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Decision: This last step is focused on describing in one line the behavior to follow so that the person responsible carries it out.
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This decision should be defended so one should be prepared to substantiate it in front of its critics. Its purpose will be to establish an ethical judgment or conclusion based on the information and available alternatives. Javier Morata Model Family medicine. Family medicine establishes the need to carry out ethical reflection and, as a result, to make interventions at the first level of clinical practice.
It mentions that ethical dilemmas are not always the type involving life or death situations because there are dilemmas found in daily practice in which one must face situations that cause ethical conflicts. Morata makes explicit the possibility that once all these steps have been exhausted, there is no satisfactory solution found, or that once the solution found is applied, that it does not totally resolve the problem.
His model consists of the following three phases: 1 Stage I: Gathering data to detect problems from the clinical, technical, and ethical point of view as well as from similar experiences in order to study the personal, family and social circumstances. During this stage the subject of the action is analyzed and has to collaborate on the solution; therefore, the degree of competence, aptitude, and ability of the physician, the patient and the remainder of the participants should be recognized.
Elaine Congress Model Elaine Congress, Professor and Associate Dean at Fordham University NY in the early s, suggested a model for ethical decision-making that would be fast and efficient at the same time.
Congress, using the two underlying philosophical traditions in social work—the Kantian or deontological self-determination and confidence and the utilitarian or teleological consequentialist —attempted to simultaneously take into consideration the principles and the philosophical bases of both traditions to propose a model called ETHIC, whose bases rest on the values, code of ethics and context in which social work is carried out.
Her method takes the following steps into consideration: E. Examine the relevant and social values of the person, business, user and professional. Propose a hypothesis about the possible consequences of the different decisions. Identify who will benefit and who will harmed in light of the obligation of the social work with the most vulnerable population. Consult with the supervisor and with other colleagues about the ethical decision judged to be adequate. It is a model that requires taking into account the basic principles contained in the codes of ethics, the context in which actions are carried out, the reasons persons have for their behavior, the moral content of the acts and their consequences.
The model proposes four steps: 1 Should be based on the deontological and utilitarian ethical theories 2 Should use a moral code 3 System of rules derived from the principles 4 Superiority of the moral rules above and beyond judgments and individual actions20 3.
Loewenberg and Dolgoff Model This work had a great influence during the s. It is based on the theoretical proposals of different authors and recommended gradual decision making and in which several factors, people and history should be taken into consideration.
It proposes the following: 1 Identify the problem and the factors contributing to maintaining the problem. Social Law Model Based on previous proposals,10 a model was proposed that intends to emphasize the justification of the ethical decisions made within the institutions. The model is divided into three parts, the first more generic, whereas in the second part the ethical principles are analyzed and a hierarchy within them is proposed; the third part includes the action and the evaluation.
First part: 1 narrate the events; 2 identify the relevant data from the case; 3 identify the nature of the ethical problem; 4 identify those affected by the problem and their reasons; 5 generate possible alternatives to the problem posed; 6 consider the difficulties of putting such alternatives into practice. In the second part, ethical evaluation and decision making is required: 7. The consequences should be related with the principles and resolve, if there exists, the conflict in principles.
This is done in order to obtain a contrast of the results with the system of reference and, in this way, make a final decision. In the third part, it is necessary 8 to place into practice the decision adopted and 9 to evaluate it. It is also necessary to consider the deontological code. Offer the patient options with objective, true and complete information.
Elect the option that seems optimal for the patient who should choose it freely based on the alternatives offered. Resolve the conflict and communicate with the interdisciplinary team the option chosen by the patient and the stance to adopt, later evaluating this choice.
Brommer, Gratto, Gravender and Tuttle Model These authors propose a model whose goal is to explain ethical decision making. The model makes fundamental reference to two broad categories that have an influence on decision making; on one hand, environmental factors and on the other, individual factors.
Among the factors attributable to the environment are diversity of the environment, work, personnel who work in the organizations, professional aspects, governmental, legal and social aspects. Individual factors may also intervene in the decision; however, these factors are not raised as constraints, but as facilitators. The model is comprised of six large groups divided into categories, although in general, it is expected that in the model about 20 variables would intervene or would be relevant for making ethical decisions.
Corey, M. Corey and P. Callanan Model These authors propose a model that integrates eight steps.
The model comes up in the context of counseling. In this aspect, it recommends not assuming a sole posture in relation to the theories.
On the contrary, one must use the elements that are useful for better decision making. These authors visualize counseling as a tool that can substantially change the lives of people.
From there, they emphasize on the ethical elements that should be considered. Kenneth Pope and Melba Vasquez Model This model was initially published in and consists of the following steps: 1 Identify the situation that requires making an ethical decision.
Bush, Connell and Denney Model This model is based on the Theory of Systems and is focused on forensic psychology ethical decision making, which includes the following points: 1 Identification of the problem 2 Development of possible solutions 3 Consideration of the consequences for each of the possible solutions 4 Election and implementation of a course of action 5 Evaluation of the results and execution of necessary changes To this model, three additional steps are added before a decision is made: A Considerations about the context of the problem and its surroundings B Identification and use of the ethical-legal resources C Analysis of the beliefs and values of the persons involved in the dilemma28 3.
In this way, personal aspects can be combined with elements of the environment. It supposes that the behavior before an ethical dilemma is found to be directly related with its nature, the characteristics of each person and close persons, as well as the opportunities available to resolve it.
The approach is based on the point of view of the institutional organization and takes into consideration the following factors: 1 Individual factors—in decision making, individuals are influenced by moral, family, and social aspects and by their education, as well as by beliefs and behaviors acquired through formal education and by the relevant cultural background for ethical behavior.
