Teaching Ethics Through Case-Based Methods

Doug Post, Ph.D.

Associate Professor

Department of Family Medicine

The Ohio State University

Patient Centered Medicine CourseO.S.U. College of Medicine

Behavioral Medicine Human Development Professionalism Ethics Diversity Violence

Palliative Medicine Meaning in Medicine Addiction Integrative Medicine Sexuality

Teaching Medical Ethics

“Medical students and residents most commonly learn how to approach ethical dilemmas by observing faculty and through hallway discussions about what they could have done differently after a difficult case.”

- Smith, Fryer-Edwards, Diekema, Braddock, 2004

Case-Writing First, decide on a topic Review and research the topic Write a draft of a case from the viewpoint of a

person caught in the thick of the case problem Look for opportunities to introduce terms or

concepts that are important to your course

- Herreid, 2000

Case-Based Teaching Methods

Trial Case Discussion Hearing Debate Problem-Based Learning Team Learning Jigsaw Technique

Bioethics Topics Physician-Assisted

Suicide Confidentiality End-of-Life Issues Futility Autonomy Managed Care Medical Student Issues

Mistakes Physician-Patient

Relationship Parental Decision-Making Professionalism Research Ethics Resource Allocation Truth-Telling

Case #1

Choose a Topic Physician Assisted Suicide

Review & Research the Topic http://depts.washington.edu/bioethx/

Write a draft of a case from the viewpoint of a person caught in the thick of the case problem.Quill TE. Death and dignity. A case of personalized

decision making. NEJM 1991; 324: 691-94.

Trial

http://www.sciencecases.org/assisted_suicide/assisted_suicide_notes.asp

Case #2 Choose a Topic

Principles of Medical Ethics

Review & Research the Topic Jonsen AR, Siegler M, Winslade WJ. Clinical Ethics: A

Practical Approach to Ethical Decisions in Clinical Medicine, 4th ed. 1998; New York: McGraw-Hill, Inc.

http://depts.washington.edu/bioethx/tools/princpl.html

Write a draft of a case from the viewpoint of a person caught in the thick of the case problem

Groups within Groupshttp://www.sciencecases.org/shannon_jake/shannon_jake.asp

Break class into 4 smaller groups and assign each group an ethical principle

Two tasks for sub-group discussion: 1) Apply ethical principle to the case and determine the physician’s actions based on that principle; 2) Discuss how they anticipate Sharon and her parents would react to the decision of their group

Spokesperson from each group presents findings Group Discussion

Case #3 Choose a Topic

Patient-Physician Relationship Review & Research the Topic

Ethics manual. Fourth edition.  American College of Physicians.  Ann Intern Med. 1998; 128(7):576-94. Comment in:  Ann Intern Med. 1998;128(7):569-71.

http://www.catholic.com/library/Birth_Control.asp Write a draft of a case from the viewpoint of a person

caught in the thick of the case problem Catholic Physician case

Debate Vote: 1) The physician should continue to practice medicine

in the same way; 2) The physician should change the way he practices medicine

Break the class into 2 groups, based on their vote Give time for groups to develop their position: arguments &

rebuttals; each group appoints 3 individuals to argue their case

Each side presents 5 minutes; 3-minute rebuttals by different spokespersons; 3-minute summaries by different spokespersons

Process discussion in the context of medical ethics

Case #4

Choose a Topic Research Ethics

Review & Research the Topichttp://www.sciencecases.org/superman/superman1.asp

Write a draft of a case from the viewpoint of a person caught in the thick of the case problemChristopher Reeves

Senate Hearing http://www.sciencecases.org/superman_ethics/superman_ethics_notes.asp

Outcome of hearing: Senators will vote on what direction they will take in writing a position paper on stem cell research

One of three votes: 1) Increase federal funding; 2) Maintain the president’s position; 3) Decrease federal funding

Four sub-groups with specific biases: 1) Stem Cell Researchers; 2) Ethicists from the National Bioethics Advisory Commission; 3) Right to Life Committee Members; and 4) Senators

Viewpoints argued to the Senators; Each group submits two questions to the Senators, who will ask these to the other two groups; groups aware of the Senators’ biases

Conduct a hearing Senate votes, majority wins

Choose a Topic End of Life

Review & Research the TopicTerri Schiavo

Write a draft of a case from the viewpoint of a person caught in the thick of the case problem

Case #5

Terri Schiavo

Viewpoint of a person caught in the thick of the case problem

Teaching Method

Questions/Comments??