SSM 7: Ethics and Law Portfolio

SSC: Ethics and Law PortfolioCatherine Hale

What is SSC: Ethics and Law?• After collaboration with previous years’ Year 5, this is a revisedversion of SSC Ethics and Law• This is the only timetabled session- all information is availableon WebCT- Year 5 : SSC: Ethics and Law Portfolio• Formally runs in Year 5 until Tuesday 6 th December 2011: handin date• Revisiting the principles of medical ethics and law from MBChB1 & 2• Hopefully you’ve already had the opportunity to reflect in yourclinical placements to date on the ethics and law you learnt inyears 1 & 2

AIMS of SSC: Ethics and Law• In the assessment of your Portfolio we will be looking at yourability to apply core ethical and legal concepts to the analysis ofcritical issues / situations• This is to ensure that you have the skills necessary to deal withethical/legal problems in clinical practice as qualified doctors

Learning Outcomes:• Demonstrate an awareness of ethical and legal issues in medicine inthe contemporary world and where appropriate of the differencesbetween public (including patient) and professional perspectives.• Reflect critically on your clinical experience from an ethical and legalpoint of view.• Apply the principles of ethics and law learnt in the early years of themedical undergraduate programme to your own clinical practice and tothe identification and analysis of critical incidents in clinical care.• Demonstrate a capacity for life-long learning, by drawing critically andindependently on public and professional sources of information andopinion, to update your ethico-legal understanding.

What is going to be in yourportfolio?• A write up of two cases from your clinical practice detailingthe clinical case and ethical and legal issues it raises• Each case should cover a different range of ethical and legalissues encountered during MBChB 3, 4 or 5.• Each write-up should be 800 words long• Your write up of your chosen cases should use the “reflectivepractitioner” model style of analysis, which in summary meansfor this SSC that you reflect on the ethical/problem; possibleways to resolve it and then state what you have learnt in theprocess

Reflective Practitioner• “Reflection-on-action" is what we usually mean when werefer to reflective practice. This is the reflecting you do after theevent: thinking through, and often discussing the incident with acolleague• It involves being self aware, not just being ruminative or navalgazing. Rather it should be action orientated and lead to change• “Reflection-in-action” is when you are working, and beingaware of what you are doing at the same time. This is the wayany confident, experienced practitioner works, it involvesknowing and doing at the same time

How do you choose cases foryour portfolio?• The two cases that you choose for write-up will normally be anarea/topic/case that you are particularly interested in includingyour elective placement• You can choose any clinical cases from MBChB Years 3,4 or 5• Cases should cover a different range of ethical and legal issuesi.e:please do not submit more than one case on each topic orwhere the facts of the case are similar• Choose cases that generally interested you and made you thinkfrom an ethical and legal perspective

Write-up of Clinical Cases• You need to summarise the facts of the problem, identify what theethical/legal issues were and analyse how issues were dealt with andresolved• Therefore, in each case you will identify and describe the relevantethical and legal principles that apply to each case; then perform ananalysis of how these principles were addressed in the management ofthe case• As a reflective practitioner you need to state what you have learnt andhow you would deal with a similar problem in the future• Where appropriate, you should suggest ways in which you mighthandle the case differently and detail what you have learnt by analysingeach case

Online Discussion Board• If you have any questions then you can postyour question on the SSC Discussion Boardon the Year 5 WebCT and I will reply to you• Please do not email me directly re: SSC• The Discussion Board will be checked on aweekly basis in term time (may be slightlylonger outside of term time)

Presentation of Portfolio• Hand in date 6 th Dec for portfolios- Med School Office• A4 paper- Double spaced and stapled in the lefthand-corner. No folders/ plastic covers etc...• Cover sheets: Print off from WebCT: Page 1 markingcriteria- fill in your candidate number: Page 2 identifywhat ethical/legal topic each of your cases coversfrom a checklist• Clinical Cases- write up

Marking criteria:A: 70+: Substantial evidence of reading; excellent ability to synthesise ethical principlesin order to resolve and analyse practical ethical dilemmas. Insight and originality ofthinking.B: 60-69: Good ability to synthesise ethical principles in order to resolve and analysepractical ethical dilemmas. Broad command of the chosen topic area and of underlyingethical principles.C: 50-59: Ability to synthesise ethical principles in order to resolve and analyse practicalethical dilemmas. Must show a command of the chosen topic area and of underlyingethical principles. There may be lapses in the organisation, or analysis of the dilemma.Fail- D/E: Limited evidence of a command of topic area and of ethical principles; mayhave missed major points, or show substantial inaccuracy in minor points.A case-study which fulfils the criteria for a pass, but which is poorly presented may beawarded a mark below 50%.

Example of ‘A’ GradeReferences:• Stroud, R. (2002). The withdrawal of life support in adult intensive care: An evaluative review of theliterature. Nursing in Critical Care, 7, 176–184.• Schneiderman, L.J., Jecker, N.S., & Jonsen, A.R. (1996). Medical futility. Annals of Internal Medicine, 125,669–674.• Shah, S., & Lloyd-Williams, M. (2003). End-of- life decision making—Have we got it right? EuropeanJournal of Cancer Care, 12, 212–214.• Rousseau, P. (2001). Ethical and legal issues in palliative care. Primary Care, 28, 391–400.• Low, L.L., & Kaufman, L.J. (1999). Medical futility and the critically ill patient. Hawaii Medical Journal, 58(3),58–62• Marco, C.A., & Larkin, G.L. (2000). Ethics seminars: Case studies in “futility”—Challenges for academicemergency medicine. Academic Emergency Medicine, 7, 1147–1151.• Nyman, D.J., & Sprung, C.L. (2000). End-of-life decision making in the intensive care unit. Intensive CareMedicine, 26, 1414–1420.• Fins, J.J., Miller, F.G., Acres, C.A., Bacchetta, M.D., Huzzard, L.L., & Rapkin, B.D. (1999). End-of-lifedecision-making in the hospital: Current practice and future prospects. Journal of Pain and SymptomManagement, 17, 6–15.• Henig, N.R., Faul, J.L., & Raffi n, T.A. (2001). Biomedical ethics and the withdrawal of advanced lifesupport. Annual Review of Medicine, 52, 79–92• Buryska, J.F. (2001). Assessing the ethical weight of cultural, religious and spiritual claims in the clinicalcontext. Journal of Medical Ethics, 27, 118–122.• Callahan, D. (2003). Living and dying with medical technology. Critical Care Medicine, 31(5, Suppl.), S344–S346.

Fails:• Small number (last year 11) includingunprofessional conduct- i.e. breaching patientconfidentiality, making unprofessional/personal comments/ unintelligible English/plagiarism (work is checked on turnitinsoftware/ little work done• Resubmission Date: May 2012