Nurse—Surgeon Conflicts in the OR: Ethical Analysis Using the Four Box Method

Issues warranting ethical analysis frequently arise in nursing practice. This article describes a method for organizing ethically salient features of a case and shows how this method is used to evaluate clinical and professional dilemmas. The method is commonly referred to as the "four box method" because features of a case are organized under four topics: (1) medical indications, (2) patient preferences, (3) quality of life, and (4) contextual features. By scrutinizing a case in this fashion, relevant moral principles and conflicts among them are highlighted. The tool reflects a casuistic, or case-based, approach to decision making, which parallels the way medical decisions are routinely made. This system was designed for health care professionals, recognizing that ethical issues must often be addressed within time and other constraints. The four box method facilitates prompt but detailed ethical analysis.