An alert,oriented,and competent frail older adult man has been told that he is dying and has asked to have a DNAR (AND)prescription put on his chart.The patient's family does not agree with his decision and asks the healthcare team to ignore the request.After a great deal of discussion among the physician,nurse,and family,they are no closer to resolution of the conflict.The nurse asks the hospital chaplain to come and help the family and the team understand each other's opposing views.Which step of the MORAL model does this illustrate?

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This illustrates the Outlining the options step.In Massaging the dilemma,the team would already have identified and defined the issues in the dilemma,and considered the values and options of all the major players.At the Outlining the options step,someone should delineate all of the options to all parties,including those that are less realistic and conflicting.In that step,someone often asks a member of the ethics committee or the hospital chaplain to help the parties understand the opposing viewpoints.Resolving the dilemma is the step in which all the options are reviewed and basic ethical principles and frameworks are applied to arrive at a decision.Looking back to evaluate is done after a decision has been made and acted on.At that time,the entire process,including the consequences,are evaluated to determine how well they worked.

An Alert,oriented,and Competent Frail Older Adult Man Has Been Told