A medical ethical reasoning model and its contributions to medical education.
OBJECTIVE
Ethical reasoning in medicine is not well understood and medical educators often find it difficult to justify what and how they teach and assess in medical ethics. To facilitate the development of moral values and professional conduct, a model of ethical reasoning was created. The purposes of this paper are to describe the ethical reasoning model and to indicate how it can be used to foster moral and ethical behaviours.


METHODS
The ethical reasoning model was created from information derived from two sources: (i) an examination of different ethical models described in the literature, and (ii) think-aloud interviews with ethical experts in Taiwan and Canada. All the components and cognitive steps used by experts in ethical decision making were extracted and categorised. Interview subjects consisted of 16 voluntary ethics experts. The ethical reasoning models reported in the literature were divided into two groups according to whether they were justification-based or task-based models. Neither of the two types represented the 'whole picture' of ethical reasoning in medicine. This analysis enabled us to identify five universal cognitive steps and the gaps between 'logical decision' and 'action'.


RESULTS
The think-aloud interviews verified the multi-dimensional components or steps used by experts when resolving ethical problems. The resulting model, designated the Medical Ethical Reasoning (MER) Model, reflects interactions within three domains: medical and ethical knowledge; cognitive reasoning processes, and attitude.


CONCLUSIONS
The MER Model accurately reflects how doctors resolve ethical dilemmas and is seen to be helpful in identifying what and how educators should teach and assess in ethical reasoning. The model can also serve as a communication framework for curricular design. A 'humane' doctor is competent in providing quality, ethical patient care. Making an appropriate ethical decision is the foundation for subsequent ethical behaviours. By contrast with the abundant evidence cited in previous research describing how doctors solve medical problems, there is little empirical evidence indicating how doctors make appropriate ethical decisions. Thus, the cognition of ethical reasoning in medicine is not well understood. This paper represents a step towards overcoming this problem.
Tsai
Tsuen-Chiuan
TC
Department of Paediatrics, E-Da Hospital, Jiau-Shu Tsuen, Yanchao Township, Kaohsiung County, TaiwanDepartment of Chinese Medicine, I-Shou University College of Medicine, Jiau-Shu Tsuen, Yanchao Township, Kaohsiung County, 82445 TaiwanDepartment of Health Care Administration, I-Shou University College of Medicine, Jiau-Shu Tsuen, Yanchao Township, Kaohsiung County, Taiwan.
Harasym
Peter H
PH
Department of Paediatrics, E-Da Hospital, Jiau-Shu Tsuen, Yanchao Township, Kaohsiung County, TaiwanDepartment of Chinese Medicine, I-Shou University College of Medicine, Jiau-Shu Tsuen, Yanchao Township, Kaohsiung County, 82445 TaiwanDepartment of Health Care Administration, I-Shou University College of Medicine, Jiau-Shu Tsuen, Yanchao Township, Kaohsiung County, Taiwan.
D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics*; D004501:Education, Medical / Q000941:ethics* / Q000379:methods; D004992:Ethics, Medical / Q000193:education*; D006801:Humans; D008962:Models, Theoretical; D011340:Problem Solving / Q000941:ethics*