On Day 1 of this course, your instructor will assign you to one of the four case studies below. Prior to beginning the discussion, review additional required resources this week associated with this discussion. For your initial post, address the discussion questions associated with the case study you were assigned. For your responses, select two classmates who were assigned different options than you. Respond to at least two classmates using the required response prompt for their option (e.g., if your initial post was Option 1, then respond to posts from Option 2, 3, and/or 4; if your initial post was Option 2, then respond to posts from Option 1, 3, and/or 4; if your initial post was Option 3, then respond to posts from Option 1, 2 and/or 4; or if your initial post was Option 4, then respond to posts for Option 1, 2 and/or 3). Your initial post must be 150 to 250 substantive words. Your response post should be at least 100 substantive words.
Option 1: Internal Review Board (IRB) Case Studies
Team 1 Members: Katja, William, Abchillahi, Caproria, and Shena
- Review each of the four
from Yale University. - Select one case and describe it in your discussion post. Indicate in your post which case number and/or name you are using.
- Discuss why you believe the determination was made and whether you believe it was the right or wrong decision.
Indicate whether you have been assigned Option 1, Option 2, Option 3, or Option 4 at the beginning of your discussion post.
Required Response: By the end of Day 7, respond to at least two classmates using the required response prompt for their option (e.g., if your initial post was Option 1, then respond to posts from Option 2, 3, and/or 4; if your initial post was Option 2, then respond to posts from Option 1, 3, and/or 4; if your initial post was Option 3, then respond to posts from Option 1, 2 and/or 4; or if your initial post was Option 4, then respond to posts for Option 1, 2 and/or 3). In a substantive post, explain why you agree or disagree with your colleagues discussion as to whether the determination was right or wrong. Provide additional supportive evidence as to your agreement or disagreement. Your responses should be at least 100 substantive words.
Option 2: Ethics Committee Case Study
Team 2 Members: Natalie, Veronica, Cammie, Latanya and Madelton
John, a 32-year-old lawyer, had worried for several years about developing Huntingtons chorea, a neurological disorder that appears in a persons 30s or 40s, bringing rapid uncontrollable twitching and contractions and progressive, irreversible dementia. It leads to death in about 10 years. Johns mother died from this disease. Huntingtons is autosomal dominant and afflicts 50% of an affected parents offspring. John had indicated to many people that he would prefer to die rather than to live and die as his mother had. He was anxious, drank heavily, and had intermittent depression, for which he saw a psychiatrist. Nevertheless, he was still a productive lawyer. John first noticed facial twitching 3 months ago and two neurologists independently confirmed a diagnosis of Huntingtons. He explained his situation to his psychiatrist and requested help committing suicide. When the psychiatrist refused, John reassured him that he did not plan to attempt suicide any time soon. However, when he went home, John pinned a note to his shirt to explain his actions and to refuse any medical assistance that might be offered, then, ingested all his antidepressant medication. His wife, who did not yet know about his diagnosis, found him unconscious and rushed him to the emergency room without removing the note.
What should the care team at the emergency room do?
- Discuss this question using the following topics and analyzing how these issues are applied to the decision made by the emergency room care team. Use at least two scholarly sources to support your discussion.
- Review of the topics within this case:
- Medical Indications: There are two diagnoses/prognoses that merit consideration. The underlying chronic disease of Huntingtons has no available treatment and a bleak long-term prognosis. However, there are effective treatments available for the acute diagnosis of drug overdose.
- How does the chronic diagnosis affect the teams response to the acute condition?
- Patient Preferences: We know from the patients suicide note that he is refusing all medical treatment. However, what do we know about these statements of preference?
- Were they informed?
- Was the patient competent to make that decision?
- The answers to these questions remain unclear, but we do know that the patient does not have decision-making capacity for the present decision of whether to proceed with the gastric emptying.
- Is there a surrogate decision-maker available?
- Quality of Life: Life with Huntingtons can be difficult with the onset of spasms and dementia. John was familiar with the quality of life associated with living with Huntingtons as he watched his mother die of this disease. On the other hand, John does have a supportive family and continues to be able to work for the time being.
- How should the diminished quality of life that is anticipated in the future affect the current decision?
- Contextual Features: Several factors in the context of this case are significant. While the patient has a legal right to refuse treatment, he is currently unconscious and his surrogate (his wife) is requesting treatment. There are also certain emergency room obligations to treat emergent conditions.
- How should the emergency staff weigh the various competing legal and regulatory duties?
- Medical Indications: There are two diagnoses/prognoses that merit consideration. The underlying chronic disease of Huntingtons has no available treatment and a bleak long-term prognosis. However, there are effective treatments available for the acute diagnosis of drug overdose.
Indicate whether you have been assigned Option 1, Option 2, Option 3, or Option 4 at the beginning of your discussion post.
Required Response: By the end of Day 7, respond to at least two classmates using the required response prompt for their option (e.g., if your initial post was Option 1, then respond to posts from Option 2, 3, and/or 4; if your initial post was Option 2, then respond to posts from Option 1, 3, and/or 4; if your initial post was Option 3, then respond to posts from Option 1, 2 and/or 4; or if your initial post was Option 4, then respond to posts for Option 1, 2 and/or 3). In a substantive post, explain why you agree or disagree with your colleagues discussion as to whether the determination was right or wrong. Provide additional supportive evidence as to your agreement or disagreement. Your responses should be at least 100 substantive words.
Option 3: Patients Bill of Rights
Team 3 Members: Mary, Charnese, Sarah, Adrianna, and Ashley
Review Section 2.1 in Chapter 2 of the textbook regarding Patients Bill of Rights.
- Perform the Web Field Trip at the end of this section, and provide the following in your discussion post:
- Post your Grading Rubric either by cutting and pasting it directly into the discussion area or post it to a word document and post it in the discussion area.
- Discuss the three Bill of Rights you researched, where they came from, and the determinations that occurred from this exercise.
Indicate whether you have been assigned Option 1, Option 2, Option 3, or Option 4 at the beginning of your discussion post.
Required Response: By the end of Day 7, respond to at least two classmates using the required response prompt for their option (e.g., if your initial post was Option 1, then respond to posts from Option 2, 3, and/or 4; if your initial post was Option 2, then respond to posts from Option 1, 3, and/or 4; if your initial post was Option 3, then respond to posts from Option 1, 2 and/or 4; or if your initial post was Option 4, then respond to posts for Option 1, 2 and/or 3). In a substantive post, explain why you agree or disagree with your colleagues discussion as to whether the determination was right or wrong. Provide additional supportive evidence as to your agreement or disagreement. Your responses should be at least 100 substantive words.
Option 4: End Stage Neurodegenerative Diseases
Team 4 Members: Barbara, Tamala, Tameko. Sabrina, and Jasmine
Review the article .
- Discuss the ethical concerns in the disease progression of neurodegenerative diseases.
- Discuss how Jonsens four-topic method works in undertaking ethical issues in late stage neurodegenerative diseases.
Indicate whether you have been assigned Option 1, Option 2, Option 3, or Option 4 at the beginning of your discussion post.
