Cook, Ann & Hoas, Helena.
National Rural Bioethics Project: The University of Montana
ETHICAL DECISIONMAKING PROCESS1
1. Determine the Organizational Foundation for Ethical Decisions
o Golden Rule: ideal, greatest benefit for greatest number
o Silver Rule: avoiding harm, a minimum requirement for ethical conduct
o Tin Rule: acknowledging the potential for harm, best interest for stakeholders,
but seeking the lesser of two harms.
2. Clarify the Organizational Standard
o Golden rule: the best healthcare for the greatest numbers of people
o Silver rule: (doing more than avoiding harm but not fully committed to the best
healthcare for the greatest number of people)
o Tin rule: pursuit of good without violating the rights of stakeholders.
3. Initiate a Process for Making Ethical Decisions
o Clarify harms to affected parties and seek the lesser harm
o Weigh the potential harms, the consequences in terms of seriousness & quantity
o Clarify the commonly accepted rules and norms for the culture/community; this
includes consideration of organizational, professional and cultural norms
o Determine mitigating circumstances, chiefly, the capacity to act with knowledge
and freedom
o Develop strategies to minimize harm to those who may be harmed
4. Develop Criteria for Outcome
o Seek the best that can be done
o Clarify the minimal criteria for organizational ethics (standard you won’t go
below)
o Disseminate the accepted rules
o Act with consistency
o Seek ways to compensate the vulnerable and disadvantaged
1
This overview is based on ideas of: Spitzer, RJ. 1998. Rekindling spirit in the organization. Robert J.
Spitzer, S.J., Ph.D.; Haddad, A. 1998. “The future of ethical decisionmaking in healthcare.” Nursing
Clinics of North America 33 (2): 373-384; Toyrv, E., Herve, R., Mutka, R., Savolainen, P. & Seppanen, M.
1998. Ethics in healthcare: developing an instrument to assess humane caring. Nursing Ethics 5, (3):228235; Young, R. & Bowen, R. 1999. On and off the playing field: ethics in medicine. Journal of Healthcare
for the Poor and Underserved, 10, (2):178-185