10 Sep 2022


The Four Steps in the Clinical Ethics Process

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Academic level: College

Paper type: Case Study

Words: 877

Pages: 3

Downloads: 0

Summary of the Case Study 

The case scenario is about L.D who is a 39-year-old female patient who goes to the emergency department with a right-sided weakness and a sudden headache. She also has a hemorrhage in the brain. A neurosurgical intervention is done, but the patient is left with serious damage. The husband to his patient is his surrogate and provides a paperwork evidence that the patient never wanted to be kept alive artificially by feeding tubes, artificial nutrition or by mechanical ventilation. Thus, the husband requests to meet the hospice and discuss their options. While the case is investigated, the team realizes that the emergency department never conducted a pregnancy test which was a requirement for signing paperwork that was related to withdrawal of life support. Thus, a pregnancy test is conducted, and the results are positive. Furthermore, the ultrasound confirms that the pregnancy was six weeks old. Despite the new information concerning the patient’s pregnancy, the patient’s husband wants to proceed with hospice care for his wife. This essay aims at using the four steps in the clinical ethics to provide an ethical decision concerning this case. 

Four Steps in the Clinical Ethics 

Medical Indications 

This is the first step in clinical ethics. This step deals with the current medical problem of the patient, and the goals concerning treatment (Boisaubin, 1996). In this stage, the medical facts are usually presented. Concerning the above case study, it is evident that the 39-year-old female patient has a right-sided weakness and a sudden headache. From studies, particularly brain imaging studies, an arteriovenous malformation with hemorrhage in the brain is revealed. However, a neurosurgical intervention is conducted although she is left with a severe neurological damage after it is done. 

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Preferences of the Patient 

This is the second step in clinical ethics. Thus, this step pinpoints what the patient wants including his or her desires, whether he or she can speak for him or herself patient’s goals. If the patient is mentally capable, the preferences about his or her treatment should be clearly stated, if he or she is incapacitated, the medical team should find whether the patient has already conveyed prior preferences (Fletcher et al., 1995). In that case, they should look at appropriate surrogate to make decisions for such patient. Finally, they should also determine whether the patient is ready to comply with medical treatment and if not, the reasons should be stated. In the case scenario above, the patient is incapacitated and that her surrogate was her husband who was supposed to make decisions for her. Despite his incapacitation, the patient had clearly expressed her prior preferences that she preferred not to be kept alive artificially by feed tubes, artificial nutrition, or mechanical ventilation. The patient had a directive paperwork that expresses her wishes since she was unable to speak for herself. 

Quality of Life 

The third step deals with the quality of life. An important objective of medical treatment is to maintain, improve, and restore the quality of life. When it comes to clinical ethics case analysis, it is vital to put into consideration the effect of treatment on the life of the patient. However, the definition of quality of life, the topic is usually subject to inflexible biases. Thus, quality of life is often determined by one’s perception of quality, and it varies among people. According to Jonsen, Siegler and Winslade, (2015), the healthcare providers should understand that their assumptions regarding the quality of life may differ with the ideas of a patient to (Jonsen, Siegler & Winslade, (2015). Thus, the physicians are advised to use the expressed values, wishes, and preferences when defining the patient’s quality of life. Thus, going back to the case scenario, one can understand the patient’s quality of life after looking at her preferences. In the case, the patient stated that she never wanted to be kept alive artificially on feeding tubes, artificial nutrition, or by mechanical ventilation. From that, one can guess the quality of life concerning that patient. 

Contextual Features 

The final step is the contextual features where the larger context where the case is occurring is considered (Jonsen, Siegler & Winslade, (2015). Besides, the contextual features related to the case and ethical analysis of the case is also determined. The case context is determined by various social factors such as the living condition of the patient, cultural and religious beliefs of both the patient and the family, dynamics of the family. Moreover, it is also crucial to be aware of the patient’s caregivers and how the different medical choices will affect the ability of the caregiver to provide care to that patient. Contextual features exemplify principles of fairness and justice, including financial and legal ramifications. When one considers the contextual features regarding L.D, it is evident that her husband is the main caregiver and thus, he is the main party that has an interest in clinical decisions concerning case. Despite the information that L.D was pregnant, the husband wished to continue with the hospice care for her and this brought an ethical conflict. 

Ethical Decision 

Regarding this case, justice would prevail if artificial treatment is withheld because it does not affect the society in any way because it has been a public policy since 1982 that the patient’s wishes regarding artificial life support to be honored. Thus, in this case, an ethical decision would be to honor the patient’s wishes that were presented in directive paperwork and withhold the artificial treatment. Nevertheless, the ethical committee can make other suggestions. For example, the hospice might use what is known as time-limited trial where there is a specific purpose, and then the patient can be provided with life support treatment for a specified time. Hospice staff can also explain to the husband the importance of being kept alive artificially since she was already pregnant. While medically and legally correct answer in this scenario may appear apparent, family conflict over such a decision may be difficult for the hospice team. 


Boisaubin, E. V. (1996). Introduction to Clinical Ethics.    JAMA ,    275 (13), 1032-1033. 

Fletcher, J. C., Hite, C. A., Lombardo, P. A., & Marshall, M. F. (1995). Introduction to clinical ethics. 

Jonsen, A. R., Siegler, M., & Winslade, W. J. (2015).    Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, 8E . McGraw Hill Professional. 

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