Ethics YL83 meetings, 1 write-up, 1 case description

WHATO Ethics YL 5, 6, 7 = discussed mostly

cases that others experiencedO Ethics YL8 = discuss cases the

student experiences

HOWO Meet with an ethics faculty preceptor 3x a

year O In one meeting, 3 students will present each

of their casesa. State the dilemmab. Describe the facts of the dilemmac. Describe the conflicting values that makes

it an ethical dilemmad. Describe the courses of action possible to

find a solution to the dilemmae. Defend the chosen course of actionf. Say how you plan to carry out the chosen

course of action

WHEN & WHEREO 3 Saturday afternoonsO 1-4 pm at ASMPH

WHYO Raise the ethical barometer of the

students consistent with the end goal of producing doctor leaders

O The student learns to process the dilemmas; they don’t feel helpless“If you name it, you control it.”

O Apply what they have learned in Ethics AND Leadership classes in real dilemmas

O Learn more about themselves

AssessmentO Participation in the Small Group

discussion (65%)O 1 case write-up of the case presented in

the SGD (25%)O 1 case description (not discussed in

class) (10%)

SGD grading sheet PARTICIPATION:

1 -No or hardly any participation (contributes once only) 2 - Minimal participation 3 – Some Participation 4 – Active participation 5 – Very Active participation

INPUTS: 1 – Gives irrelevant input most of the time 2 – Relevant factual input 3 – Asks good questions BUT does not give relevant factual

input 4 – Questions asked & Inputs given allow the group to have

a deeper insight into the discussion ATTITUDES:

1 - Shows respect, courtesy, courage in the discussion 0 - Does not show respect, courtesy or courage in the

discussion

Perfect Score: 10 points

Grading criteria of the case write-up

25% - Completeness of pertinent facts 25% - Clarity of stating the conflicting

values 25% - Examination of different courses of

actions25% - Defense of chosen course of action

and planned manner of implementation

Perfect Score: 100%

Grading criteria for case description

Clarity of statement of the facts of the dilemma Scale of 1 to 5 : (1 = not clear; 5= very clear)

Clarity of statement of the dilemma Scale of 1 to 5: (1 = not clear; 5= very

clear)

Perfect Score: 10

Final Grade Assessment

O Participation in the Small Group discussion (65%) – average of the 3 SGD grades

O 1 case write-up of the case presented in the SGD (25%)

O 1 case description (not discussed in class)

(10%)

Ethical Decision-Making:

2 models/tools

UNESCO modelO Taught to you in YL5-YL7

UNESCO Model for Ethical Reasoning1.Fact deliberation

A. What are the facts B. Who are the stakeholders

2.Value deliberationWhat is the dilemma; what are the competing values or issues in the case

3.Duty DeliberationWhat are the options?

4.Tests of ConsistencyWhat should be the decision

5.Make the final decisionsWhat is the course of action

UNESCO framework for Ethical Decision-making

Angeles ModelO Created by Dr. Tonette Angeles, head of the

J.B. Fernandez, Jr. Ethics Center, and Philosophy professor at Ateneo de Manila University; lectured to you in YL5 (Culture) and YL6 (Conflicts of Interest)

O Is what is going to be used among the consultant staff in The Medical City in newly-created Ethics Rounds (therefore we are integrating with TMC)

O Is an expansion of the UNESCO modelO Simpler to understand and use

Angeles Model for Ethical Reasoning

1.What are the facts2.Who are the stakeholders3.What is the dilemma; what are the

competing values or issues in the case4.What are the options5.What should be the decision6.What is the course of action

Dr.Antonette Palma-Angeles, J.B. Fernandez, Jr. Ethics CenterAteneo de Manila University

1. Gather the factsOGather and clarify the facts of the

case in questionO If case proves to be especially

contentious, gathering facts separates facts from fiction.

O We have a tendency to use intuition and rush judgments; BEEN THERE, DONE THAT.

OFor doctors, tendency is to look at only medical facts

OQuestions that should be asked are:O “What do we know?”O “What do we need to know?”

2. Who are the stakeholders

O In a dilemma, many people who all seem to have valid positions are involved.

O Who are involved, affected in this case? e.g. the patient, the patient's next of kin,

other doctors in the team, the hospital, etcO What are the stakes for them? What are

there interests?

3. Articulate the dilemmaO Bakit ako nababagabag? Distress shows that values are being

violated or threatenedO Question is: Which values are at play in the

case?O If you list them, then it could be clear which

values weigh more and most heavily to you

3. Articulate the dilemmaOMake a “dilemma statement”

OArticulate a dilemma in a _____ vs. _____ format reflecting the issues or values that are collidingO Commitment to well-being of patients vs.

protection of hospital's interests

4. List the alternativesOSometimes it helps to just brainstorm and

then eliminate untenable optionsOThere are usually two extreme

alternatives in a dilemmaOThink creatively…come up with a third,

middle option. OThe solutions should reflect the values

articulated in the dilemmaO It helps to talk to trusted friends about

the caseOMake a 3-column matrix

5. Compare the alternatives with the values

O Match alternatives with values O Eliminate alternatives if moral values they

uphold are not that important to youO If we create a matrix where values are

matched with options, it becomes clear to us what values are behind options or solutions

6. Weigh the consequencesOWhat are the consequences of

alternatives to key stakeholdersOShort term and long termOConsider both positive and negative

consequencesO Some positive consequences are more

beneficial than othersO Some negative consequences are more

detrimental than others

The Matrix

7. Make a decisionO The decision reflects one’s values