Ethical decision-making processes used by health care providers.

This paper reports the results of a study conducted with 18 health care providers (HCPs) in two Toronto hospitals. The study examined and assessed how these HCPs make clinical-ethical decisions in the light of a theoretical model of clinical-ethical decision making. Nine nurses and nine doctors were interviewed through two-phased, in-depth, semi-structured interviews. The results suggest that, in relation to the two major elements of the model, namely the ethical component and the decision theory component, the HCPs did not follow a consistent and systematic pattern of ethical decision making. Differences emerged between their actual self-reported behaviour and their potential more capability (i.e. their abstract thought process). The general picture that emerged was that decisions were made in a narrow, habitual manner, through the elimination of the most significant and demanding elements of the process. HCPs' ethical approaches affected the entire process of the decision making: their perception of the problem, their search for and selection of information and evidence, and their development of alternatives and resultant consequences. It is suggested to (a) further investigate and understand the subjective realities of the individuals involved in the decision making processes, their values and the meaning they ascribe to their choices, and (b) to establish extensive educational programmes to enhance HCPs' decision-making capacity and subsequently promote an effective and responsible professional practice.