Appendix 2 - clinical pragmatism framework

Question 1

assessment

Answer 1

…of medical facts, contextual factors, patient’s capacity, patient’s preferences/needs, surrogate decision makers, competing interests, institutional factors, powers

Question 2

moral diagnosis

Answer 2

…of problems posed by the case and options for resolution

Question 3

plan

Answer 3

goal setting, decision-making, and implementation of a plan of action by means of a shared, deliberative process

Question 4

evaluation

Answer 4

…of results

Question 5

democratic model of moral problem solving

Answer 5

clinicians/ethics consultants facilitate and guide moral problem-solving without dictating or engineering the outcome

reciprocity: all parties entitled to be heard and work together to arrive at a mutually satisfactory resolution

ethics consultants should promote careful consideration of the range of options