David, who has suffered with ALS for 20 years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David's respirator if asked to do so. David has now indicated through a prearranged code of blinking eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive. The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital's policy. She states that once a patient is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against hospital policy to have any staff members present during such a procedure. After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues the life support.

What do we need to know? Who is involved in the situation? Where does the ethical situation take place? When does it occur?

II. Define the precise ethical issue.

For example, is it a matter of fairness, justice, morality, or individual rights?

III. Identify the major principles, rules, and values.

For example, is this a matter of integrity, quality, respect for others, or profit

IV. Specify the alternatives.

List the major alternative courses of action, including those that represent some form of compromise. This may be a choice between simply doing or not doing something.

V. Compare values and alternatives.

Determine if there is one principle or value, or a combination of principles and values, that is so compelling that the proper alternative is clear.

VI. Assess the consequences.

Identify short-term, long-term, positive, and negative consequences for the major alternatives. The short-term gain or loss is often overridden when long-term consequences are considered. This step often reveals an unanticipated result of major importance.

VII. Make a decision.

The consequences are balanced against one's primary principles or values. Always double-check your decision.