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Table 1 Modified “SME model” with supportive questions

From: Ethical challenges assessed in the clinical ethics Committee of Psychiatry in the region of Southern Denmark in 2010–2015: a qualitative content analyses

What is the ethical dilemma? What are the facts in this case and what laws and guidelines are relevant? Who are the involved parties? What does the relevant ethical positions, values and norms say about the dilemma? What are the possible ways of action?
Specify, what makes the situation difficult?
Clarify, what is at stake and what the ethical challenge is?
What relevant information is available?
Is relevant information missing?
What laws and guidelines are relevant?
Are there any special elements to consider?
Is the ethical challenge well-known in clinical practice?
What is the usual way of handling the ethical challenge?
What is the treatment plan and what is it the intention to obtain with it?
Who are affected?
Who can/must make a choice?
Identify – if possible – what the involved parties knows and what their values, wishes and intentions are.
What consequences does the outcome have for the involved parties?
Can we build up or maintain a relationship of trust?
How is this ethical challenges related to the core values of Danish psychiatry:
respect, professional competency and responsibility?
Autonomy
 • Has the patient been informed and asked?
 • Is the patient in a state where he can evaluate the consequence of his choice? Is the patient consistent?
 • Is the patient under pressure?
What would be to the best of the patient?
 • How are the wishes and values of the patient respected?
 • How is integrity, dignity, vulnerability of the patient respected?
 • How is the level of confidence?
How do we avoid causing harm?
 • Does the good we do outweigh the potential harm - to the patient, to others affected, and to the overall use of resources?
Consequentialism
 • What will benefit the most and harm the fewest?
Deontology
 • Are there decisions which can be generalised?
 • Consider the patient as a goal by itself, not only as a means to obtain something else.
Virtue ethics.
 • What is a good doctor in this situation?
 • What virtues/values are relevant and how are they to be expressed?
What are the options of action in this situation?
What arguments are there for and against?
Is there a risk stigmatizing?
What are the consequences of the actions on both in both short and long term?