The proposal emphasizes on ethical decision making. It does not prescribe. It arises from the idea that in the organizations, employees generally perceive ethical problems when these arise. Discussion Hospital ethics committees face, on a daily basis, the enormous challenge of analyzing deep moral problems and have the responsibility of issuing opinions and recommendations regarding their resolution.
To meet these commitments, a professional, multidisciplinary staff is required, having the theoretical tools and necessary experience to make judgments that will affect essential aspects of human nature. The analysis of an ethical dilemma in medicine is of great complexity, especially due to the great diversity of aspects involved and because of ethical positions, sometimes poorly defined, of the committee members.
To carry out this task, it is crucial that when cases are discussed there is information available that would give order to the process to ensure an exhaustive review of the different aspects involved as well as a clear definition of the ethical stances faced in topics in which divergent opinions are commonly held and positions found.
In the experience of the authors, the review process carried out by some of the ethics committees in Mexico tends to be poorly structured and commonly lack systematization. Generally, it is guided by intuition. The ethical postures are not made explicit and occasionally the dilemmas are not clearly stated.
This situation makes for a difficult debate and makes resolution rare.
The models described in this article are examples of various attempts to deal with the discussion and analysis of ethical dilemmas in the health care field. Most of the models emphasize the specification of the dilemma, identification of values and ethical principles that may serve as a basis for its resolution and, finally, in decision making. Derived from the identification of commonalities in the models reviewed and with the integration of local experience, an attempt is being made to identify a proposal adapted to our context with the highest level of simplification.
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It was possible to identify four relevant stages. The first is to establish the ethical dilemma, an aspect in which the majority of the models agreed.
In the second stage the facts seen as relevant should be specified for discussion and potential resolution of the dilemma. In the third stage, it is appropriate to make explicit the values and principles that will be considered as well as the ethical stances assumed in the case itself.
In the fourth stage it is required that a joint decision be made as a committee in order to establish educated recommendations to those requesting the decisions. In order to facilitate an in-depth and relevant analysis of cases presented to the clinical and hospital ethics committees, the participation of professionals from diverse areas of health care is required, including legal areas.
In general, it can be considered that this aspect is found to be advanced in Mexico because the legislation provides a defined frame of reference. This article, however, is centered on the proposal of structuring, in a reasonable and flexible manner, review of the cases, which should be sufficiently dynamic and general such as to allow approaching the high complexity of the problems presented.
This aspect requires the clinical or hospital ethics committees to promote and facilitate the education and culture necessary for its members to incorporate these elements into their professional background with the purpose that the discussion and analysis be many, broad and sensitive around the different world views. The fact of delving deeply into the ethical theories that underpin medical practice will contribute to offer greater clarity and transparency to the recommendations by the hospital ethics committee.
These recommendations, without a doubt, will deeply affect not only the life and future of the patients, but will also have a decisive influence in their familial and social surroundings. Based on the analysis of the models that have been described for dealing with ethical dilemmas, four stages in the review process could be identified.
The stages are as follows: 1 identify the ethical dilemma; 2 explain the relevant facts for the discussion of the dilemma; 3 expose the ethical positions; 4 make a decision.
Fulfillment of these stages would make it possible to ensure a comprehensive review by the clinical ethics committees. The members of hospital ethics committees require forming an ethical posture that allows them to give greater strength and transparency to its recommendations. Ethical responsibilities Protection of human and animal subjects.
The authors declare that no experiments were performed on humans or animals for this investigation. Confidentiality of Data. As humans we make these distinctions repeatedly. Initially, elevating ingroup and diminishing outgroup may occur in inconsequential ways, as demonstrated by Tajifel's minimal group paradigm. Ordinary behaviors function as dynamic processes that shift cultural norms all the time; for example, American men used to wear top hats as part of everyday dress, but John F.
Going hat-less is now a social norm. Moral exclusion However, seemingly benign changes in behavior can dilemma etico definicion as an entry point for shifting into a system of destruction Staub, People change through their own actions; practicing new habits, seemingly trivial acts, gradually alter both an individual and a collective psyche.
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For example, at its inception using the salute, "Heil Hitler," was not explicitly harmful to anyone. Yet scholars now perceive adoption of this greeting as a seminal turning point in the most commonly dilemma etico definicion system of nefarious acts against a group of people Staub, dilemma etico definicion The innocuous becomes insidious.
Because individuals hold positions at various levels of corporate and governmental structures, the institutionalization of particular modes of thinking and behaving happens gradually. When individuals in positions of authority adopt customs they are legitimized. When cultural norms shift toward exclusion of certain groups they can be rationalized; thereby granting legitimization of behavior into the collective consciousness. Ofreneo and de Vela developed a model to depict systems of violence situated within a society which are co-created by the social psychological process of moral exclusion, cultural norms that justify violence, and the dilemma etico definicion and political hierarchies of power that maintain it.
At the bottom is dilemma etico definicion social psychological, within an individual psyche. Principi di bioetica In the middle of the model is the social dilemma etico definicion, informal group level interaction where behavior is either ignored or applauded which normalizes it or condemned and eradicates it. At the top is the social structure, governments, dilemma etico definicion, and institutions that solidify and reify cultural norms through legislation and policy decisions.
Examples[ edit ] Moral exclusion includes situations of distinct severity, such as war, genocide, and slavery. Some examples are controversial, like abortionimmigrationand dilemma etico definicion death penalty.The stages are as follows: 1 identify the ethical dilemma; 2 explain the relevant facts for the discussion of the dilemma; 3 expose the ethical positions; 4 make a decision.
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Confidentiality of Data. We will be acting proactively to offer you detailed information regarding Ignou prospectus and will ensure that you get every detail with. Initially, elevating ingroup and diminishing outgroup may occur in inconsequential ways, as demonstrated by Tajifel's minimal group paradigm. The authors declare that no patient data appear in this article.
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