Step 1 – Identifying the Key Question
- Determine the philosophical problem(s) the group is working to solve
- The question we ask will determine the type and scope of answer we get.
- You want to ensure that the group is working on the same problem and asking the best question to help solve that problem.
- List each as a possible question that the group might tackle.
- For each, ask: if we get an answer to this question, will it provide sufficient direction for us to deal with the issue?
- Select a key question from the list.
- Many questions will present themselves; the challenge is choosing which should be addressed in the time immediately available.
Tips for Success
Often we want to focus on specific interventions (should we treat the pneumonia, should we attempt resuscitation, etc.), but it’s important to remember that how we answer these will depend entirely upon the goals of care for the patient.
- Focus on a broad question that, if answered well, will likely include more specific ones and will provide meaningful direction for moving forward.
- Some questions are really about missing information. Avoid these, we will get to them in the next section.
- Avoid yes or no questions to allow a broad range of answers.
- Questions that begin with “What should” or “How should” work well.
- Only include descriptors in the question about which there is explicitly shared agreement.
- Try to use honest and accurate, yet morally neutral, language — language that others will be able to hear without feeling threatened or judged.
- While this process looks linear, it does allow movement back and forth between steps. It is just fine to choose a key question, continue with the conversation, then return back to confirm and if need be, alter the question selected.
- Don’t worry if this step seems difficult — it is! Take the time to do this work first.
- It can be helpful for the leader(s) to think about this in advance and come to the meeting with one or two possibilities in mind.
To download the Ethics Based Decision Process Workup, please click here.