Teaching Ethics Through Case-Based Methods Doug Post, Ph.D. Associate Professor Department of Family Medicine The Ohio State University

Patient Centered Medicine Course O.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   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:

Trial

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, 4 th ed. 1998; New York: McGraw-Hill, Inc.   Write a draft of a case from the viewpoint of a person caught in the thick of the case problem

Groups within Groups  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): Comment in: Ann Intern Med. 1998;128(7):   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 Topic   Write a draft of a case from the viewpoint of a person caught in the thick of the case problem  Christopher Reeves

Senate Hearing  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 Topic  Terri 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??