Ethicists debate the impact of deontological ethics versus utilitarian ethics in decision-making in healthcare. Yet, rules or duty based ethical interpretation possesses an inherent ambiguity that seems at times incompatible with the science of healthcare. A utilitarian ethical approach may be useful in a clinical setting. Consequence based decision making has the potential to define levels of ethical impact for both the patient and practitioner.
Variation in societal expectations and ethical standards of practitioners is evident across the spectrum of professions who treat patients. An underlying subconscious societal tallying of the cumulative effects of a decision may drive this discrepancy. Higher stakes garner higher scrutiny. A cardiovascular surgeon’s mistake may result in the instantaneous demise of a patient whereas a dentist’s mistake may result in the loss of a tooth. Quantifying outcomes may help explain why the public applies different ethical standards to plastic surgeons, chiropractors, or dentists as opposed to pediatric surgeons, transplant surgeons, or critical care physicians.
An objective measurement scale for ethical dilemmas in healthcare could provide practitioners with a tool for stratifying decisions based on effect. Beneficence, non-maleficence, justice and autonomy have become central tenets in medical ethics curricula and healthcare policy. While useful in general terms, individual interpretation varies widely. A specific relationship between the principle and an outcome is not well established.
For example, the principle of autonomy suggests that a patient should exercise autonomous thinking, intent, and action when making decisions free from undue pressure or influence while being fully informed. The decision isn’t quantified such that the effects of an autonomous decision to review and sign a privacy policy is vastly different from an autonomous decision to undergo treatment for Ebola. Further, current medical ethics does not often include effects of the decision on the practitioner. Potential harms from the treatment to the practitioner are not often discussed. For example, a practitioner who elects to treat a highly contagious disease process may be exposed to potentially lethal pathogens. Similarly, a vascular surgeon may be exposed to excessive amounts of radiation over a career while treating patients. In an attempt to quantify and objectively measure the impact of the decision in question, a short assessment tool has been developed to assist the practitioner. The tool is based on the outcome of a decision.
If a patient must sit and read a privacy policy, it may be argued that a loss of time and money may be incurred by the process. According to the assessment tool, this would be a relatively low ethical impact decision with a score of six for the patient. Conversely, if a patient were being counseled on a pancreatic tumor that would require an extensive resection, the ethical impact of the decision to treat and consent would be higher. The scale has been simplified for everyday use. It is intended that the practitioners score and patient’s score are combined to determine the overall impact. If the decision by the patient and the practitioner would result in the loss of many lives it would have a high impact score. Certainly a loss of significant amounts of money or time could be construed as more burdensome than negligible amounts. In the scoring mechanism outlined below the most common worst outcome determines the score assigned. While the current form only addresses the negative aspects of an ethical scenario, one could envision a scale where the benefits are considered and scored as well (gain of function -8, gain of money -2, etc.) In the current tool, the nature and reversibility of the incident takes precedence over the magnitude. This scoring mechanism may be applicable outside the realm of healthcare.
