Ethox Structured Approach

First published in the Network’s Practical Guide in 2004, the Ethox structured approach was developed by Mike Parker, Anne-Marie Slowther and colleagues at the University of Oxford.

The authors have also prepared a flowchart indicating the key stages, which you can download here.

As Garcia-Capilla and colleagues note, the framework is used by some UK clinical ethics services.

This framework puts forward 11 progressive stages to work through when deliberating about a case:

  1. What are the relevant clinical and other contextual facts (e.g., family dynamics, GP support availability)?
  2. What would constitute an appropriate decision-making process? Questions to consider include: Who is to be held responsible? When does the decision have to be made? Who should be involved? What are the procedural rules (e.g. confidentiality)?
  3. List the available options.
  4. What are the morally significant features of each option? Questions to consider include: What does the patient want to happen? Does the patient have capacity (is the patient competent)? If the patient lacks capacity or competence, what is in their “best interests”? What are the foreseeable consequences of each option?
  5. What does the law and/or guidance say about each of these options?
  6. For each realistic option, what are the moral arguments in favour and against?
  7. Choose an option based on your judgment of the relative merits of these arguments using the following tools. Are there any key terms the meaning of which needs to be agreed (e.g. “best interests”, “person”)? Are the arguments valid? Consider the foreseeable consequences (local and beyond). Do the options “respect persons”? What would be the implications of this decision if it were to be applied as a general rule? How does this case compare with other cases?
  8. Identify the strongest counter-argument to the option you have chosen
  9. Can you rebut this argument? What are your reasons?
  10. Make a decision.
  11. Review this decision in the light of what actually happens, and learn from it.

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.

Book your place at the 2026 UKCEN Conference and Workshop, hosted by Cardiff and Vale UHB Clinical Ethics Committee.

 

We partner with the Institute of Medical Ethics (IME), an organisation which is dedicated to improving education and debate in medical ethics. Visit the IME website.