Case study

The outline of a good assignment will look something like this:

Mary is a 17-year-old Jehovah’s Witness. Mary’s family is also Jehovah’s Witness and they are very active in their church. Mary appears to be devout in her belief and claims that her faith is extremely important to her. Mary has even created a local mentoring group for younger Jehovah Witness girls. Recently, Mary was diagnosed with aplastic anemia, a life-threatening illness in which a person’s immune system attacks the person’s bone marrow. In a meeting wit Mary and her parents, you relay the information that Mary will die without blood transfusions. Mary and her parents refused to consent to the life-saving blood transfusions. As a physician, you are aware that you are able to override parent’s wishes about blood transfusions in pediatric patients, but are concerned that Mary is mature enough and may be capable of making an informed choice. You are torn between viewing Mary as a child who you have to protect, and Mary as a young adult who is capable of making choices about her care. As Mary’s physician, what do you do?

Overall Feedback

I think these articles look great. Very well rounded!

I think one interesting question to ask about this case is this: is it reasonable to refuse blood transfusions? In other words, although Mary’s faith says she should not receive transfusions, we might wonder whether that is a rationally defensible claim. Maybe it is, but it’s a question worth asking.

Second, I think we should ask about the hierarchy of patient priorities. Maybe she understands that she might die, but it’s more important to be faithful to God.

Third, I think you might incorporate some discussion of the distinction between respecting a patient’s right to refuse treatment, and, on the other hand, whether we must treat a patient’s request as a command to do something. So it’s one thing to say, “Ok we won’t treat Mary if she doesn’t want it.” But it would be something entirely different if she said, “My faith dictates that you MUST do X,Y, and Z for me.” For instance, female genital mutilation might be an example. Sometimes that practice is connected with religious beliefs. I wonder if there is a difference when the patient is asking the provider to do something rather than when the patient is refusing treatment. Does that make sense?

Finally, I’ll say that I think given Mary’s situation, she will need regular transfusions, not just a single set. Likely she will need to come in monthly or more often. So proposing that she be compelled to do the transfusions is likely not just a one-time thing, but makes her adopt a whole lifestyle.

Good work so far!

Assignment Description

The purpose of the Position Paper assignment is to give students an opportunity to demonstrate their ability to 1) apply ethical principles and theories to a specific case, 2) analyze the dilemma using an ethical decision-making framework, and 3) articulate a fully justified position about the case.

The final paper should be between 6-8 pages in length, excluding the cover page and references list (using a minimum of 5 academic sources). The paper must address each of the following elements, and each element should be noted in the narrative with proper APA section headers.

Case and Topic Introduction (1 page)

This section of the paper must include the case being explored, and clearly identify the ethical dilemma in the and provide enough background information, including definitions, to allow the reader to understand the issues. When constructing the topic introduction, you should assume the reader is not familiar with the topic. All statements of fact (i.e. statements from other authors or empirical evidence) should be clearly supported with relevant information from the scholarly literature. For example, if you state that the use of a particular technology is increasing, you must have a scholarly source supporting that statement. This is also true for statistics, definitions, or other pertinent informati` on used.

Problem Statement and “Road Map” (1 paragraph)

This section forms the basis for the problem statement. Although more than one problem may be identifiable in a given topic, students are encouraged to narrow the problem statement to ONE main dilemma in order to make the analysis manageable within the confines of the assignment. Be sure to identify which of the questions is the primary ethical question. In other words, which question reflects the most significant issue that must be dealt with in order to form an opinion about the dilemma? For example, a main ethical dilemma in a given case could be stated like this: “The main ethical dilemma in this case is whether or not Mrs. Sanders artificial feeding should be continued.”

Once the main ethical dilemma is stated, I want each student to include a thesis statement, or a “road map,” of exactly what they plan to argue and on what ground they will argue it on. For example, using the dilemma above, a student could state “In this paper, I will argue that it is unethical to remove artificial nutrition from Mrs. Sanders based on Mrs. Sanders autonomy, her past wishes, and the notion that her surrogates are not adhering to the guidelines of oral advanced directives.”

