Burkemper method
3
A Method of Case Analysis & Justication Facts (Case Description): Describe the scenario that leads to the dilemma for the clinician, providing all relevant factual information. Stakeholders: Identify the key persons likely to be aected by the decision, and state what matters most to them. Note that stakeholders may include institutions and the wider community. Though information abo ut the stakehold ers could be included in the acts section, this step invites fuller consideration of the concerns and beliefs of persons who may be aected by the decision. Ethically Releant Factors: Identify speci!c signi!cant factors of the case toward which the clinician ought to be sensitive in determining the ethically right and virtuous way to resp ond. "an include: • speci!c goods or harms #in relation to the various stakeholders$ • possibilities of speci!c goods or harms. • %peci!c ethical rights #such as the right of a patient not to be deceived$ &'amples: • (r . )ones* #the patient*s$ goal of +++++ or desire preferencewish for ++++++ • the patient*s wife*s desireconcern that +++++++ • the burden of+++++ ++ on (r . )ones from +++++ ++ treatment • the burden of +++++ + on the pa tient*s wife • the possibility that ++++ treatment will enable (r . )ones to live another two years #the value staying alive$ • the treatment*s inability to restor e (r . )ones* capacity to • the signi!cance of avoiding wrongfully -playing od/ # The author would need to explain what is meant by “playing God” in this case.) • Dr. %mith*s desire to continue (r. )ones* treatment • The possibility that i n confronting Dr . %mith with her concer ns, %arah #the nurse$ will threaten the good working relationship she has with Dr . %mith • (r . )ones* right to know the full truth about his condition #The author would need to explain what is meant by “right“ and why Mr. Jones has such a right.) %ometimes &0s re1ect uncertainties #about a prognosis, advance directive, institutional policy, religious directive, etc.$ &'amples: • The probabi lity )ane will never r ecover consciousness. • The possibility, however small, that )ane will reco ver consciousness. • The possibility )a ne*s comment about - never wanting to live li ke a vegetable/ meant +++. • The possibility )ane*s comment about -never wanting to live like a vegetable/ meant +++2something other than the meaning mentioned above3 . • The possibility &0D 4+ + means 5, and that r emoving )ane*s feeding tube would violate "atholic teaching.
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A Method of Case Analysis & Justication
Facts (Case Description): Describe the scenario that leads to the dilemma for theclinician, providing all relevant factual information.
Stakeholders: Identify the key persons likely to be aected by the decision, andstate what matters most to them. Note that stakeholders may include institutionsand the wider community.
Though information about the stakeholders could be included in the actssection, this step invites fuller consideration of the concerns and beliefs ofpersons who may be aected by the decision.
Ethically Releant Factors: Identify speci!c signi!cant factors of the case towardwhich the clinician ought to be sensitive in determining the ethically right andvirtuous way to respond. "an include:
• speci!c goods or harms #in relation to the various stakeholders$
• possibilities of speci!c goods or harms.
• %peci!c ethical rights #such as the right of a patient not to be deceived$
&'amples:• (r. )ones* #the patient*s$ goal of +++++ or desire preferencewish for ++++++
• the patient*s wife*s desireconcern that +++++++
• the burden of+++++++ on (r. )ones from +++++++ treatment
• the burden of ++++++ on the patient*s wife
• the possibility that ++++ treatment will enable (r. )ones to live another twoyears #the value staying alive$
• the treatment*s inability to restore (r. )ones* capacity to +++++++
• the signi!cance of avoiding wrongfully -playing od/ #The author would needto explain what is meant by “playing God” in this case.)
• Dr. %mith*s desire to continue (r. )ones* treatment
• The possibility that in confronting Dr. %mith with her concerns, %arah #thenurse$ will threaten the good working relationship she has with Dr. %mith
• (r. )ones* right to know the full truth about his condition #The author would
need to explain what is meant by “right“ and why Mr. Jones has such a right.)
%ometimes &0s re1ect uncertainties #about a prognosis, advance directive,institutional policy, religious directive, etc.$ &'amples:
• The probability )ane will never recover consciousness.
• The possibility, however small, that )ane will recover consciousness.• The possibility )ane*s comment about -never wanting to live like a
vegetable/ meant +++.
• The possibility )ane*s comment about -never wanting to live like avegetable/ meant +++2something other than the meaning mentionedabove3 .
• The possibility &0D 4++ means 5, and that removing )ane*s feeding tubewould violate "atholic teaching.
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• The possibility &0D 4++ means 6 and that removing )ane*s feeding tubewould not violate "atholic teaching.
Ethical Con!icts: Identify how some &0s invite the clinician to consider one#general$ course of action, while other &0s invite the clinician to consider anopposing course #or opposing courses$ of action.
This step elucidates the reason or reasons the case presents a dilemma tothe clinician.
&'ample: #The case is about patient sufering acute respiratory ailure. eseems to express a desire to ha!e his !entilator remo!ed.$
%everal factors invite Dr. %tephens to agree to remove the ventilator from"harlie. They include:
• "harlie*s apparent decision to be removed from the ventilator
• 0ose*s desire to honor her husband*s recently e'pressed wish to beremoved from the ventilator
• the discomfort the ventilator may be causing "harlie
7n the other hand, several factors invite (s. %tephens #the N8$ to agree tokeep "harlie on the ventilator. They include:
• the possibility "harlie*s recently stated wish to have the ventilatorremoved may not re1ect his deep9seated goals or adeuateunderstanding about his prognosis
• the likelihood that short term mechanical ventilation will help"harlie to recover what he views as an acceptable uality of life
• the signi!cance of "harlie having more time to live #the value ofstaying alive$
"ei#hin# Ethically Releant Factors: Determine which ethically relevant factorstake precedence, and provide #to the e'tent possible$ reasons for weighing thefactors as you do.
;hile all ethically relevant factors deserve consideration, some of themshould have greater in1uence in determining which courses of action areethically appropriate. %ometimes a single factor stands out as mostimportant.
$eneral Reco%%endation: In light of how you weigh the ethically relevant factorsin the previous step, e'plain which general course of action the clinician ought to
take in order to respond to the most important factor#s$. "onsider all <usti!ableoptions, and if more than one good option e'ists, e'plain #either here or in thefollowing section$ why the option you recommend is preferred among others.
Sensitiity (and Rened Reco%%endation): =cknowledge how the proposedrecommendation may risk showing some insensitivity toward other ethicallyrelevant factors, and e'plain what, if anything, the clinician can do to manifestsensitivity toward these factors.
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