Sheet for Case-Examination in Clinical Ethics

Reported by Date

＊Aim of the Examination : (a) Decision Making　 (b) Problem Solving　 (c) Evaluation

0-1 Patient profile
0-2 Summary of the patient’s medical history
I. Analysis and sharing of information　A. Medical information
1A-1 Possible choices of treatments, their merits and demerits/risks: general estimation		1A-2 Social issues
1A-3 Explanation by the medical staff to the patient	to the patient’s family
B. Life and will of the patient and family
1B-1 The patient’s understanding and will	1B-2 The family’s understanding and will
1B-3 The patient’s life and values

II. Examination and orientation
Finding the problem 2-1 The Best choice: individualized judgment by the medical staff Examine on the basis of 1A and 1B	2-2 Consensus among the people involved regarding the best choice Compare 2-1 and 1B-1, 2
Analysis of the problem and how to solve it. 2-3 Causes of divergence/impediment and possible ways of solving it	2-4 How to promote communi- cation between the patient and the medical staff in order to reach a consensus E.g., How to support the patient to enable them to choose their own treatment appropriately.

III. Process of communication aiming at consensus You may describe the process after the examination according to the following format:
3-1 How has the communication with the patient and his/her family proceeded?		3-2 Social arrangement Describe what you have done to arrange and/or negotiate things for the patient and his/her family.
3-3 Conclusion and/or Decision	3-4 Follow up: Suggest necessary or useful points for the patient and his/her family after the decision is made.