[Method of analysing ethical conflicts in care practice]

In every clinical relationship decisions must be taken in conditions of uncertainty, which requires reasonableness and prudence. How is this to be done in the best way possible? By deliberating. The two most successful methodological proposals in the application of bioethics have been casuist and principalist, which have similar contents but different bases. In this article these proposals are applied to a practical case in which the withdrawal of life supporting treatment was posed. The analysis is carried out in four steps: the first is to realise, in the absence of malice, a clinical evaluation of the indication or indications for intervening medically. The second step takes us to the principle of justice or the contextual features, procuring an equitable share out of health resources. The third step refers to the principle of autonomy, that of the patients' preferences. This principle is the latest to emerge in health relationships and is probably the one that poses the most problems. Respect for the autonomy of the person affected implies considering three aspects: capacity, information and voluntariness. The fourth and final step deals with the principle of benefit or quality of life. This criterion is necessarily linked to the preferences of the patient himself and, besides, its general content includes attempt by the health practice to promote well-being, to assist and cure diseases, to promote and maintain health, to alleviate pain and suffering, to avoid premature death and to ensure a peaceful death. Deliberation and weighing up each of the contents of the above steps is the methodological proposal that is set forth, with the argument favouring the pre-eminence of one or another of the aspects depending on the data presented by each case.