A Framework for Analysis of Ethical Dilemmas in Critical Care Nursing

Critical care nurses are confronted regularly with ethical quandaries such asdisputes about withdrawal of life-sustaining therapies, lack of adequate in-formed consent, and conflicts about access to care or resource allocation. When confronted with ethical questions, critical care nurses can enhance their personal integrity and advocacy by using a systematic framework in thinking about how to respond. This column explores the application of one such framework—the expanded version of James Rest’s 4-component model—to critical care practice. Rest developed a 4-component model for ethical analysis consisting of moral sensitivity, moral judgment, moral motivation, and moral action.1 Unlike most other models that focus only on analysis of the most ethically justifiable action to take, Rest’s model analyzes the role of the ethical practitioner from the initial recognition of an ethical dilemma to the implementation of the most morally justifiable plan of action to resolve the dilemma. Rest’s model begins with the ethical practitioner’s recognition that an ethical dilemma exists, and the ability to discern this is termed moral sensitivity. Then comes the component of moral judgment, and this component is similar to many other models of ethical rea-