How to Determine Alternative Solutions

In your continuing effort to develop a policy regarding transplants for patients on methadone maintenance, Dr. Jones has now asked you to propose at least three alternative solutions to Mr. F’s case. Additionally, the committee would like you analyze the consequences of each solution and the people who may be affected by it. Finally, they would like you to determine how each solution will relate to the ethical principles presented in this case. Using the template Dr. Jones provided, you need to write up your thoughts to share with the committee.

This step-by-step guide will help you complete your work. 

1. Review the email from the Ethics Committee. You may want to print the email and highlight the important points.

2. Download the Proposed Solutions template.

3. Determine the alternative solutions.
   The first step in this task is to consider some possible solutions to the problem at hand. To help set you on the right track, before you begin, let’s look at an example that illustrates some possible alternatives. Let’s consider the example of assisted suicide, as we have been in the earlier steps in the process. Your patient, Scott Perkins, is terminally ill. You do not expect him to live more than 6 months. He has asked you to help him take his own life, explaining to you that he is in great pain and would prefer to end his suffering quickly. What are your options?

1. You can refuse to help him;

2. You can unconditionally agree to help him; or

3. You can agree to help him under a set of conditional circumstances. For example, your conditional criteria could indicate that you will only help him if he is in the last month of his life and no longer responds to pain medication.

Keep in mind that during this step you are simply identifying possibilities. You may have some preliminary opinions about Mr. F’s case, but you should set those aside for now. Even if you think you may be opposed to one of the alternatives, you should still list it. During this step, you are not making any ethical or moral judgments about the possibilities. 

List all the alternatives you can think of and insert them in the first column of the Proposed Solutions template. Remember you have been asked to come up with at least three alternatives—one extreme, the other extreme, and then at least one conditional compromise, however feel free to include as many alternatives as you can think of.

4. Note related open questions.
   In the process of considering alternatives, questions may arise for you about details related to specific issues within this case or the options you are considering.  There is space in the template for you to list any questions you might have.  You don’t HAVE to have questions, but if you do, note them.
   
   You may seek out answers to any questions on the Internet if time allows.  Keep notes on any such findings if you think you may use them in defending any options or conditions, and make sure to cite your sources. If there isn’t enough time to find answers to all of your questions, list the questions in the appropriate column, and write down how the answers to the questions would impact the ethical principles involved with the related solution. 
   
   For example, in the case of assisted suicide, you might want to know how often it is that doctors think someone only has a short time to live, when in reality they live much longer.  If you don’t have the answer, you may include a potential solution that says, “Assist suicide if doctors agree the patient has only a very short time to live.”  And then you should write as an open question: “Do people who are said to have a short time to live frequently live much longer?”  Then, when relating the solution to the relevant principles, you should note how the answer to your open question would impact the ethical principles involved.
   
   Keep in mind that even if you have time to do Internet research you may not be able to answer every question you have on a case.
   
   
5. Determine who will be affected by this alternative.
   Let’s continue using your patient, Scott Perkins, as an example. As you think about each alternative, what are the consequences for Scott? For Scott’s family? For you? For the hospital? For society? As you think about the consequences for each party, you may realize that this is an illegal act and that you could lose your medical license. Suddenly your other patients may also be affected by this situation. What will happen to your other patients if you are no longer able to treat them?
   
   In column three of the Proposed Solutions template, list all those people who will be affected by this decision.
   
   
6. Determine the consequences of each solution.
   Consider the positive and negative consequences associated with each alternative. What are the good results from this decision? What are the bad results from this decision? How will it affect each of the people you listed in column three?
   
   Remember that this decision may have far-reaching effects. There will certainly be consequences for all the people involved in the issue, but there may also be broader ramifications for your colleagues, for the hospital, in the community and in the world at large. You should also think about what precedent your decision will set and how the decision will affect similar cases in the future.
   
   
7. Analyze how each solution relates to the ethical principles of the issue.
   As you weigh each alternative, you should also consider how it relates to the ethical principles you identified in Ethics Task 1.1: Define Ethical Principles. Capture these ideas in the fourth column of the Proposed Solutions template.
   
   
8. Complete the table by repeating these steps for each alternative you identify.
   
   
9. Check your work. Before submitting your work, take a moment for detailed review..
1. Did you propose at least three possible alternatives?
2. For each alternative did you:
1. List relevant open questions?
2. Determine those potentially affected?
3. Consider both the positive and negative consequences?
4. Determine how it addresses the ethical principles of the case?
3. Did you capture your ideas on the Proposed Solutions template?
4. Did your team create one document that represents the ideas and effort of each team member?
   
   
10. Submit your work to the mentor.
    Review the checklist on the Submit Your Work section of this task and submit the document to your mentor.

What is Ethics? This short paper answers the question, "what is ethics?" and provides an overview of how it's used.

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