Family Medicine Ethics: An Integrative Approach.

The practice of modern medical ethics is largely acute, episodic, fragmented, problem-focused, and institution-centered. Family medicine, in contrast, is built upon a relationship-based model of care that is accessible, comprehensive, continuous, contextual, community-focused and patient-centered. "Doing ethics" in the day-to-day practice of family medicine is therefore different from doing ethics in many other fields of medicine, emphasizing different strengths and exemplifying different values. For family physicians, medical ethics is more than just problem solving. It requires reconciling ethical concepts with modern medicine and asking the principal medical ethics question-What, all things considered, should happen in this situation?-at every clinical encounter over the course of the patient-doctor relationship. We assert that family medicine ethics is an integral part of family physicians' day-to-day practice. We frame this approach with a four-step process modified from other ethical decision-making models: (1) Identify situational issues; (2) Identify involved stakeholders; (3) Gather objective and subjective data; and (4) Analyze issues and data to direct action and guide behavior. Next, we review several ethical theories commonly used for step four, highlighting the process of wide reflective equilibrium as a key integrative concept in family medicine. Finally, we suggest how to incorporate family medicine ethics in medical education and invite others to explore its use in teaching and practice.