Identify a case from your experience that contains an ethical issue.
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?