APPENDIX 1-2

Storch Model for Ethical Decision Making: Guiding Questions for Clinical Decision Making

Janet L. Storch

1. INFORMATION AND IDENTIFICATION

• Talk with all parties involved. From that conversation, there should emerge a central story.

• Learn about the patient’s medical status and the expectations they or their family have for outcomes, as well as the expectations of the health care team.

• Gather non-medical information about social conditions, family roles and relationships, quality of life, and power dynamics in the situation.

• Determine level of competency/capacity.

2. CLARIFICATION AND EVALUATION

Consider the values involved:

•What is the significance of the values involved— oral, religious, cultural, personal, professional?

• What is the significance of these values to the people involved?

• What is the story behind the value conflicts?

• Consider the ethical principles involved:

• Which principles might be most important in this situation?

• Are some principles in conflict with others?

Consider the social expectations and the legal requirements involved:

• Is there any institutional history on a similar situation?

• What institutional policy requirements are important?

• What legal provisions need to be considered?

Determine a range of potential actions and their consequences:

• Focus on ethically acceptable courses of action.

• Build consensus around which action is most fitting for the situation.

• Ensure patient, family, and team have common understandings about the plan of action.

• Plan to meet again to consider consequences/learning.

3. ACTION AND REVIEW

FIGURE 1-2-1

Storch Model for Ethical Decision Making