Theoretical Medicine

, Volume 12, Issue 2, pp 157–170 | Cite as

An integrative model of clinical-ethical decision making

  • Rivka Grundstein-Amado


The purpose of this paper is to propose a model of clinical-ethical decision making which will assist the health care professional to arrive at an ethically defensible judgment. The model highlights the integration between ethics and decision making, whereby ethics as a systematic analytic tool bring to bear the positive aspects of the decision making process. The model is composed of three major elements. The ethical component, the decision making component and the contextual component. The latter incorporates the relational aspects between the provider and the patient and the organizational structure. The model suggests that in order to arrive at an ethically, justifiable sound decision one make reference to those three elements.

Key words

decision making process ethical clinical decision making models medical ethics moral thought process organizational structure professional-patient relationship value theory 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Martin A. A clinical model for decision making. J Med Ethics 1978;4:200–6.Google Scholar
  2. 2.
    Siegler M. Decision making strategy for clinical-ethical problems in medicine. Arch Intern Med 1982;142:2178–9.Google Scholar
  3. 3.
    Candee D, Puka B. An analytic approach to resolving problems in medical ethics. J Med Ethics 1983;9/10:61–9.Google Scholar
  4. 4.
    Pellegrino ED. The anatomy of clinical ethical judgments in perinatology and neonatology: a substantive and procedural framework. Semin Perinatol 1987;11:202–9.Google Scholar
  5. 5.
    Grundstein-Amado R. Ethical Decision Making Processes in the Health Care System. [Dissertation]. Toronto: University of Toronto, 1990.Google Scholar
  6. 6.
    Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 3rd ed. New York: Oxford University Press, 1989.Google Scholar
  7. 7.
    Kluckhohn C. Values and value-orientations in the theory of action: an exploration in definition and classification. In: Parson T, Shils EA, eds. Toward A General Theory of Action. Cambridge, MA: Harvard University Press, 1951:388–433.Google Scholar
  8. 8.
    Callahan S. The role of emotions in ethical decision making. Hastings Cent Rep 1988;18:9–14.Google Scholar
  9. 9.
    Kluckhohn FR, Strodtbeck FL. Variations in Value Orientations. Evanston: Row, Peterson and Company, 1961.Google Scholar
  10. 10.
    Rokeach M. The Nature of Human Values. New York: The Free Press, 1973.Google Scholar
  11. 11.
    Beck C. Educational Philosophy and Theory: An Introduction. Boston: Little Brown and Company, 1974.Google Scholar
  12. 12.
    Beck C. The Nature of Values and Implications for Value Education, 1984 (unpublished manuscript).Google Scholar
  13. 13.
    Levine RJ. Ethics and Regulation of Clinical Research. Baltimore: Urban & Schwarzenberg, 1986.Google Scholar
  14. 14.
    Jameton A. Nursing Practice: The Ethical Issues. New Jersey: Prentice-Hall, Inc, 1984.Google Scholar
  15. 15.
    Rawls J. A Theory of Justice. Cambridge MA: Harvard University Press, 1971.Google Scholar
  16. 16.
    Simon HA. The Administrative Behavior. New York: Free Press, 1957.Google Scholar
  17. 17.
    Elstein AS. Cognitive processes in clinical inference and decision making. In: Turk DC, Salovey P, eds. Reasoning, Inference, and Judgment in Clinical Psychology. New York: The Free Press, 1988:17–50.Google Scholar
  18. 18.
    March J, Simon H. Organizations. New York: John Wiley, Inc, 1958.Google Scholar
  19. 19.
    Harrison F. The Managerial Decision Making Process. Boston: Houghton Mifflin Company, 1987.Google Scholar
  20. 20.
    Wilson C, Alexis M. Basic framework for decisions. Journal of the Academy of Management 1962;5:20–5.Google Scholar
  21. 21.
    Hodgkinson C. Towards A Philosophy of Administration. Oxford: Basil Blackwell, 1978.Google Scholar
  22. 22.
    Broekman JM. The philosophical basis of medicine as a philosophical question. Theor Med 1987;8:135–45.Google Scholar
  23. 23.
    Childress JF. Who Should Decide? Paternalism in Health Care. New York: Oxford University Press, 1982.Google Scholar
  24. 24.
    Childress JF, Siegler M. Metaphors and models of doctor-patient relationships: their implications for autonomy. Theor Med 1984;5:17–30.Google Scholar
  25. 25.
    Hoffmaster B, Weston W. The patient in the family and the family in the patient. Theor Med 1987;8:321–32.Google Scholar
  26. 26.
    Lock JD. Some aspects of medical hermeneutics: the role of dialectic and narrative. Theor Med 1990;11:41–9.Google Scholar
  27. 27.
    Mouzelis NP. Organisation and Bureaucracy. London: Routledge & Kegan Paul, 1985.Google Scholar
  28. 28.
    Perrow C. Complex Organizations. A Critical Essay. New York: Newbery Award Records, Inc, 1986.Google Scholar
  29. 29.
    Eakin J. Hospital power structure and the democratization of hospital administration in Quebec. Soc Sci Med 1984;18:221–8.Google Scholar
  30. 30.
    Fletcher C. Commentary. J Med Ethics 1983;9:69–70.Google Scholar

Copyright information

© Kluwer Academic Publishers 1991

Authors and Affiliations

  • Rivka Grundstein-Amado
    • 1
  1. 1.Department of PsychiatryBaycrest Centre for Geriatric CareNorth YorkCanada

Personalised recommendations