He also argues that each of these worlds has its own «claim to validity,» namely: We used this framework at the University of Chicago`s Burn and Complex Wound Center and found it effective in solving the ethical problems that arise. The purpose of this paper is not to prove the superiority of the four-quadrant approach over other models, but to discuss its usefulness and application in the context of combustion feeding. It is also important to define how expected management decisions could benefit or harm the patient. For severe burns, these include the optimal timing of surgery, the need for topical or systemic antibiotics, nutritional optimization, volume replacement, airway management, and rehabilitation. It is important to note that severe burns often have long-term functional and aesthetic consequences that should be discussed and addressed with the patient and family members. From there, you can build ethical solutions on a much more complex level and in a more consistent way – that is, they can become more ethical, do more «good». That is what it is all about. In the lower left quadrant, we have illegal and ethical actions. Therein lies one of the confusions for some people. If they read illegally, they do not read further. They say, «If it`s illegal, don`t do it, no matter what.» When Rosa Parks did not give up her seat in the colored bus section to a white passenger after the white part was filled, she acted illegally but ethically. When Mahatma Gandhi liberated India from the British, he acted illegally but ethically. When Miep Gies hid Anne Frank, the Jewish girl, from the Nazis, she acted illegally but ethically.
Jonsen, Siegler, and Winslade described an approach to clinical-ethical case analysis known as the «four-quadrant» approach.5 This framework, which is based on the four principles but takes a more practical and clinically oriented approach to ethical challenges,6 has been popularized by its use in the postgraduate training program of the MacLean Center for Clinical Medical Ethics at the University of Chicago.7 In this context, All ethical issues are analysed in the context of four themes: medical indications, patient preferences, quality of life and contextual characteristics (social, economic, legal and administrative). Each question can be addressed through a series of specific questions, with the aim of identifying the different circumstances of a particular case and relating them to their underlying ethical principle.8 Thank you for listening. May you all give goodness to the world and to each other in the four quadrants. The first quadrant, medical indications, includes diagnosis, prognosis, proposed measures for assessment and treatment, and expected outcomes. For all clinical scenarios, it is advisable to first describe what is known about the medical facts of the case. In the context of incineration supply, this may include the nature and severity of the burn, the planned interventions and the expected sequence. While this topic is part of any clinical discussion, in cases where there are ethical challenges, it is particularly important to further articulate the purpose and objectives of planned interventions. Finally, in the upper left quadrant, we have legal and unethical actions. These actions are another source of confusion. Again, once people read «legally,» they don`t read any further. They say, «If it`s legal, I can do it no matter what.» However, history is full of unethical laws.
It was legal to have slaves; killing Jews; to have separate water fountains for blacks; Put Nelson Mandela in jail for defying apartheid laws in South Africa. It is legal to deport a mother residing illegally in America and separate her from her 2-year-old American daughter; All these legal acts are unethical. So we have four main schools of normative ethics: rules-based ethics, contractualism, virtue-based ethics, and consequentialism. Everyone, I would say, has their own claim to validity: the principles of charity and non-evil are emphasized during this discussion of the goals of care. In fact, any decision made regarding therapy, such as: whether and when surgery should be performed, weigh the clinical and ethical benefits and risks. Questions of goals of care and decision-making capacity often arise in severely burned patients due to the severity of burns and the fact that patients may not be able to make acute informed decisions. Before entering into ethical discussions about the goals of treatment, we try to make an accurate diagnosis of the problem and determine its severity and expected results. In addition, we want to give the patient and their family meaningful answers to questions about recovery and the chances of successful treatment. Many frameworks are in place to help health care professionals address ethical challenges that arise during clinical care. The best known is that of Beauchamp and Childress.3 This framework addresses ethical issues in the context of four moral principles: respect for autonomy, charity, non-evil, and justice (see Table 1). This framework has been influential because the values it represents seem to align with our moral standards.
In addition, it provides a practical approach to both teaching and analyzing ethical challenges. One shortcoming of this framework, however, is that there is little empirical evidence that humans apply the four principles to ethical decision-making.4 How the fractal nature of the four-quadrant integral model can help (solve) paradoxes within ethics. Clinical cases do not exist in isolation, but are part of a larger context that may be relevant to ethical analysis. Contextual characteristics that can influence decision-making include patient-specific factors such as family dynamics, financial resources, or religious or cultural identity; the possible legal effects of care; and the personal biases of everyone involved in patient care. Although these aspects are often not explicit, they can have an impact on patient care and therefore need to be taken into account. Page K. The four principles: Can they be measured and do they predict ethical decisions? BMC Med Ethics. 2012;13:10. doi:10.1186/1472-6939-13-10. Identifying these four validity claims brings us to the next step in this investigation, which is how the integral model can be applied to these different ethical perspectives.