ETHICAL ANALYSIS AND PROBLEM-SOLVING
ETHICAL ANALYSIS AND PROBLEM-SOLVING
CRITICAL THINKING – FALL 2008
In everything we do as health professionals, we should strive for excellence in the quality of care and for providing care and relating to others within appropriate ethical standards. “Ethical” principles set standards for “right conduct”. Each profession has a set of rules or standards that govern the conduct of a person or the members of that profession. For example, the American Psychological Association has suggested five basic principles, some of which derive from the ancient Hippocratic Oath: (a) benefit those you work with and take care to avoid harm, (b) establish relationships of trust with patients and co-workers, (c) promote accuracy, honesty and truthfulness in science and practice, (d) work for justice and fairness, (e) respect the dignity and worth of all people and the rights of individuals to privacy, confidentiality, and self-determination.
It may seem that significant ethical problems and conflicts would be quite rare in the health care setting, since “everyone knows how to act”. However, many complex situations occur in which an analysis of the situation leads the health care professional to be placed in some sort of conflict between their different obligations to stakeholders. The three problems presented below are examples where this might occur. In each problem, you are to assume that you are the responsible health care worker who must formulate a plan and act in the situation. You may find it convenient to think of each case from the point of view of your intended profession.
In the first class period the full group will discuss all three problems and will try to identify the major issues and concerns that each presents. In the time between the first and second class on these problems, each student should choose one problem to concentrate on, and should research aspects of that problem that appear to be relevant to formulating (a) a way of thinking about the problem, and (b) a suggested problem resolution. On the second day, each group will divide into small subgroups that will each further discuss the problem they have chosen. On the third day, each subgroup will meet for the first 30-45 minutes to finalize their approach to the problem. The entire class will then reconvene to discuss problem resolutions. In this discussion, the instructors will facilitate problem-solving by changing specific details of the problem situation in order to determine if such changes substantively affect the way the problem is resolved. Each student will then write up their chosen problem. The written performance product should contain a discussion of (a) the ethical issues that their problem presents, and (b) the proposed solution
Ethical Problem I: You have been providing care to a patient named Sue who has recently been diagnosed with a terminal illness. The illness is likely to produce an increasingly severe and painful disability. There is almost no hope of survival beyond three years. She tells you she has contacted a doctor in another state for purposes of arranging an assisted suicide. She asks you not to tell anyone. You have worked with this patient for many years and know her to be emotionally labile and easily angered, often threatening to do things (e.g., leaving her husband and children, quit her job after having a conflict with a co-worker) but not following through.
Ethical Problem II: A patient of yours, named Bob, has been recently diagnosed with severe obsessive-compulsive disorder, engaging in repetitive behaviors, including handwashing and checking that take up almost his complete day. He is no longer able to work and has been abandoned by most of his friends. The behavior has now begun to affect his nutrition because he is concerned about food contamination. The patient applies to enter an experimental drug trial of a new drug called “Repitrol” and you inadvertently learn that the patient is assigned to a placebo treatment for 8 weeks. In one previous study of “canine acral lick”, a dog model of OCD, Repitrol has been reported to have caused complete remission of all OCD symptoms in a 6-week trial.
Ethical Problem III: In your work at an acute rehabilitation hospital, you encounter a wealthy stroke patient, named Ed, who has had a middle cerebral artery stroke in the right hemisphere. He has severe attentional problems and has obvious difficulties in problem solving. You learn that the patient has been living with his daughter and has been divorced from his ex-wife, Paris, for five years. The daughter, who is 22, has been severely depressed for over a year and has been unable to work as a result. He has had practically no contact with Paris after their divorce settlement gave her $2.5M of his estate. Two weeks into his rehabilitation, she suddenly re-appears and seeks to take over financial and health-care decision-making for him.
Suggested References to Get You Started
American Psychological Association (1992). Ethical principles and code of conduct. American Psychologist, 47, 1597-1611.
Bailey, D.M. & Schwartzberg, S.L. (1995). Ethical and Legal Dilemmas in Occupational Therapy. (WB 555 E84)
Beauchamp, T.L. & Walters, L. Contemporary Issues in Bioethics, Fifth Edition.
Emanuel, E.J. & Miller, F.G. (2001). The ethics of placebo-controlled designs. A middle ground. New England Journal of Medicine, 345, 915-919.
Ganzini, L., Harvath, T.A., Jackson, A., Goy, E.R., Miller, L.L., & Delorit, M.A. (2002). Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicide. New England Journal of Medicine, 347, 582-588.
Wheat, K. (2000). The law's treatment of the suicidal. Medical Law Review, 8, 182-209.
You can find ethics codes to various professions online at the Illinois Institute of Technology’s Center for the Study of Ethics in the Professions. ( )
The outline for the code of ethics of the American Physical Therapy Association can be found at
The outline for the code of ethics of the American Speech and Hearing Association can be found at
An outline of some of the issues in placebo control research designs can be found at
You can find Florida statutes regarding guardianship (Title XLIII, Chapter 744, Guardianship) at the following URL:
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