1. The situation in a nutshell. Please write a brief sentence summarising the situation as you see it.

2. Who is involved in/affected by the current dilemma?

• Who might be involved/affected?
• Who (if anyone) caused the situation?
• What is your relationship (role) vis-á-vis the main people involved?
• How are you affected by the situation?
• What responsibility do you carry for resolvingthe current dilemma?
• Who else needs to be involved to resolve the situation?

3. What is the context in which the situation occurs?

• Where is the dilemma occurring?

O day care centre

O residential care home

O hospital/clinic

O other

• When did the dilemma start or become apparent?
• Are there constraints/guidelines to consider?

O budgetary

O organisational

O a law/legal directive

O professional guidelines

O ethics policy

O other

4. How do you think the situation is experienced by everyone involved?

5. About the dialogue with everyone involved

• What have you learnt from talking to the people involved?
• In addition to the dialogue with the people involved, who else have you consulted?

O colleagues

O hierarchical superior

O ethics committee

O other

6. Which principles, values and related concepts seem to be at stake?

O acting with compassion

O acting with integrity (in accordance with your own beliefs)

O avoiding what might be harmful or hurt the people involved/affected

O balancing and respecting the family versus the personal interests of those involved/affected

O being able to exercise discernment (sensitive insight) 

O being truthful and trustworthy

O exercising humility

O promoting the good and wellbeing of the people involved/affected    

O respecting confidentiality, privacy and/or dignity (circle relevant responses)

O respecting the right for people to make decisions about their lives/what should happen to them

O respecting the uniqueness of everyone concerned

O taking into consideration potential vulnerability, dependency and/or power relations

O treating people fairly and equally       

O understanding the life stories of the people involved/affected

O other

7. Taking possible action or reacting           

• What are your main/realistic options?
• What do you think the major argument against your decision might be?
• How would you refute this argument?
• How do you feel about your decision?

8. (LATER) What did you learn with hindsight?