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Ethics Case Analysis Paper Requirements 

All assignments due: April 13, 2011

 

One of the requirements for graduation at Stritch School of Medicine is completion of a paper analyzing a case that involves an ethical conflict, dilemma, or problem you have experienced or witnessed. Instructions for that assignment follow. In addition, this year, we are also studying whether a different assignment, one focusing on the death of a patient you cared for, may be a more satisfying exercise and make salient the role of the patient’s spirituality in their care. If you agree to help us study this new assignment, you will be randomly assigned to complete either the “Ethics Case Paper” (Group A) or the assignment on “Spiritual Care and the Death of a Patient” (Groups B & C).

 

Ethics Case Paper - For those writing the “Ethics Case Paper,” the case is to be analyzed following the framework provided below called Instructions for Preparing Ethics Case Presentations. Those instructions provide 6 sections that you should complete: (1) Narrative of the Case, (2) Language and Issues of the Case, (3) Perspectives and Key Points of View, (4) Facilitating Resolution, (5) What Actually Happened, and (6) Commentary. In order to provide this information, the paper is expected to be a minimum of 5 pages in length (double-spaced). No references are necessary but you may wish to consult some standard works if you are struggling with putting the case into the language of ethical analysis or trying to figure out if your position falls within the range of solutions typically considered ethically acceptable by current practice standards.

 

Spiritual Care and Death of a Patient – For those writing this paper, Instructions for Preparing Essay regarding Spiritual Care and the Death of a Patient are provided below. This assignment does not provide specific sections that you must complete. But, in general, we ask you to tell us about a patient you cared for who died. You should describe the case and tell us about the patient’s needs, beliefs, and wishes and how they were addressed or not addressed. Please tell us about anything in particular that seemed important about the case. And, please describe your reactions to and feelings about the case. We expect that such papers will need to be at least five double-spaced pages in length in order to be complete. No references are necessary.

Purpose: No matter which assignment you’re asked to complete, the purposes of this exercise are the same. First, the written assignment serves to demonstrate your ability to recognize interpersonal, communication, spiritual and ethical aspects of medical care and write a well reasoned description and commentary.. Second, the paper provides an opportunity for you to develop your own ability to think about such issues, articulate your own independent thinking, and express your reactions and feelings about these dimensions of care regarding a situation involving one of your patients. Third, the paper can illustrate one facet of what we hope is the kind of doctor that Stritch educates: a woman or man who is profoundly aware of the human dimension of medical practice, committed to a high standard of care in personal practice, and dedicated to a careful consideration of what it means to honor the doctor-patient relationship.

 

 

Instructions for Preparing Ethics Case Presentations

Traditional Assignment (Group A)

This is the assignment for all persons who wish to choose their own assignment rather than participate in the educational study.  It is also the assignment for anyone randomized to the first group (Group A) in the educational study.

 

Select a Case: What constitutes an ethics case or issue? 

Students often select cases in which there is a conflict of opinion regarding the best course of action or treatment to pursue. Such conflicts can arise between physicians and patients, among members of the health-care team, between physicians and family members, between patients and family members, and among family members. Conflicts of this type can often be analyzed by focusing on the competing values of each party (e.g., extending life versus minimizing suffering). Presentations of cases involving conflicts can lead to discussions of such ethical issues as autonomy, competence (decision-making capacity), informed consent, paternalism, and the rights and responsibilities of physicians, patients, and family members.

Cases can be presented which do not involve any interpersonal conflicts. Students may wish to present a case because they believe that a decision was incompatible with an important ethical norm, value or principle.  For example, decision makers who seek to promote a patient's best interests (as perceived by the physician and family) may neglect the patient's right to information regarding the diagnosis, prognosis, and treatment alternatives. Thus, even though a physician and a patient's family may agree that the patient will not be told that she has cancer, the decision to withhold information may merit ethical examination.

 

Almost any case contains ethical issues because the norms of the doctor-patient relationship are, ideally, based on ethical principles and motivations. To identify ethical issues, students can select a case and observe how the physician-patient relationship is conducted. Particular attention can be given to how the attending and house staff interact with the patient, what and how information is conveyed, how and by whom treatment decisions are made, and how the patient's decision-making capacity is assessed. If a surrogate decision maker is involved, students might consider the following questions: How and by whom was it decided that the patient lacked decision-making capacity? How was the surrogate selected? Was sufficient information given to the surrogate? Was sufficient consideration given to the patient's values and best interests in the decision-making process?

