Healthcare Ethics: Lecture Note by Dr. T. McCormick

Abstract

One of the major roles of healthcare ethics is to provide clinical case consultation when ethical conflicts or dilemmas arise within the healthcare team or between the team and the patient-family. To understand the concept of healthcare ethics, the seminar entitled “Teaching ethics in a clinical setting: Using the 4 box method” by Doctor Thomas R. McCormick, University of Washington, was held in March 2006 at Kyorin University. The mission in this seminar was: (1) to focus on case studies involving ethical issues in the clinical setting, (2) to develop a common language and conceptual framework for the study and analysis of the cases, (3) to use the seminars as “practice sessions” for discussing ethical issues, speaking, and listening to the perspectives of others, (4) to aim for openness in sharing our values, our ideas and our feelings about the cases and the relationships involved, and (5) to better understand ourselves and our values. Some clinical cases were analyzed and discussed using the four box method. This helpful tool in constructive ethical decision making is composed of four topics: Medical indications for intervention, Preferences of the patient, Quality of life, and Contextual issues. Using the classical case of Baby Doe, it was shown that the judgment about refraining from medical intervention for this handicapped baby might vary in the surrounding conditions, i.e. social welfare system, legal frame work, or the values of the infant's family. The second case of 87-yrs-old male with COPD, indicated the problems of autonomy and QOL, which might be common not only in the US but also in Japan. The case showed how to make autonomous decision for the life in the US. The third case of 17 yrs-old Jehovah's Witness with terminal renal failure involved the conflict between the patient's decision and parent's decision. Although it is possible to get a legal intervention for the 17 year-old patient, this may not be a good choice for the family. From this case, we discovered that the process of decision-making is as important as the result of the decision. These case studies, together with the principles and the four box paradigm used to analyze them, provided a helpful method and disclosed how healthcare professions make constructive bioethical decision when we are faced with an ethical dilemma.