Neiswanger Institute for Bioethics and Health Policy = Loyola University Chicago Stritch School of Medicine Online Masters of = Art Program

From: Subject: Neiswanger Institute for Bioethics and Health Policy Loyola University Chicago Stritch School of Medicine Online Masters of Art Program Date: Tue, 20 Jul 2010 12:41:31 -0500 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_004D_01CB2808.E153B540" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5931 This is a multi-part message in MIME format. ------=_NextPart_000_004D_01CB2808.E153B540 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.bioethics.lumc.edu/education/ethics_paper.html =EF=BB=BF Neiswanger Institute for Bioethics and Health Policy = Loyola University Chicago Stritch School of Medicine Online Masters of = Art Program

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Ethics Case Analysis Paper=20 Requirements

All assignments due: April 13, = 2011

One of the = requirements=20 for graduation at Stritch School of Medicine is = completion of=20 a paper analyzing a case that involves an ethical = conflict,=20 dilemma, or problem you have experienced or witnessed. = Instructions for that assignment follow. In = addition, this=20 year, we are also studying whether a different = assignment,=20 one focusing on the death of a patient you cared for, = may be a=20 more satisfying exercise and make salient the role of = the=20 patient=E2=80=99s spirituality in their care. If you = agree to help us=20 study this new assignment, you will be randomly = assigned to=20 complete either the =E2=80=9CEthics Case = Paper=E2=80=9D=20 (Group A) or the assignment on=20 =E2=80=9CSpiritual Care and the Death of a = Patient=E2=80=9D (Groups=20 B & C).

Ethics = Case=20 Paper = -=20 For those writing the =E2=80=9CEthics Case = Paper,=E2=80=9D the=20 case is to be analyzed following the framework = provided below=20 called Instructions for Preparing Ethics Case=20 Presentations. Those instructions provide 6 = sections that=20 you should complete: (1) Narrative of the Case, (2) = Language=20 and Issues of the Case, (3) Perspectives and Key = Points of=20 View, (4) Facilitating Resolution, (5) What Actually = Happened,=20 and (6) Commentary. In order to provide this = information, the=20 paper is expected to be a minimum of 5 pages in length = (double-spaced). No references are necessary but you = may wish=20 to consult some standard works if you are struggling = with=20 putting the case into the language of ethical analysis = or=20 trying to figure out if your position falls within the = range=20 of solutions typically considered ethically acceptable = by=20 current practice standards.

Spiritual Care and=20 Death of a Patient =E2=80=93=20 For those writing this paper, Instructions for = Preparing=20 Essay regarding Spiritual Care and the Death of a = Patient=20 are provided below. This assignment does not = provide=20 specific sections that you must complete. But, in = general, we=20 ask you to tell us about a patient you cared for who = died. You=20 should describe the case and tell us about the = patient=E2=80=99s=20 needs, beliefs, and wishes and how they were addressed = or not=20 addressed. Please tell us about anything in particular = that=20 seemed important about the case. And, please describe = your=20 reactions to and feelings about the case. We expect = that such=20 papers will need to be at least five double-spaced = pages in=20 length in order to be complete. No references are=20 necessary.

Purpose: = No matter which=20 assignment you=E2=80=99re asked to complete, the = purposes of this=20 exercise are the same. First, the written assignment = serves to=20 demonstrate your ability to recognize interpersonal,=20 communication, spiritual and ethical aspects of = medical care=20 and write a well reasoned description and commentary.. = Second,=20 the paper provides an opportunity for you to develop = your own=20 ability to think about such issues, articulate your = own=20 independent thinking, and express your reactions and = feelings=20 about these dimensions of care regarding a situation = involving=20 one of your patients. Third, the paper can illustrate = one=20 facet of what we hope is the kind of doctor that = Stritch=20 educates: a woman or man who is profoundly aware of = the human=20 dimension of medical practice, committed to a high = standard of=20 care in personal practice, and dedicated to a careful=20 consideration of what it means to honor the = doctor-patient=20 relationship.

