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