Step 1: Identify/Clarify the Ethical Issue

Is it really an ethical issue?

Ethical issues arise when the ethically defensible response is unclear or contested, when the ethical response is clear but cannot be enacted, or when what seems to be the ‘right thing to do’ also appears wrong in some important way. Serious ethical issues are sometimes called ethical dilemmas; referring to instances where you are confronted by a choice in which each course of action is wrong in some important way. In a true ethical dilemma, each potential course of action will violate an important moral principle. Sometimes, decision making in these cases may be challenging, and even distressing. However, the difficulty of resolving ethical dilemmas is not a reason to give up trying to understand the right thing to do. As troubling as these decisions might be, they also present an opportunity to contemplate the best thing to do under the circumstances.

What is at stake and for whom?

Often, ethical issues arise when it is difficult to prioritize, or accommodate and reconcile, between different principles, values, and/or moral beliefs. Ethical issues may also arise when principles and values conflict with one another.

How is the issue perceived from different perspectives?

An ethical issue is often perceived differently by those involved. Ethics is composed of various moral theories and values which may differ from one society to the next and often varies even within a given society or group. In addition, people of the same cultural background and with the same worldview, might perceive a problem differently depending on their proximity and involvement in the situation. It is realistic to expect that ethics will be something about which reasonable people might disagree. Considering how the issue might be understood from different perspectives, as well as the possibility of divergent goals, is essential. Depending on the nature of the issue, this step can include considering perspectives of local communities, patients/families and colleagues, as well as other organizations or stakeholders.

What practical concerns need to be identified?

  • When must a decision be made?
  • Who is responsible for making a decision?
  • What has been done so far to address this issue?

More detail can be found on pages 13-15 of the HHEAT Handbook.

Return to HHEAT Handbook at a Glance.

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