Students are encouraged to discuss the decision-making process with the attending, house staff and the patient or family. Such cases can facilitate an exploration during ethics conferences of the proper role of each party in treatment decisions, effective methods of communication, and means to minimize conflicts through better communication.

 

What information should I present? There should be five topics covered in your case presentation:

  1. The Narrative of the Case:  The student should attempt to present all relevant medical and social facts about the patient. Ethically sound decision-making is based on good medical care and a good factual basis regarding patient care. Much relevant information is easily obtainable from the patient's chart.

  2. The Language and Issues of the Case: Cases are often discussed in terms of a particular topic, e.g., informed consent, the decision-making capacity (competence) of the patient, forgoing life-sustaining treatment, physician-assisted suicide, etc. The reasons for choosing one course of action over another are often explained in terms of one of the prima facie duties of physicians to patients, respect for autonomy, nonmaleficence, beneficence, or justice. You should not jargonize your write up unduly. However, you should be able to identify the topic under which your case falls and to identify the duties to the patient that are involved in the case.

  3. Perspectives and Key Points of View: This is probably the single most important part of any case analysis. You should go person by person and explain how each saw the situation. Very often, you will find that one or more of the points of view are not well understood by you or others involved in the case. Attempting to understand the reasons and preferences of the parties involved can help to identify important conflicts and their sources. On the other hand, seemingly unresolvable conflicts can be resolved when a sincere effort is made to understand the underlying reasons and values.

  4. Facilitating Resolution: What approaches might have been taken to bring about case resolution? e.g., family and caregiver conference? Ethics case consultation? A discussion among certain members of the health-care team? Is there any way you could have contributed to the solution?

  5. What actually happened? Please be sure to include the outcome of the case.

  6. Commentary: Your commentary should highlight the professional duties that physicians have to patients and how these duties were respected or compromised in the case resolution.

Click here to view a sample ethics case presentation paper.

 

 

Instructions for Preparing Essay regarding Spiritual Care and the Death of a Patient

This assignment is only available to students randomized to Groups B & C. If you choose not to participate in the educational study, you must complete the traditional assignment of the Ethics Case Paper.

 

ASSIGNMENT

Please tell us about your experience in caring for a patient who died. Your paper should focus on your personal experience of this patient and all the people involved in this process. We also hope that you will tell us about the ways in which you and the other members of the healthcare team took care of the patient and his or her family’s spiritual needs.

Consider telling us about issues that were important from your perspective, this might include matters of communication, the ways in which particular care givers did/or did not demonstrate compassionate presence, the extent to which the patient and patient’s family’s spiritual needs were evident to, assessed or addressed by the caregivers. Share any insights regarding the spiritual needs or resources of the members of the healthcare team, including yourself. Please close your paper with a discussion of how this experience has impacted how you care for yourself today and/or how this has influenced your care of patients, if at all.

 

GOALS

The paper will allow you to explore how spiritual care is integrated into the overall care of the patient.

Acquire some foundational knowledge necessary in integrating spirituality into the care of patients.

Provide you an opportunity to incorporate spirituality as part of your professional and personal development.

 

OUTCOMES

This reflection should enable you to recall how the various members of the healthcare team, including yourself, communicating with patients, families, and each other about spiritual issues.

You will identify behaviors and attitudes that contribute to or detract from providing healthcare that appropriately addresses a patient’s spiritual needs.

 

EXPECTATION

These papers will be graded on a Pass/Fail basis. The papers are expected to be thoughtful, thorough, and well written. Furthermore, the paper should follow standard grammar and spelling and that you proofread your work. Papers that are complete and well-written will pass. Failing papers must be re-written and re-submitted. If you need assistance in identifying or processing an experience, please see Drs. Michelfelder, Kuczewski, or Michael McCarthy (Ministry). 

This requirement can be an opportunity for you to show your ability to reflect, write, and wrestle with important issues in a respectful manner on a topic crucial to patient care. Although the paper is not due until April 13, 2011, it is not too early to begin to consider some of the end of life situations you may have encountered during your clinical rotations.


 

GRADING: The papers are graded on a Pass/Fail basis. Papers that are complete and well-written will pass. Failing papers must be re-written and re-submitted.

 

DUE DATE: Papers are due April 13, 2011 at 4:00pm. Failure to meet the deadline will result in a grade of "FAIL." No exceptions will be made.  A remediated "Fail" will be reported as "P*."

 

Email your paper in Word document format to ethicspaper@lumc.edu by 4pm on April 13, 2011. 
PLEASE NAME YOUR DOC FILE WITH YOUR LAST NAME (ex. Bob Johnson's paper- Johnson.doc)

 


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