Argument (2-3 pages)

This section of the paper will be used to create cogent arguments about the selected topic in direct response to the problem statement identified in the topic introduction. Essentially, your argument should reflect how particular ethical principles, theories, obligations or duties can be applied to the argument. It is also important to include relevant information from the literature in support of each argument. For example, from the dilemma above, you would want to break down concepts like autonomy and substituted judgment in order to justify your position regarding Mrs. Sanders. This section should be where the majority of your sources are used.

Hint: Be sure you are actually arguing for your position instead of simply assuming that it is correct (don’t beg the question).

Counter-Arguments (1-2 pages)

Counter-arguments are those statements directly challenging the initial argument. Here, it is important to point out the weaknesses of initial arguments and/ or consider the circumstances under which one might abandon or otherwise alter the initial position. All counter-arguments should reflect how a particular theory or principle can be applied to refute original arguments. The use of information from the literature will also serve to strengthen the quality of the counter-arguments, and will help to ensure that a variety of contrasting viewpoints are represented.

Counter-arguments in this section should be equally compelling to the initial arguments. This allows a greater degree of certainty that the analysis is unbiased, objective, and fair to a variety of viewpoints. So, for example, a counter argument for the case above could begin with a statement like this: “Critics of this position would likely claim that we ought to discontinue Mrs. Sanders artificial nutrition based on the notion that her care is futile since she will likely never leave the hospital.”

Response to Counter-Argument and Conclusion (1-2 pages)

This section should communicate a direct response to the counter argument, and prove why the counter claims are insufficient or inappropriate. It should indicating your initial position is more compelling and why. For example, a student might state “While critics might argue that Mrs. Sanders case futile, based on Trotter’s conception of futility it can be seen that they are mistaken, since artificial nutrition is accomplishing Mrs. Sanders pre-stated goals.”

Expectations and Evaluation*

Recognizing that ethical narrative reflects a degree of subjectivity and creativity on the part of the writer, written assignments in this course will not be evaluated on individual thoughts or positions. Rather, work will be evaluated on the depth and clarity of thoughts and ideas; presence of all required assignment elements; accurate understanding, interpretation, and application of ethical theories and principles; and narrative organization and writing mechanics. Close attention to details in the following categories will help to ensure successful completion of written assignments in HCE 430: Applied Ethics in Health Care.

General Writing Expectations

Writing Mechanics:

Papers must meet acceptable writing standards for undergraduate-level work, including paragraph construction and sentence structure. For guidance on academic writing, visi Commons. Papers must be carefully proof-read prior to submission so as to capture misspellings, grammatical errors, and problems with sentence or paragraph structure. It is often helpful for students to read their own writing out loud in order to capture some of the more obvious errors. It is also often helpful to see the help of a friend or family member who can serve as editor. The includes free services to help students with the writing process. You can make an online appointment with a writing tutor for assistance.

General Requirements

All courses in the RHCHP School of Nursing require adherence to standards set forth by the Publication Manual of the American Psychological Association, 6th edition, published in 2010. This is an important element of academic writing and students are required to carefully follow APA standards. The APA publication manual is available through the and most other book retailers. Additionally, writing resources including APA style sheets and information about academic writing are linked through the Course Syllabus. Papers that do not substantively comply with APA standards may be returned unread.

Assignment Layout and Adherence to APA Standards

· Papers must not significantly fall below or exceed guidelines for length as outlined in the assignment descriptions.

· Papers must be formatted in accordance with standards set forth by the APA manual as described above.

· Assignment submissions should include a cover sheet as well as running headers and paper numbers (placed electronically within the body of the paper),

· All written work must be free of plagiarism, either intended or unintended.

· Sources must be properly captured with in-text citations, and each in-text citation must include a corresponding and properly formatted entry in the reference list.

· As recognized by APA standards, papers are to be constructed using the 12 point Times New Roman font.

* Adapted from:
Rhodes, T. L. & Finley, A. (2013). Using the VALUE rubrics for improvement of learning and authentic assessment. Washington, DC: Association of American Colleges and Universities.

Revised: Fall 2016 A.E. Hine