Moral factors

Moral factors are elements in decision making that relate to our relationships, as individuals and communities, with other people and the values used to [Page 784]structure ways of living well. Moral factors pervade every medical decision but often go unnoticed because in standard practice there is consensus on how to balance competing moral factors best. These factors become most apparent in particularly troubling circumstances, such as a diminished mental capacity, limited resources, or vulnerability of subjects in research. Western medicine has a long tradition of attempting to enumerate and codify these factors to provide a practical guide for both ethical conduct and decision making. Attempts to do so include the Hippocratic oath, the American Medical Asso ciation's Code of Ethics, the Nuremberg Code, the Declaration of Helsinki, and the Belmont Report. Code-based approaches to understanding moral factors essentially rely on a snapshot of circumstances. Focusing on one set of values or a standard set of circumstances to the exclusion of others can create a blindness to other relevant factors. The consequences of losing sight of the diversity of moral factors can lead to a failure to identify a lack of consensus and the need for an evaluative moral calculus. Moral philosophers such as Aristotle, Kant, Mill, and Dewey each proffer theories on moral factors based on different understandings of the good life. In the end, moving from theory to practice requires that training, experience, and careful analysis be used for identification of relevant moral factors.

The sheer scope of moral factors necessitates that only a broad outline of kinds can be delineated in the current entry. The variety of relevant moral factors in any set of situations in a clinical environment can be analyzed at policy, care provider, and patient levels. These factors become more complex when treatment occurs in a research context. The sections below address three of the most interesting and important moral factors that manifest during considerations of complex medical choices. These include issues of autonomy and bodily integrity, clinical research, and nonmedical elements. Within each topic, the moral factors for various stakeholders are explored.