services/options are accessible

What we know for sure: about the family, friends, and support people

What we know for sure: about the other care providers, who is involved and what their perspectives are

What we know for sure: about the system, who else is affected, relevant policies, laws, etc.

What we don’t know but can find out Who is responsible for getting this information?

3. What are the key underlying values?

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Brainstorm what are important values that the decision should live up to (see Appendix for some examples)

To be successful in this step requires a shared and clear agreement on the meanings of the values (and what living up to them would look like in real life)

If there are values that can’t be lived up to (because some are in tension/conflict/disagreement with others), prioritize them, then discuss your justifications for this

Tip: avoid one-word values, these are open to different interpretations (“autonomy” vs. “support the patient to have final say over which treatment option they prefer”)

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VALUES LISTHow important are these relative to each othe

r?

However we answer the question, it’s important that…

Priority: 5 = Crucial3 = Very important1 = Important

4. Identify the options - what are some possible answers to the key question?

POSSIBLE OPTIONS

Option A Option B Option C

5. Make a decision and evaluate

ETHICS ANALYSIS: HOW WELL DOES EACH OPTION ALLOW US TO LIVE UP TO RELEVANT VALUES?

Possible ways of answering the question ident

ified above include:

Option A

Enter answer from above table

…

Option B

Enter answer from above table

…

Option C

Enter answer from above table

…

Prioritized Value #1

Prioritized Value #2

Prioritized Value #2

Prioritized Value #3

Prioritized Value #4

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How well does this allow us to:

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Notes (if applicable)

Summary of decision recommendations

Our recommendation/decision

Our rationale for this decision/ recommendation is…

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NEXT STEPS

Action that needs to be take

n

Who will be accountable for

doing thisTime line for act

ionHow will outcomes be communicated back to deci

sion team

Implementing the decision

Communication - letting others know

Reconvene to ensure decision having intended impacts

NECESSARY PARTNERSHIPS

People we should be working wit

hContact I

nfo

Who will be in touch with the

m?

Key questions or messages for the part

ner

How will outcomes be communicated to the decision

team?

Professionals from other teams or services

Loved ones or family members the patient would be comfortable including in the conversation

Appendix

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EXAMPLES OF COMMON VALUES IN HEALTHCARE DECISIONS

It’s important that…

…we respect people’s right to make decisions about their own lives, based on their own preferences, values, and beliefs.

…we promote the welfare of others, which may include preventing harm, removing harm, promoting well-being, or maximizing good.

…if decisions are made on behalf of a patient, they maximize benefits and minimize harms for the patient.

…we focus on relations between people and work to maintain those relationships.

…we accommodate, protect or support differences including cultural, religious, or others, among people and groups.

…we ensure we are faithful to the trust relationship with the patient; that we live up to our commitments.

…we treat people and groups fairly by treating morally relevant cases alike.

…we promote fair relations among individuals and social groups.

…we ensure fair access to resources and opportunities, including fair distribution of benefits and burdens.

…we protect the vulnerable by assisting those who have to struggle to overcome social stigma, bias or historical injustice in order to achieve equal opportunity.

...we ensure people’s quality of life. In other words, a person’s ability to engage in activities they value, as judged from their perspective.

Adapted from the Ethics Worksheet, developed by the Core Curriculum Working Group of the Clinical Ethics Group at the Joint Centre for Bioethics, University of Toronto.

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