Nursing Ethical Framework: Four Topics Approach

The Four Topics Approach is considered to be useful when making ethical decisions in nursing practice. In my career, there was a case when the approach helped me to find a resolution of a rather complicated issue. The first topic to be considered was concerned with medical indications. The patient was a forty-year-old male who had lung cancer. Most probably, it was the terminal stage. Matsunuma et al. (2014) identified the following symptoms of the terminal stage of lung cancer: hyponatremia, anorexia, desaturation, fatigue, and hypoalbuminemia. Out of the identified symptoms, the patient had hyponatremia and fatigue.

Thus, his condition was close to the terminal stage. However, the patient was offered treatment with the prospect of relieving the symptoms and increasing the prospect of recovery. Since the patient had only two symptoms out of the ones identified by Matsunuma et al. (2014), the probability of him not having the terminal stage was rather high. The goals of treatment were to relieve the patient’s pain and provide him with a higher quality of life. There are several treatment options for lung cancer, such as radiation therapy, surgery, targeted therapy, and chemotherapy (Lemjabbar-Alaoui, Hassan, Yang, & Buchanan, 2015). Choosing one or several of them might have relieved the patient’s symptoms.

The second phase of the Four Topics Approach is dealing with patient’s preferences. Even though the man was informed of the benefits of treatment, he was unwilling to undergo it. However, the patient had expressed a prior preference for his wife to be the surrogate to make decisions for him. Upon serious consideration, we decided to let the wife know about her husband’s refusal to undergo treatment and asked her to persuade the patient.

The third topic of the approach is the quality of life and respect for autonomy. In the discussed case, there were ethical issues concerning improving the patient’s quality of life. If we were to make a decision without him, we might have violated those ethical principles. However, since he had expressed his preferences earlier and since his wife asked us to try everything possible to save her husband, the violation should not be considered as a serious one.

The last topic includes the principles of justice. No legal or religious issues affected clinical decisions. We did everything according to the patient’s will. The treatment plan was successful, and we managed to prolong the patient’s life for several years.

I would like to say that the Four Topics Approach was highly helpful in that situation. Step by step, my colleagues and I created the most beneficial treatment plan without violating any ethical principles. In my opinion, the approach is valid to apply in practice.


Lemjabbar-Alaoui, H., Hassan, O., Yang, Y.-W., & Buchanan, P. (2015). Lung cancer: Biology and treatment options. Biochimica et Biophysica Acta, 1856(2), 189-210.

Matsunuma, R., Tanbo, Y., Asai, N., Ohkuni, Y., Watanabe, S., Murakami, S., … Kasahara, K. (2014). Prognostic factors in patients with terminal stage lung cancer. Journal of Palliative Medicine, 17(2), 189-194.

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