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Education | Ethics Paper Requirements

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:

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.

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.

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.

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?

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

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 [email-masked] 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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Last reviewed:
07/15/10