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

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

3. 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

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

5. 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

6. 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%)

7. 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

8. 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%

9. 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

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%)

11. Ethical Decision-Making: 2 models/tools

12. UNESCO model
Taught to you in YL5-YL7

13. 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

14. 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

15. 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

16. 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?”

17. 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?

18. 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

19. 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

20. 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

21. 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

22. 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

23. The Matrix
Alternatives
Values/Principles
Consequences

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