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and referral resources. It is essential (particularly as a student and in early practice)
that you identify both support and consultation resources for yourself. Peers tend to
be the first recourse when genetic counselors meet a challenging situation. Sharing
common experiences is important for reassurance, even when you have decided the
best action in a particular situation. Ethics committees exist in most health-care
facilities in the USA. Additionally, the NSGC has a committee that is available to
assist with ethical dilemmas. These consultants provide recommendations, not
imperatives, about available options.
13.4 MORAL Model for Ethical Decisions in Clinical Situations
Situations
Crisham ( 1985 ) created the MORAL model for clinical decision-making. In this
model, Crisham explicitly identifies ethical principles as relevant factors. The
moral model includes a grid (shown in Table 13.1) for identifying the values you
wish to honor in making a particular decision and the practical considerations you
need to take into account. Values might include the ethical principles previously
described in this chapter, or the values might be implied in explicit behavioral
outcomes such as maximizing coping ability or avoiding escalation of family con-
flict. Practical considerations may include legal issues, time constraints, reim-
bursement concerns, and other factors that influence decisions in a particular work
setting.
Prior to decision-making, you need to describe the problem and the participants,
including who makes the decision and what ethical value(s) or principle(s) is at
stake. The steps in Crisham’s decision-making model spell out the acronym
MORAL:
- Massage the dilemma: This process includes recognizing whose interests are
involved in a conflict and defining the dilemma from their perspectives. The
patient’s dilemma might result from a sense of conflicting loyalties. To formulate
a goal for decision-making, consider beginning with a sentence, “I would like to
act in such a way that...”.
Table 13.1 MORAL model
for ethical decision-making
grid
Options Values Practical Considerations- – –
- – –
- – –
- – –
- – –
Adapted from Crisham ( 1985 )
13 Professionalism: Ethically Based Reflective Practice