Instructions for=20 Preparing Ethics Case = Presentations

Traditional Assignment=20 (Group=20 A)

This is = the assignment=20 for all persons who wish to choose their own = assignment rather=20 than participate in the educational study. It is = also=20 the assignment for anyone randomized to the first = group (Group=20 A) in the educational study.

Select a = Case: What=20 constitutes an ethics case or issue?

Students = often select=20 cases in which there is a conflict of opinion = regarding the=20 best course of action or treatment to pursue. Such = conflicts=20 can arise between physicians and patients, among = members of=20 the health-care team, between physicians and family = members,=20 between patients and family members, and among family = members.=20 Conflicts of this type can often be analyzed by = focusing on=20 the competing values of each party (e.g., extending = life=20 versus minimizing suffering). Presentations of cases = involving=20 conflicts can lead to discussions of such ethical = issues as=20 autonomy, competence (decision-making capacity), = informed=20 consent, paternalism, and the rights and = responsibilities of=20 physicians, patients, and family members.

Cases can = be presented=20 which do not involve any interpersonal conflicts. = Students may=20 wish to present a case because they believe that a = decision=20 was incompatible with an important ethical norm, value = or=20 principle. For example, decision makers who seek = to=20 promote a patient's best interests (as perceived by = the=20 physician and family) may neglect the patient's right = to=20 information regarding the diagnosis, prognosis, and = treatment=20 alternatives. Thus, even though a physician and a = patient's=20 family may agree that the patient will not be told = that she=20 has cancer, the decision to withhold information may = merit=20 ethical examination.

Almost any = case contains=20 ethical issues because the norms of the doctor-patient = relationship are, ideally, based on ethical principles = and=20 motivations. To identify ethical issues, students can = select a=20 case and observe how the physician-patient = relationship is=20 conducted. Particular attention can be given to how = the=20 attending and house staff interact with the patient, = what and=20 how information is conveyed, how and by whom treatment = decisions are made, and how the patient's = decision-making=20 capacity is assessed. If a surrogate decision maker is = involved, students might consider the following = questions: How=20 and by whom was it decided that the patient lacked=20 decision-making capacity? How was the surrogate = selected? Was=20 sufficient information given to the surrogate? Was = sufficient=20 consideration given to the patient's values and best = interests=20 in the decision-making process?

Students = are encouraged=20 to discuss the decision-making process with the = attending,=20 house staff and the patient or family. Such cases can=20 facilitate an exploration during ethics conferences of = the=20 proper role of each party in treatment decisions, = effective=20 methods of communication, and means to minimize = conflicts=20 through better communication.

What = information should=20 I present? There should be five topics covered in your = case=20 presentation:

The = Narrative of the=20 Case: = The student should = attempt to=20 present all relevant medical and social facts = about the=20 patient. Ethically sound decision-making is based = on good=20 medical care and a good factual basis regarding = patient=20 care. Much relevant information is easily = obtainable from=20 the patient's chart.

The = Language and=20 Issues of the Case:=20 Cases are often = discussed=20 in terms of a particular topic, e.g., informed = consent,=20 the decision-making capacity (competence) of the = patient,=20 forgoing life-sustaining treatment, = physician-assisted=20 suicide, etc. The reasons for choosing one course = of=20 action over another are often explained in terms = of one of=20 the prima facie duties of physicians to patients, = respect=20 for autonomy, nonmaleficence, beneficence, or = justice. You=20 should not jargonize your write up unduly. = However, you=20 should be able to identify the topic under which = your case=20 falls and to identify the duties to the patient = that are=20 involved in the case.

Perspectives and Key=20 Points of View: This is probably the = single most=20 important part of any case analysis. You should go = person=20 by person and explain how each saw the situation. = Very=20 often, you will find that one or more of the = points of=20 view are not well understood by you or others = involved in=20 the case. Attempting to understand the reasons and = preferences of the parties involved can help to = identify=20 important conflicts and their sources. On the = other hand,=20 seemingly unresolvable conflicts can be resolved = when a=20 sincere effort is made to understand the = underlying=20 reasons and values.

