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Applied Ethics · Chapter 14

The Four Topics Workbench

Jonsen, Siegler and Winslade's grid has survived nine editions since 1982 because it fits on a whiteboard and because the sequence is the argument. Take a real case apart fact by fact and put each one in its box — the workbench will tell you why it belongs there and what it costs you when it sits in the wrong one. Then write the sentence that turns the mess into an answerable ethics question.

The case

Choose a case
The brief
Put every fact in a box

The grid, filling in front of you

0 of 0 placed
1Medical indicationsWhat is going on and what can each option actually achieve?
    2Patient preferencesWhat does this person want, and who may speak?
      3Quality of lifeWhat will life be like on each path — and by whose judgment?
        4Contextual featuresFamily, money, law, policy, staffing, belief, conflicts of interest
          The grid's honest limit. Four boxes tell you what to gather, not what to conclude. Two competent clinicians can fill this in identically and still disagree. That is not fatal — it converts an argument about values into a shared, inspectable record of exactly where the disagreement lives — but anyone selling the grid as a decision procedure is overselling it.