Medical decision-making: Whose values?

Abstract

Bioethical debates contribute to discussions about the direction of healthcare funding as we enter the twenty - first century. The funding of healthcare is debated by economists, bioethicists and clinicians. Because of their practice experience and knowledge base social workers are also well-placed to contribute to such issues. The debate has taken place at the ‘macro’ rather than the ‘micro’ level. Yet many ethical decisions about healthcare are made at the patient's bedside. Are they procedural or clinical decisions? Are decisions made for a group or class of patient or on an individual basis? Answers for these questions are sought in a study of medical decision-making for head-injured patients admitted to the Intensive Care Unit of a major teaching hospital.

This paper attempts to draw out ethical principles which are part of medical decision-making. The notion of contextual ethics is likened to the ecological approach of Carel Germain which provides a useful framework for ethnomethodological research.