3.3. Evaluate approaches to resolving ethical dilemmas

This guide will help you answer 3.3. Evaluate approaches to resolving ethical dilemmas.

Resolving ethical dilemmas requires taking a thought-out and structured approach. In health and social care settings, ethical dilemmas are common and often involve making tough decisions where no ideal solution exists. Evaluating methods for resolving these dilemmas is crucial for workers to ensure fairness, professionalism, and positive outcomes for service users.

An ethical dilemma arises when moral principles conflict and a choice has to be made that will have consequences for all involved. Workers must weigh their options carefully, use appropriate frameworks, and reflect on the process to strengthen their professional practice.

The Role of an Ethical Framework

Ethical frameworks are tools that provide clear principles and guidance for resolving dilemmas. In health and social care, these frameworks help to organise thoughts, guide actions, and justify decisions. Using an ethical framework ensures consistency, professionalism, and accountability.

The four primary principles in ethical decision-making are:

• Autonomy – Respecting an individual’s right to make decisions about their life.
• Beneficence – Acting in a way that benefits the individual.
• Non-maleficence – Avoiding causing harm.
• Justice – Treating people fairly and ensuring equal opportunities.

Evaluating approaches includes examining how these principles are applied and whether they conflict.

Structured Approaches to Ethical Dilemmas

Several structured models for addressing ethical dilemmas exist in health and social care. These allow workers to break complex situations into manageable steps, ensuring thoughtful and fair decisions are made.

The Six-Step Process

1. Define the Dilemma
   Clearly identify the conflict of values or principles. Start by asking: What are the key issues? Who is affected? Which rights or principles are in conflict? Defining the dilemma ensures the focus stays on resolving the core issue.
2. Gather Relevant Information
   Collect all necessary facts about the situation. This includes the context, the perspectives of everyone involved (service users, family, staff), legal obligations, and organisational policies. By working with complete and accurate information, the risk of overlooking critical factors is reduced.
3. Identify Options
   List all possible actions, even if some seem undesirable. Exploring a broad range of choices ensures that decisions are not rushed or biased.
4. Weigh the Outcomes
   Analyse each option. Consider the risks, benefits, and potential consequences for all individuals involved. Determine which course of action aligns most closely with ethical principles and legal responsibilities.
5. Decide on Action
   Select the best course of action based on analysis. Workers should feel able to justify their decision professionally, morally, and legally.
6. Reflect and Learn
   Reflect on the outcome after implementation. Consider whether the chosen approach was effective and what the process revealed about professional practice. Reflection builds experience and confidence for future dilemmas.

The “Doing Good Model”

This model centres on assessing the benefits and harms of an action. It includes a focus on whether the chosen response achieves the most good for the individual while causing the least harm.

• Identify whether the action supports well-being.
• Examine whether it improves the safety and quality of life for the individual.
• Assess whether harm is being minimised for everyone directly or indirectly involved.

An effective approach considers if the benefits outweigh the risks, while keeping the individual’s rights and dignity intact.

Consultation and Ethical Committees

Consulting others is a valuable method of resolving dilemmas. It brings additional expertise, diverse views, and accountability to the decision-making process. Placing difficult cases before an ethics committee is often a required step in health and social care.

Benefits of consultation include:

• Gaining input from professionals with experience or expertise in similar cases.
• Sharing responsibility, reducing stress for workers who may otherwise feel isolated.
• Creating transparency when making decisions that could be scrutinised.

While consultation is not practical in every situation, it is a useful approach in cases involving significant risks or legal concerns.

Case-by-Case Resolution

Some dilemmas require an individualised response, particularly when the situation is sensitive or unique. Workers should consider the context and circumstances of each case rather than relying solely on universal policies.

Case-by-case approaches can include:

• Adjusting the level of involvement for the individual, based on their wishes and rights.
• Balancing short-term and long-term consequences for individuals in exceptional situations.
• Weighing the impact of action on other care users if resources are limited.

The focus should remain on the ethical foundations and the interests of everyone involved.

Examples of Resolving Ethical Dilemmas

Real-life situations challenge workers to apply these approaches effectively. Two examples are outlined below to show different strategies for resolution.

Refusal of Treatment

An older service user refuses to take prescribed medication. Their autonomy and right to make choices conflict with a duty to provide beneficent care and avoid harm.

Resolution Approach

• Define the dilemma: Respect for their autonomy versus the professional duty to promote health.
• Gather information: Understand the reasons for refusal. Are they afraid? Do they fully understand the consequences?
• Explore options: Respect the choice while ensuring they have support, or seek professional advice on next steps.
• Analyse outcomes: Does respecting their autonomy cause harm that could have been prevented? Can concerns be resolved with better communication?
• Reflect: Consider how the approach could improve other service users’ care.

Confidentiality and Safeguarding

A young adult reveals personal information about being in an abusive relationship but insists it must remain confidential. The worker must choose between protecting privacy and taking action in their role as a safeguard.

Resolution Approach

• Define the dilemma: Respecting confidentiality conflicts with ensuring safety.
• Gather information: Assess whether the individual is at risk of serious harm or exploitation.
• Examine options: Speak to them about the need to share their information if required by safeguarding policies.
• Decide: Engage safeguarding teams while discussing every step transparently with the individual.
• Reflect: Evaluate how processes like training and communication support better-handled future dilemmas.

Strengths and Weaknesses of Different Approaches

Each resolution strategy has areas where it works well and others where it may fall short. Evaluating these is important to improving practice.

Strengths:

• Structured approaches ensure fairness and consistency.
• Consulting other professionals promotes accountability and shared decision-making.
• Reflective methods encourage improved outcomes and learning over time.

Weaknesses:

• Structured frameworks can feel rigid, especially in sensitive or fast-moving situations.
• High reliance on consultation can slow down decisions in urgent cases.
• Individual reflection can lack external scrutiny, leading to potential bias.

Balanced approaches address these weaknesses by combining frameworks, teamwork, and personal reflection as needed.

Why Evaluation is Important

In health and social care, ethical dilemmas are unavoidable. Evaluating approaches to resolving them helps improve decisions and ensure professional services. It helps workers think critically about their practice and how they impact others. Strong ethical practices rely on a commitment to continuous learning and accountability.