One of the
requirements for graduation at Stritch School of Medicine is completion of a
paper reflecting on the ethical or human dimensions of caring for a
patient. You have a choice of two assignments: (1)
Ethics Case Paper or the
essay on (2)
Spiritual Care and the
Death of a Patient.
(1)
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 six
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
five 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.
(2)
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 choose, 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.
Ethics Case Paper
Instructions for Preparing Ethics Case Presentations
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 six sections 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.
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.
Click
here
to view a sample
ethics case
presentation paper.
Spiritual
Care and the Death of a Patient
Instructions for Preparing an Essay regarding
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 18, 2012, it is not too early to begin to consider some of the
end of life situations you may have encountered during your clinical
rotations.
