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丂丂



0-2 Summary of the patient乫s medical history


I. Analysis and sharing of informationA. 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乫s family

B. Life and will of the patient and family

1B-1 The patient乫s understanding and will


1B-2 The family乫s understanding and will


1B-3 The patient乫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.