Case Management Insider

The process of ethical decision-making

By Toni Cesta, PhD, RN, FAAN
Senior Vice President
Lutheran Medical Center
Brooklyn, NY

The ethical decision-making process is similar to the case management process and the nursing process. The steps include:

  • Assessment: Gather and document pertinent facts, medical and non-medical. Consider who is involved, what the time parameters are, where the problem lies, and why it has occurred.
  • Diagnosis: Identify the ethical issue as clearly as you can. Be sure the issue you are dealing with is truly an ethical issue and not an issue of missed communication or patient care management.
  • Planning: While planning the solution to the problem, determine the objective of the ethics consult. A helpful tip is to determine the long and short-term consequences of each potential solution. Can you ethically justify each course of action that you are considering? If you cannot ethically justify any potential solution, that solution should be eliminated as a possibility.

Clearly identify the moral obligations of the hospital and in your role as a case manager. Select the course of action that is most defensible. When in doubt, err on the side of the patient. This course of action is almost always defensible.

Most importantly, when you are unable to solve the problem, that is the time in which to call an organizational ethics consultation! The organizational ethics committee can review all the information you previously gathered and help in facilitating a decision.

  • Implementation: Implement the selected course of action to address the ethical dilemma.
  • Evaluation: During the evaluation step, you, in concert with the organizational ethics committee, should critique the decision. If consequences have occurred, or do occur in the future, those should be discussed as an opportunity to learn and use the information gathered to help when the next issue arises. (For more information about codes of ethics, see box below.)

Professional Codes of Ethics Specific to Case Management

Several professional organizations provide codes of ethical conduct. As a case manager, you should be familiar with them as they provide a structure and framework for your practice:

  • American Nurses Association. Web:
  • National Association of Social Worker's Code of Ethics. Web:
  • Code of Professional Conduct for Case Managers, adopted by the Commission for Case Manager Certification. Web:
  • American Case Management Association: From the home page, click Resources, then click Publications. The code can be found in the "Standards of Practice and Scope of Services" document which can be downloaded.
  • Case Management Society of America Statement of Ethical Case Management. Practice. Web: From the home page click Individual. Under the Quick Links section, choose Standards of Practice. The ethics section is in the "Standards of Practice for Case Management" document which can be downloaded.