3 meetings, 1 write-up, 1 case description Ethics YL8 3 meetings, 1 write-up, 1 case description

WHAT Ethics YL 5, 6, 7 = discussed mostly cases that others experienced Ethics YL8 = discuss cases the student experiences

HOW Meet with an ethics faculty preceptor 3x a year In one meeting, 3 students will present each of their cases State the dilemma Describe the facts of the dilemma Describe the conflicting values that makes it an ethical dilemma Describe the courses of action possible to find a solution to the dilemma Defend the chosen course of action Say how you plan to carry out the chosen course of action

WHEN & WHERE 3 Saturday afternoons 1-4 pm at ASMPH

WHY Raise the ethical barometer of the students consistent with the end goal of producing doctor leaders The student learns to process the dilemmas; they don’t feel helpless “If you name it, you control it.” Apply what they have learned in Ethics AND Leadership classes in real dilemmas Learn more about themselves

Assessment Participation in the Small Group discussion (65%) 1 case write-up of the case presented in the SGD (25%) 1 case description (not discussed in class) (10%)

SGD grading sheet Perfect Score: 10 points PARTICIPATION: INPUTS: 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 actions 25% - 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 Participation in the Small Group discussion (65%) – average of the 3 SGD grades 1 case write-up of the case presented in the SGD (25%) 1 case description (not discussed in class) (10%)

Ethical Decision-Making: 2 models/tools

UNESCO model Taught to you in YL5-YL7

UNESCO Model for Ethical Reasoning Fact deliberation What are the facts Who are the stakeholders Value deliberation What is the dilemma; what are the competing values or issues in the case Duty Deliberation What are the options? Tests of Consistency What should be the decision Make the final decisions What is the course of action UNESCO framework for Ethical Decision-making Cases will come from different sections, and

Angeles Model 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) 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) Is an expansion of the UNESCO model Simpler to understand and use

Angeles Model for Ethical Reasoning What are the facts Who are the stakeholders What is the dilemma; what are the competing values or issues in the case What are the options What should be the decision What is the course of action Cases will come from different sections, and Dr.Antonette Palma-Angeles, J.B. Fernandez, Jr. Ethics Center Ateneo de Manila University

1. Gather the facts Gather and clarify the facts of the case in question If case proves to be especially contentious, gathering facts separates facts from fiction. We have a tendency to use intuition and rush judgments; BEEN THERE, DONE THAT. For doctors, tendency is to look at only medical facts Questions that should be asked are: “What do we know?” “What do we need to know?”

2. Who are the stakeholders In a dilemma, many people who all seem to have valid positions are involved. Who are involved, affected in this case? e.g. the patient, the patient's next of kin, other doctors in the team, the hospital, etc What are the stakes for them? What are there interests?

3. Articulate the dilemma Bakit ako nababagabag? Distress shows that values are being violated or threatened Question is: Which values are at play in the case? If you list them, then it could be clear which values weigh more and most heavily to you

3. Articulate the dilemma Make a “dilemma statement” Articulate a dilemma in a _____ vs. _____ format reflecting the issues or values that are colliding Commitment to well-being of patients vs. protection of hospital's interests

4. List the alternatives Sometimes it helps to just brainstorm and then eliminate untenable options There are usually two extreme alternatives in a dilemma Think creatively…come up with a third, middle option. The solutions should reflect the values articulated in the dilemma It helps to talk to trusted friends about the case Make a 3-column matrix

5. Compare the alternatives with the values Match alternatives with values Eliminate alternatives if moral values they uphold are not that important to you 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 consequences What are the consequences of alternatives to key stakeholders Short term and long term Consider both positive and negative consequences Some positive consequences are more beneficial than others Some negative consequences are more detrimental than others

The Matrix Alternatives Values/Principles Consequences

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