Case Study on "ing Grief Without Consent"

Quoted Instructions for "ing Grief Without Consent" Assignment:

CASE STUDY: Studying Grief Without Consent

John Clark, a graduate student at a major university, wanted to research the emotional needs of families who had a dying relative. He decided that the best way to conduct this research was to work as a participant-observer in a hospital. He already had training and experience as a counselor, and he added to his qualifications by taking a course to become a nursing assistant.

A small community hospital interested in family care allowed him to volunteer for ten hours a week as a nursing assistant and counselor. The hospital had never conducted medical research before, and had no committee for the protection of human subjects. In fact none was required by state or federal law at the time. Clark informed the administration and the staff of his research intentions and received their approval for his work.

Working in the intensive care unit and the emergency room, Clark gave basic care, took vital signs, and assisted the nurses. When a critical care patient was admitted to the unit, he was assigned to work with the family. He provided counseling, helped them deal with the hospital administration, acted as an information liaison between staff and family during nonvisiting hours, and stayed with the family when they were told of the death.

Following each death, he wrote a case history and maintained a check list of common grief reactions. He showed these reports to no one. After a period of three months, he wrote a paper reporting his findings. From this study, the staff developed a course to teach nurses how to deal with the critical care patient*****s family.

The families Clark counseled were told only that he was a nursing assistant and counselor working with the hospital to give special attention to their needs. They responded very positively to the services that he provided. They were not told that a research project was being conducted or that a study would be written.

Clark later decided to use his study as a central part of his doctoral dissertation, and to extend his research where necessary. The university at which he was enrolled had an active research review committee for the protection of human subjects, which was required to examine all research conducted under its auspices.

Should Clark and the hospital have obtained the consent of the families to participate in the research even though it was not legally required? Should the chairman of Clark*****s department now send the research study to the university*****s review committee? If so, what should the committee recommend?

[Reference information = Levine and Veatch, eds. 1984. Cases in Bioethics. Hastings-on-Hudson, NY: The Hastings Center, 77.]

How to begin

- You should begin by considering a number of things. First, read through the case and decide what the major issue(s) is. In other words, what is at stake in this case? Is this an issue of confidentiality? Autonomy? Are there broader themes or issues such as the patient-physician relationship or distributive justice? After making these general observations, move on to the specifics of the case.

- Generally, the point of a case is that something must be done. Specifically, there are multiple options, and we must decide which is preferable. You should identify and consider various possible solutions/actions. Also feel free to fill in hypothetical details. Often we will not know all the details of a case. What these details are can affect your decision about what you think should be done. If there is a relevant detail missing, discuss how this detail (potentially) effects your conclusion. Or, if necessary, state your assumptions up front. For example, *****In this case, I will assume the physician has discussed X with the patient."

- Note: Sometimes the facts of a case will be important, but do not let emphasis on these distract you form the ethical issues of the case. Your argument should focus on the ethical conflict.

- Remember to bring up possible objections to your point of view. Sometimes, this will come out in your discussion of possible options. For example, you may pose one option as something certain people would propose and then discuss why you disagree with it. However, if this is not clear in your general discussion, then make it clear.

- Finally, be clear about which option(s) you support and why. Again, this will usually be clear from your general discussion. However, if not, make it clear.

What I will look for when grading your case study:

NOTE! One of the first things I will look for is whether you are able to use the theories/readings effectively. Below is a detailed description of other specific things I will look for.

- Overall moral argument/position

For your analysis, you need to take a clear position and defend it. To do this, avoid *****back and forth***** discussions (especially within the same paragraph). Also, always make sure it is clear when you are presenting your view and when you are considering another viewpoint. A good way to clue the reader into your overall argument is to state it in your introduction along with a summary or suggestion of how you will defend it.

- Also, make sure to stay focused on the moral issues of the case. Yes, what is legal or suggested by professional codes will often be relevant and useful for your case, but it does not always coincide exactly with the moral argument. For example, in most states physician-assisted-suicide is illegal; however, many argue that this is morally acceptable when practiced with consenting, competent adults.

Use of moral theories, concepts, and readings when appropriate

- One goal of this course is to learn to see the connections between abstract moral theories and everyday, practical issues. When making your arguments consider whether they relate to any of the theories or concepts discussed in the readings. If so, make this connection explicit. However, do not feel like you have to cram as many theories as possible into your case analysis. This can actually detract from your argument if they are not relevant or you spend too little time on each point. Best to focus on the few that are most relevant or useful. (Also consider this connection when considering an objection to your position.)

Objection and response

- A common philosophical tool in constructing an argument is to consider the position of those who disagree with you. This shows that you understand why reasonable people would disagree, but also gives you the chance to explain why your position is still better. When considering an objection to your argument, make sure it is clear to the reader this is what you are doing (otherwise, it will appear you are contradicting yourself). Also be sure to give your opponent the credit/time they deserve. You will usually need a few sentences to a paragraph to adequately explain your opponent*****s position (remember the point is to acknowledge this is a reasonable view, not just something we can dismiss out of hand). Then, after you explain the objection, go on to refute it. You can do this either by showing a flaw in your opponents position or providing an argument that you think is stronger than the one presented by your opponent.