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Not all decisions are made easily, and, in some cases, there are multiple factors that influence decision‐making, such as personal experience, religion, regulatory codes, legal issues and so on. In practice, a practitioner will use a combination of all such factors to reach a decision; this is sometimes described as a systematic study of moral choices. In the first instance, the code of behaviour or conduct presented by a regulatory body is considered correct. Within healthcare, there are many examples of ethical decision‐making process which include varying numbers of steps to follow. Overall, there is the general adoption of principle‐based ethics to guide decision‐making practice within healthcare, which is evident in this example.

Step 1 – Ability to recognise an ethical issue. Ask yourself: could this scenario or decision cause harm or damage to someone or some group? Are there choices between different alternatives; for example, a good and bad alternative or, maybe, two bads or two goods? Is this situation bigger than what is efficient? Or what is legal? What are your initial gut reactions? By considering the scenario on an emotive level you can recognise your own assumptions, values and biases so that you can set them aside before analysing the situation critically.

Step 2 – Gathering the facts. What facts are already known? What other relevant facts need to be gathered? Who are the relevant stakeholders within this scenario and its outcome? Has everyone involved been consulted? Are some concerns more important than others?

Step 3. Evaluation of alternative options or actions. Includes questions from a range of approaches. From a utilitarian approach ask: which actions/option do the least harm and produce the most good? Considering the deontological approach – which actions/option best respects all stakeholder rights? From a nursing approach, which actions/option treat people proportionately or equally? Which actions/option best serve the whole community and not just some if its members? From a virtue approach, also consider which actions/option lead me based on the type of person I want to be?

Step 4. Make the decision. When all approaches have been considered, which actions/option best addresses the scenario? Which action/option is best based on all the stakeholder core values? Consider what others might say when you have shared your chosen actions/option, can you justify your choice?

Step 5. Carry out the actions/option chosen and reflect on the outcome. Plan how your decision can be implemented with the upmost care, pay attention to any concerns raised by all of the stakeholders. Implement your plan and evaluate. Reflect on the results of your choice of decision and what have you learned from this specific scenario. Consider how the ethical problem could be prevented in the future.