The purpose of this paper is to apply the information discussed in the first part of the course regarding ethical theories and principles along with the Four Topics Method for Analysis of Clinical Ethics Cases (Jonsen, Siegler and Winslade, 2006) to the analysis of a case study. This assignment is a group project assignment. Each member of the group will receive the same grade for the group assignment. You will work in groups of 3-4. Each student will submit a final electronic copy of this assignment to receive their grade. The case analysis paper must include the members of the group. Group work involves working together to submit a final edited coherent product that represents the consensus of the group. This assignment is a formal paper using APA format. The purpose of this paper is to apply the information discussed in the first part of the course regarding ethical theories and principles along with the Four Topics Method for Analysis of Clinical Ethics Cases to the analysis of a case study. Identify the primary ethical issue in this case. What might be a possible resolution based upon this ethical theory? Use the Four Topics Method by Jonsen, Siegler and Winslade to analyze the case. 1. Based upon the information in the case study, answer the questions for each topic, indicating if information is not available. 2. Summarize your analysis of the responses you identified using the Four Topics Method. What ethical principles are at issue in the case? What are your conclusions based upon this analysis? 3. References, APA format, spelling and grammar 4. Submit an electronic copy or a hard copy to the course instructor by the due date. A penalty will be assessed if the paper is turned in late unless prior arrangements have been made with the course instructor. Use the following for the framework of the paper and all other course assignments: Four Topics Method for Analysis of Clinical Ethics Cases Jonsen, A.R., Siegler, M., & Winslade W.J. (2006) Clinical ethics: A practical approach to ethical decisions in clinical medicine (6th ed.) New York: McGraw-Hill. Medical Indications – The Principles of Beneficence and Non-maleficence Questions: What is the patients medical problem? History? Diagnosis? Prognosis? Is the problem acute? Chronic? Critical? Emergent? Reversible? What are the goals of treatment? What are the probabilities of success? What are the plans in case of therapeutic failure? In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided? Patient Preferences – Principles of Respect for Autonomy Is the patient mentally capable and legally competent? Is there evidence of incapacity? If competent, what is the patient stating about preferences for treatment? Has the patient been informed of benefits and risks, understood this information, and given consent? If incapacitated, who is the appropriate surrogate? Is the surrogate using appropriate standards for decision making? Has the patient expressed prior preferences, e.g. Advance Directives? Is the patient unwilling or unable to cooperate with medical treatment? If so, why? In sum, is the patients right to choose being respected to the extent possible in ethics and law. Quality of Life – Principles of Beneficence and Non-maleficence and Respect for Autonomy What are the prospects, with or without treatment, for a return to normal life? What physical, mental, and social deficits is the person likely to experience if treatment succeeds? Are there biases that might prejudice the providers evaluation of the patients quality of life? Is the patients present or future condition such that his or her continued life might be judged undesirable? Is there any plan and rationale to forgo treatment? Are there plans for comfort and palliative care? Contextual Features – Principles of Loyalty and Fairness Are there family issues that might influence treatment decisions? Are there provider (physicians and nurses) issues that might influence treatment decisions? Are there financial and economic factors? Are there religious and cultural factors? Are there limits on confidentiality? Are there problems of allocation of resources? How does the law affect treatment decisions? Is clinical research or teaching involved? Is there any conflict of interest on the part of the providers or the institution? Read the case study below and address the following criteria: Case: Juana a 20-year-old, Black Hispanic female, 25 weeks pregnant, was brought to the emergency department (ED) in an ambulance by the paramedics. She arrived in the ED immobilized on a flat board with a hard cervical collar in place. Juana was the driver of a sedan involved in a single-vehicle collision. She stated she was driving at approximately 60 miles per hour on the highway and suddenly lost control of the vehicle and crashed into a light pole. She also stated her head hit the windshield and shattered the glass. She denied loss of consciousness. Upon her arrival in the ED, Juana was alert and oriented to person, place, and time and had a Glasgow Coma Scale of 15/15. Her initial complaints were lightheadedness, weakness, left shoulder pain, and severe abdominal cramping that started immediately following the car accident. She had a past medical history of sickle cell disease and no previous pregnancies. Her lungs were clear bilaterally. Juana’s heart rate was 90 beats per minute (bpm), her respiratory rate was 28, and her initial blood pressure (BP) was 130/80, and fetal pulse rate was 90. Once the cervical spine films were taken and the flat board was removed, her BP reflected orthostatic changes of 100/60 and pulse of 120 bpm. She exhibited signs and symptoms of internal bleeding and was advised to have a blood transfusion and emergency surgery in an attempt to save her and the fetus. She refused to accept blood or blood products and rejected the surgery as well. Her refusal was based on a fear of blood transfusion due to her belief in Bible scripture. The ethical dilemma presented is whether to respect the patient’s autonomy and compromise standards of care or ignore the patient’s wishes in an attempt to save her life. See the attached for case study analysis guidelines
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