Ethics- Decision Making Model (Brasile)

Decision making model for ethic situations:

Ethical Decision Making Process
-Frank Brasile

Recognize A Moral Issue:

An elderly woman who has advanced dementia and is a high fall risk desires to
participate in a nature walk. CTRS is unsure if she is cognitively or physically
able to make a healthy decision to participate and self-govern herself with her
medical condition of advanced dementia during the group intervention. The
conflict is both at a personal and an institutional level. What makes this decision
uncomforting is the fact that the client is a possible risk of falling and injury while
participating in the intervention.

Begin Your Decision Making:

The patient has a history of heart disease, advanced dementia, is considered a high
risk for falling, and has tendencies to wonder away. As individual considerations,
these facts do not pose an impossible threat, however, all of these factors
combined make the client a possible risk during an outdoor event.
The people involved in this decision are the CTRS, the client, and the facility in
which the client lives and the CTRS works.
The obligations are to the client. Providing the best care for each patient is the
main obligation for every CTRS. The end decision is up to the CTRS. It is their
responsibility to provide the best and safest patient care and make the difficult
decision about a patients safety. According to the ATRA Code of Ethics,
Therapeutic Recreation personnel have a duty to preserve and protect the right of
each individual to make his/her own choices. Each individual is to be given the
opportunity to determine his/her own course of action in accordance with a plan
freely chosen.
The persons effected by the decision are the client, the CTRS and the facility. If
the wrong decision is made, the client could possibly miss out on an effective
treatment option or the client could be harmed while out on the nature walk if she
were to wonder off on her own and become weak and fall. The CTRS could be
affected if the wrong decision is made. If the client participates in the activity and
is harmed, the CTRS will be held reliable. If the client does not participate in the
activity, the CTRS will then have to find new ways to give the client the kind of
experience she would have had if she had participated in the activity. The final
party the will be affected by the decision is the facility. If the wrong decision is
made and the patient is harmed while participating in the activity, the facility will
be liable.





Ethics- Decision Making Model (Brasile)
Brainstorm Alternatives:
Alternative 1: Allow the client to come on the outing provided that a member off
the facility staff stay with her at all times. Adding an extra member of staff to
watch over her at all times will take away a portion of the clients freedom in the
activity but will ensure her safety during participation.
Alternative 2: Prevent the client from participation in the group activity but allow
her the opportunity for a similar experience one-on-one with the CTRS. Taking
away the distractions of other clients will allow the client the experience but take
away the risk of wondering and falling.

Look at Each From Various Points of View:
Alternative 1:
o The Virtue Approach- trust the client will not wonder off and stick with
the group. This way if anything happens, she will be with the CTRS and
other staff members and will be safe.
o The Utilitarian Approach- the client may feel she is being treated
differently than the other participants of the activity because she will not
be able to participate in the same manor.
o The Rights Approach- this alternative allows the client to make her own
decision in regards to her treatment; however it does allow the CTRS and
the facility to feel more at ease with the possible risk situation.
o The Fairness Approach- this alternative is the fairest and safest possibility.
It allows the client to receive the same experience and treatment as all the
other participants while keeping her from wondering and getting hurt.
o The Common Good Approach- This alternative gives the client the ability
to be with other participants in the activity and enjoy the company while it
keeps her safe from possible risks and harm.
Alternative 2:
o The Virtue Approach- with ample supervision, the client will be able to
gain a similar experience as the rest of the group but only under special
circumstances in a one-on-one setting with the CTRS.
o The Utilitarian Approach- the client may feel she is being treated
differently than the other participants of the activity since she will not be
able to participate in the activity when they all do.
o The Rights Approach- this alternative give the client the opportunity to
have the experience and solves the risk situation, however, it does not
allow to client to gain the same experience as the other participants of the
group. She will not be on the same outing.
o The Fairness Approach- this alternative isnt the most fair of the options.
It will keep the client safe; however, it does not provide the same
treatment as the other participants and may be unfair.
o The Common Good Approach- This alternative actually takes away the
ability to share the experience with other participants.



Ethics- Decision Making Model (Brasile)
Look at Each Suggested Alternative in View of Obligations, Ideals and Greatest Good:
Alternative 1:
o The most benefited party in this alternative is the client and the facility
because the client will get exactly what they want by being able to
participate in the nature walk and the facility will have insurance that the
client will be safe.
o No obligation will be reneged with this alternative.
o Yes, this is an option that would make the CTRS feel more comfortable.
o This alternative holds up to the ideal that the client should be able to
participant in all interventions of their choosing.
o The possible effects of this decision:
The facility will have to employ an extra staff member for the
activity or use a volunteer that could be utilized elsewhere
The client will gain the desired experience
If the client does start to wonder away from the group, the staff
member or volunteer will be able to redirect them to the group
If the client does fall or become injured, there will be a qualified
person available to assist them
o This alternative treats all parties in a fair manor.
o This alternative is best for all concerned.
o This alternative would make a good rule for all people to live by: If you
are unable to perform a task solo, ask for help or assistance.
o This alternative would lead to the best overall consequences.
Alternative 2:
o The most benefited party would be the facility because they will be able to
give the client a similar experience to the one they wanted but also know
for sure the client will be safe from harm.
o With this alternative, the obligation that the client is allowed to choose
their treatment will be reneged.
o This is not something that the CTRS would be able to live with.
o This alternative does not perfectly hold up the ideal that the client should
be able to participate in all interventions of their choosing.
o The possible effects of this decision:
The facility and CTRS will have to make time for the one-on-one
activity
The facility may have to pay the CTRS overtime
The client will miss out on the benefits of group interventions
The client will be safe
The client will be able to personalize the activity to what they may
prefer
o This alternative is not the most fair.
o This alternative is not the best for all parties concerned.
o This alternative would not make a good rule to live by: If you are unable
to do something, make your own rules to get what you want.
o This alternative will not lead to the best overall consequences.

Ethics- Decision Making Model (Brasile)
Make You Own Decision:
With all things considered, the first alternative would have the least amount of
negative consequences with the largest amount of benefits to all parties
concerned.
This decision would be one that other people would respect. It allows the client to
remain autonomous while keeping liabilities and risks at bay.