Feldman, S., Gillam, L., McDougall, R. J.,
& Delany, C. (2025).
Journal of Medical Ethics, jme-110569.
Abstract
Background Clinical ethics reasoning is one of the unique contributions of clinical ethicists to healthcare, and is common to all models of clinical ethics support and methods of case analysis. Despite being a fundamental aspect of clinical ethics practice, the phenomenon of clinical ethics reasoning is not well understood. There are no formal definitions or models of clinical ethics reasoning, and it is unclear whether there is a shared understanding of this phenomenon among those who perform and encounter it.
Methods A scoping review of empirical literature was conducted across four databases in July 2024 to capture papers that shed light on how clinical ethicists undertake or facilitate clinical ethics reasoning in practice in individual patient cases. The review process was guided by the Arksey and O’Malley framework for scoping reviews.
Results 16 publications were included in this review. These publications reveal four thinking strategies used to advance ethical thinking, and three strategies for resolving clinical ethics challenges in individual patient cases. The literature also highlights a number of other influences on clinical ethics reasoning in practice.
Conclusion While this review has allowed us to start sketching the outlines of an account of clinical ethics reasoning in practice, the body of relevant literature is limited in quantity and in specificity. Further work is needed to better understand and evaluate the complex phenomenon of clinical ethics reasoning as it is done in clinical ethics practice.
The article is, unfortunately, paywalled. Follow the link above and contact the main author.
Here are some thoughts:
This scoping review examined how clinical ethicists undertake or facilitate clinical ethics reasoning in practice, focusing on individual patient cases. The review identified four thinking strategies used to advance ethical thinking: consideration of ethical values, principles, and concepts; consideration of empirical evidence; imaginative identification; and risk/benefit analyses. Three strategies for resolving clinical ethics challenges were also identified: time-limited trial, integrating patient values and clinical information, and perspective gathering. Other factors influencing clinical ethics reasoning included intuition, emotion, power imbalances, and the professional background of the ethicist. The authors highlight that the literature on clinical ethics reasoning is limited and further research is needed to fully understand this complex phenomenon.
