Ethics Challenge

The RCSIsmj invites students to submit an essay discussing an ethical issue raised in a case published in the most recent edition. The essay will be reviewed by a faculty panel of experts and the best one will be published in the next issue of the journal. Please note that the ethics essay should not be an opinion piece. The essay should discuss ethical issues academically, using appropriate references where necessary. Submissions should not exceed 2,500 words. Please submit entries to submissionssmj@rcsi.ie.

2010 Ethics Challenge

This is the second instalment of the RCSIsmj Ethics Prize. The editorial staff would like to congratulate Adwait Mehta and Janso Padickakudi for their winning essay for the 2008/09 challenge. Please see here for their submission.

Again, we invite all students to submit an essay discussing the ethical questions raised in the case study presented here. Medical ethics is an essential aspect of the medical curriculum and we hope to encourage RCSI students to think critically about ethical situations that arise during their education and their careers in healthcare.

All essays will be reviewed by a faculty panel of experts and the winning essay will be published in the 2010/11 print edition of the RCSIsmj. This is a perfect opportunity to get published and the only officially guaranteed publication in the RCSIsmj.

The deadline for submission will be the same as the general submission deadline for all articles for the 2010/11 RCSIsmj edition. Please keep up to date by checking back here.

Any questions? Email us at editorsmj@rcsi.ie.

The Case: CAN DOCTORS SAY “ENOUGH”?

A 77-year-old woman was admitted to New York Presbyterian Hospital, Columbia Division, with intestinal obstruction. The patient had a history of multiple prior abdominal surgeries for resection of colonic polyps, partial colostomy for bowel incarceration, and small bowel obstruction. The patient underwent coronary artery bypass surgery and valve replacement 3 years prior to admission. She was very obese, was diabetic, and had peripheral vascular disease. Her mental status was normal. She was a Holocaust survivor, was married, and had one daughter. The patient underwent bowel resection for a large villous adenoma. One month postoperatively she developed septic shock and was re-explored. An anastamotic leak was found along with multiple intra-abdominal abscesses, which were drained. She went to the surgical ICU post-op. Her subsequent hospital course was marked by severe complications. She developed multiple enterocutaneous fistulas, required ventilator support because of respiratory failure, needed regular hemodialysis, and was alimented intravenously with total parenteral nutrition because her GI tract was nonfunctional. She developed fungemia due to fungal endocarditis and required pressors most of the time because of almost continuous sepsis. A very large and very deep sacral decubitus ulcer further complicated her care. Although she would open her eyes and visually follow people in her room, she made no response to any sort of verbal or tactile stimulus. The nurses noted, however, that she would moan softly when they changed her dressings. Despite the worsening prognosis, the patient’s daughter insisted on continued aggressive care. She stated that her mother had survived the Nazi concentration camps and would survive this illness. She further said that, although her mother had no written advance directives nor a healthcare proxy, she had on several occasions commanded her daughter, “Don’t let anything happen to me,” which the daughter interpreted as an order to make sure everything was done to keep her mother alive. The patient’s physicians felt by the fourth month of her ICU stay that there were no chances that she would leave the hospital alive, and they requested a medical ethics consultation and review by the hospital ethics committee.

Key Questions to be addressed:

1. Identify the ethical issues involved in this case.
2. How would you address them?
3. Discuss your course of action and justify them within the framework you have established.
4. Consider weaknesses in your position and address potential challenges to your decision.

Submission Guidelines

Please construct a lucid, structured and well-presented argument for your course of action in this case. Please ensure you have addressed all the questions highlighted and discuss these ethical issues academically, making sure to reference when necessary.

Your essay will be evaluated on three major criteria:

1. Ability to identify the ethical issues raised by the case.
2. Fluency of your arguments (note that there is no penalty for which side you discuss, just be sure to develop your arguments)
3. Academic quality with regard to depth of research, appropriateness of references and quality of sources.

Back to Submission Guidelines.