Instructions for Preparing the Ethics Case Analysis

Select a Case: Identify a case from your experience that contains an ethical issue. 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 nurse and patients, among members of the health-care team, between nurses 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/nurse 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/nurse-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 primary case 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?
What information should I present?
There should be six sections 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. At all times maintaining confidentiality buy using a fictitious name or initials. (10 points).
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 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. (20 points).
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. (30 points).
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? (10 points).
5. What actually happened? Please be sure to include the outcome of the case. (10 points).
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. (20 points).
It is common for the question of “third person writing” when trying to stay in APA format – to answer the question before it arises. Third person should go without saying for all aspects of the paper, however, when one gets to the commentary it might be more difficult, try. A great deal of weight will not be place on this aspect. But it is expected.