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Resolving Tough Choices

At any moment in daily life, situations can arise which change things forever. So much so, attempts to even remember what life was like before can be skewed. Memorable days, such as 9/11/2001, shift our world to the point where the new world-view is just a part of life. Individually, our world-view can be changed just as drastically. Take for instance the story of a brother and sister riding the subway home late one evening. Far from a serene setting, they were treating each other horrendously. One of the nearby passengers finally spoke up to the dad, and with an obvious shortness of voice, asked him to calm his children down. The father, who until the comment, was staring off into space, stated, "Oh, I'm sorry they're acting up, their mother just died tonight, I'm sorry." This startled all the onlookers and each became much more gracious to the grieving family.

The family experienced a world-view changing moment that evening, and to a much lesser extent, so did the onlookers. Our frames of reference are always lacking information in one way or another. When news is heard which changes things, our world-view changes to a response incorporating the new information. Although tough ethical decisions need not be surprising, they are no less world altering for those involved.

The Lesser of Two Evils

Tough ethical decisions have been referred to as choosing "the lesser of two evils." Tough choices are just that: tough. When values are in conflict, decisions which place one value over another can be difficult. Take for instance, the story of a gang member whose bullet wounds need to be treated. Since he doesn't have insurance, he must be treated at home by the only available caregiver, his sister. Just before being discharged from the hospital, the doctor is faced with the decision whether or not to tell the sister, against the brother's wishes, her brother is HIV positive. Here, several values conflict. Telling the sister breeches the brother's trust, he expects the doctor to abide by the laws of medical confidentiality. However, the sister expects the doctor to do no harm, and trusts his advice. Caring for the man's wounds will no doubt, be a big risk to her.

Tough decisions have options. Often, like the story above, the decision appears to be simply "yes" or "no," should the doctor tell the sister or not. However, after reviewing the situation, there may be other options. This is where it is helpful to turn to an ethical decision making model.