How is clinical ethics reasoning done in practice? A review of the empirical literature

Clinical ethics reasoning is one of the unique contributions of clinical ethicists to healthcare, and is common to all models of clinical ethics support and methods of case analysis. Despite being a fundamental aspect of clinical ethics practice, the phenomenon of clinical ethics reasoning is not well understood. There are no formal definitions or models of clinical ethics reasoning, and it is unclear whether there is a shared understanding of this phenomenon among those who perform and encounter it.

A scoping review of empirical literature was conducted across four databases in July 2024 to capture papers that shed light on how clinical ethicists undertake or facilitate clinical ethics reasoning in practice in individual patient cases. The review process was guided by the Arksey and O'Malley framework for scoping reviews.

16 publications were included in this review. These publications reveal four thinking strategies used to advance ethical thinking, and three strategies for resolving clinical ethics challenges in individual patient cases. The literature also highlights a number of other influences on clinical ethics reasoning in practice.

While this review has allowed us to start sketching the outlines of an account of clinical ethics reasoning in practice, the body of relevant literature is limited in quantity and in specificity. Further work is needed to better understand and evaluate the complex phenomenon of clinical ethics reasoning as it is done in clinical ethics practice.