Four Quadrants
The “four quadrants” approach was developed in the USA by Jonsen, Siegler and Winslade, in their book Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, which was first published in 1982.
As Sokol notes, the approach may be particularly useful to clinical ethics services.
As its name implies, the approach invites reflection on four quadrants, which should be worked through in order. These four quadrants guide the committee to attend to specific domains of ethical consideration:
Indications for medical intervention: What is the diagnosis? What are the options for treatment? What are the prognoses for each of the options?
Quality of life: Will the proposed treatment improve the patient’s quality of life?
Preferences of the patient: Does the patient have mental capacity or competence? If so, what do they want? If not, then what is in the patient’s best interests?
Contextual features: Do religious, cultural and legal factors have an impact on the decision?
Click here to download a PDF with further information about ethical frameworks, including worked-through examples of how each of the different frameworks would approach the ethical analysis of a case.