Method for Analysis of Clinical Ethics Cases Essay

Method for Analysis of Clinical Ethics Cases Essay

In the course of nursing practice, nurses encounter ethical dilemmas while handling clinical cases. Jonsen’s four-topic approach offers a relevant case-based method to solve ethical dilemmas encountered during the delivery of healthcare (Toh et al., 2018). The model encompasses four topics: medical indications, patient preferences, quality of life, and contextual features. These four quadrant model approaches clinical cases based on four moral principles, including respect for autonomy, beneficence, non-maleficence, and justice (Teven & Gottlieb, 2018). Medical indications focus on the principles of beneficence and non-maleficence, while patient preference is principally embodied in respect of autonomy. On the other hand, quality of life integrates beneficence, non-maleficence, and respect for autonomy, while contextual features address the principle of justice.

While rotating in the obstetrics and gynecology ward, I encountered a case scenario that warranted the deployment of the four-quadrant model approach. The patient was a 28-year-old Christian who had just received her first ultrasound scan that had revealed a fetus with very severe congenital malformations that warrant termination of pregnancy. As Christians, the patient and her family strongly objected to this decision as they believed life is sacred, begins at conception, and is the will of God. In fact, they opted for prayers and other spiritual interventions and that miracles could happen as God is the ultimate healer. A careful look at the ultrasound revealed anencephaly making the fetus incapable of extrauterine life. The patient was a primigravida and strongly desired to keep her pregnancy. In this case scenario, the termination of pregnancy was in the best interest of the patient since failure would result in stillbirth and associated psychological distress associated with giving birth to such an anomalous fetus. Therefore, should patient autonomy to keep the pregnancy and consider spiritual intervention be respected?

I suggested the involvement of an interprofessional team, and a meeting was convened together with family members and all stakeholders, including religious leaders. Initially, it was hectic, but after careful negotiation and consideration of previous similar cases,  a collective decision was made to terminate the pregnancy since the fetus had almost zero chances of extrauterine survival and its quality of life was extremely poor. Similarly, the parents were educated about the importance of prenatal screening and other risk factors associated with congenital malformations. Additionally, the patient and her family were also counseled and emotionally supported to go through this difficult period. In conclusion, this model allowed the resolution of an ethical dilemma brought about by conflicting religious and scientific perspectives of life.



Teven, C. M., & Gottlieb, L. J. (2018). The four-quadrant approach to ethical issues in burn care. AMA Journal of Ethics20(6), 595–601.

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Toh, H. J., Low, J. A., Lim, Z. Y., Lim, Y., Siddiqui, S., & Tan, L. (2018). Jonsen’s four topics approach as a framework for clinical ethics consultation. Asian Bioethics Review10(1), 37–51.


Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.

In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?

Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.

Review the rubric for further information on how your assignment will be graded.

TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases

Medical Indications: The Principles of Beneficence and Nonmaleficence

1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?

2. What are the goals of treatment?

3. In what circumstances are medical treatments not indicated?

4. What are the probabilities of success of various treatment options?

5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

Patient Preferences: The Principle of Respect for Autonomy

1. Has the patient been informed of benefits and risks, understood this information, and given consent?

2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?

3. If mentally capable, what preferences about treatment is the patient stating?

4. If incapacitated, has the patient expressed prior preferences?

5. Who is the appropriate surrogate to make decisions for the incapacitated patient?

6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy

1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?

2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?

3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?

4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?

5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?

6. What are plans and rationale to forgo life-sustaining treatment?

7. What is the legal and ethical status of suicide?

Contextual Features: The Principles of Justice and Fairness

1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?

2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?

3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?

4. Are there financial factors that create conflicts of interest in clinical decisions?

5. Are there problems of allocation of scarce health resources that might affect clinical decisions?

6. Are there religious issues that might influence clinical decisions?

7. What are the legal issues that might affect clinical decisions?

8. Are there considerations of clinical research and education that might affect clinical decisions?

9. Are there issues of public health and safety that affect clinical decisions?

10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

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