Facilitating=20 Resolution: = What approaches might = have been=20 taken to bring about case resolution? e.g., family = and=20 caregiver conference? Ethics case consultation? A=20 discussion among certain members of the = health-care team?=20 Is there any way you could have contributed to the = solution?

What actually=20 happened? Please be=20 sure to include the outcome of the = case.=20

Commentary:=20 Your = commentary should=20 highlight the professional duties that physicians = have to=20 patients and how these duties were respected or=20 compromised in the case resolution.=20

Click = here to view a sample ethics case = presentation=20 paper.

Instructions for=20 Preparing Essay regarding Spiritual Care and the = Death of a=20 Patient

This = assignment is only=20 available to students randomized to Groups B & C. = If you=20 choose not to participate in the educational study, = you must=20 complete the traditional assignment of the Ethics Case = Paper.

ASSIGNMENT =

Please = tell us about=20 your experience in caring for a patient who died. Your = paper=20 should focus on your personal experience of this = patient and=20 all the people involved in this process. We also hope = that you=20 will tell us about the ways in which you and the other = members=20 of the healthcare team took care of the patient and = his or her=20 family=E2=80=99s spiritual needs.

Consider = telling us=20 about issues that were important from your = perspective, this=20 might include matters of communication, the ways in = which=20 particular care givers did/or did not demonstrate=20 compassionate presence, the extent to which the = patient and=20 patient=E2=80=99s family=E2=80=99s spiritual needs = were evident to, assessed=20 or addressed by the caregivers. Share any insights = regarding=20 the spiritual needs or resources of the members of the = healthcare team, including yourself. Please close your = paper=20 with a discussion of how this experience has impacted = how you=20 care for yourself today and/or how this has influenced = your=20 care of patients, if at all.

GOALS

The paper = will allow you=20 to explore how spiritual care is integrated into the = overall=20 care of the patient.

Acquire = some=20 foundational knowledge necessary in integrating = spirituality=20 into the care of patients.

Provide = you an=20 opportunity to incorporate spirituality as part of = your=20 professional and personal development.

OUTCOMES

This = reflection should=20 enable you to recall how the various members of the = healthcare=20 team, including yourself, communicating with patients, = families, and each other about spiritual = issues.

You will = identify=20 behaviors and attitudes that contribute to or detract = from=20 providing healthcare that appropriately addresses a = patient=E2=80=99s=20 spiritual needs.

EXPECTATION

These = papers will be=20 graded on a Pass/Fail basis. The papers are expected = to be=20 thoughtful, thorough, and well written. Furthermore, = the paper=20 should follow standard grammar and spelling and that = you=20 proofread your work. Papers that are complete and = well-written=20 will pass. Failing papers must be re-written and = re-submitted.=20 If you need assistance in identifying or processing an = experience, please see Drs. Michelfelder, Kuczewski, = or=20 Michael McCarthy (Ministry).

This = requirement can be=20 an opportunity for you to show your ability to = reflect, write,=20 and wrestle with important issues in a respectful = manner on a=20 topic crucial to patient care. Although the paper is = not due=20 until April 13, 2011, it is not too early to begin to = consider=20 some of the end of life situations you may have = encountered=20 during your clinical rotations.

GRADING: The=20 papers are graded on a Pass/Fail basis. Papers = that are=20 complete and well-written will pass. Failing papers = must be=20 re-written and re-submitted.

DUE DATE:=20 Papers are due April 13, 2011 at 4:00pm. Failure to = meet the=20 deadline will result in a grade of "FAIL." No = exceptions will=20 be made. A remediated "Fail" will be = reported=20 as "P*."

Email your=20 paper in Word document format to = ethicspaper@lumc.edu by=20 4pm on April 13, 2011.
PLEASE NAME YOUR DOC = FILE=20 WITH YOUR LAST NAME (ex. Bob Johnson's paper-=20 Johnson.doc)

=C2=A92000-2010.=20 Loyola University Chicago Stritch School of Medicine = and the=20
Neiswanger=20 Institute for Bioethics and Health Policy (Maywood, = IL). All=20 rights reserved.
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