A National Framework for Bioethical Standards in Reproductive Technology & End-of-Life Care (Published)
Intractable ethical controversies—particularly in reproductive medicine, end-of-life decision-making, and value-laden questions surrounding patient autonomy and professional responsibility—continue to immobilize policy development and operational coherence across the U.S. healthcare system. Existing institutional ethics structures often lack the conceptual depth and methodological rigor necessary to navigate disagreements rooted not merely in divergent preferences but in fundamentally different philosophical, moral, and theological foundations. As a result, healthcare institutions experience unresolved conflicts, increased clinician moral distress, inconsistent decision pathways, and an erosion of public trust.This study sought to design, validate, and pilot a comprehensive national Philosophical-Theological Model (PTM) for institutional ethical deliberation. The primary aim was to create a scalable framework capable of clarifying foundational moral commitments, structuring reasoned discourse, and integrating clinical, philosophical, and spiritual domains into a unified decision-making process.A design-based research methodology guided the development and evaluation of the PTM. The process involved three phases:(1) Theoretical Synthesis, integrating scholarship from moral philosophy, theology, bioethics, and clinical ethics consultation models;(2) Expert Delphi Panel Validation, engaging interdisciplinary leaders in ethics, chaplaincy, philosophy, and health policy to refine and evaluate the model’s coherence, applicability, and methodological robustness;(3) Multi-Site Pilot Implementation, deploying the PTM across selected healthcare systems to assess feasibility, operational impact, and user experience among clinicians, ethicists, and chaplains.The research produced a validated, tiered PTM framework that systematically distinguishes empirical questions, normative commitments, and theological-anthropological presuppositions. Pilot data demonstrated notable gains in deliberative quality and efficiency, with ethics committees reporting clearer problem-framing, more structured dialogue, and reduced procedural ambiguity. Clinician surveys indicated a measurable reduction in moral distress, particularly in units frequently confronted with ethically charged decisions. Additionally, the model significantly elevated the role of chaplaincy by formally integrating spiritual assessment and the exploration of moral worldviews into the deliberative process.The PTM offers a practical, scalable, and conceptually rigorous pathway for addressing long-standing ethical conflicts within U.S. healthcare institutions. By illuminating and organizing the philosophical and theological commitments that implicitly shape ethical judgments, the model strengthens institutional ethics processes, enhances clinician formation, and supports a more coherent integration of spiritual care. As a result, the PTM contributes meaningfully to rebuilding the ethical infrastructure of healthcare systems and enabling more grounded, transparent, and sustainable approaches to contemporary bioethical challenges.
Keywords: bioethics, clinical ethics consultation, ethical decision-making, healthcare ethics committees, moral distress, philosophical-theological model (PTM)