Chapter 2 Professional Ethics 33 Copyright Goodheart-Willcox Co., Inc. professional associations. At other times, it may be appropriate to for- mally seek advice from supervisors, professional colleagues, or medical ethics committees. Generally, if you believe you can legally act, you should first ­ consider if the patient is able to understand and decide issues and can provide autonomous guidance on preferred methods of care (or refusal of care, as the case may be). Next, consider what is in the best interest of the patient (under the principle of beneficence) and whether you can act without harming the patient. Finally, consider whether serving this patient means that you are providing just and equitable care or deny- ing care to others by expending your time or available resources in this manner. medical ethics committee a group of knowledgeable healthcare-related experts who are convened to provide advice and assistance in resolving unusual, complicated ethical problems that involve issues affecting the care and treatment of patients There are several ethical decision frameworks you can use. One example is the five-step decision model described below, which was adapted from the Josephson Institute’s approach to ethical decision ­ making: 1. Determine the facts. Examine the facts and separate them from assumptions and opinions. 2. Define and examine the ethical issue. Define the precise ethical issue and examine which ethical principles and values are involved. Review the ethical guidelines of your profession and organization. 3. Identify alternatives and their consequences. Carefully consider the benefits, burdens, and risks to each stakeholder involved in each alternative. Eliminate any impractical, illegal, and improper alternatives. Monkey Business Images/Shutterstock.com Ethical Dilemma Imagine that you are a dentist. Consider a situation in which the principle of beneficence calls upon you to assist a patient who is in so much pain that he wishes to have a tooth immediately extracted. Upon examination, you cannot find anything particularly wrong with the tooth and suspect the pain is caused by a nerve issue unrelated to the tooth itself. You believe that the patient should be referred to a specialist for additional assessment. Is it honoring the patient’s autonomy to extract the tooth as requested? Might it be malfeasance to honor the patient’s wish when not medically indicated? What if you pulled the tooth and the pain continued?