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. 2020 Jun 28;3(2):142–145. doi: 10.1093/jamiaopen/ooaa018

Table 2.

Application of an ethical decision-making process11

Ethics decision-making steps Examples
1. Identify the context of an ethical decision Dependencies on opioids and the potential for over-prescribing has created a need for a BPA
2. Formulate a specific ethical question Will this opioid-focused BPA be designed to provide at least as many benefits for patients as for other stakeholders?
3. Identify stakeholders
  • Providers

  • Patient

  • Pharmaceutical companies

  • Community

4. Generate options (value promoting and burdens endured)
  • Implement the BPA for all opioid prescriptions

  • Implement the BPA only when prescribing opioids outside of specified classes

  • Implement the BPA only on opioid prescriptions that exceed a threshold (eg, 10 pills)

5. Select (and recommend) one option Designing the BPA to trigger only when prescribing specified classes of opioids is ethically justified because it is the only one that benefits patients at least as much or more than other stakeholders
6. Discuss how to prevent or address future ethical conflicts Future classification of opioids may change, creating the potential for new or different ethical conflicts. If such reclassification occurs, ethical considerations for this BPA should be reviewed

Abbreviation: BPA: best practice advisory.