Microsoft powerpoint - case #1 worksheet - powerpoint version

Case Study #1
Name: ________________________________________________
Date: _________________________________________________
Ethical Decision Making Model
Seminar in Medical Ethics PL 4700
John F. Morris, Ph.D.
Rockhurst University
Does your proposed course
of action lead to
If YES – then proceed …
Possible Solutions
Level III
Level II –
Level I –
ethical principles?
social roles?
Dr. Carol Watson has been a dermatologist for over 15 years, with a thriving practice in Overland Park, KS. Over the years she became good friends with Karen Johnson, a physical therapist who runs a clinic in the same medical building as Carol. The two talk to each other almost daily, go to lunch regularly, and have even gone to several local health care oriented banquets together with their husbands. About six months ago, Karen asked Carol’s advice on OTC acne medications for her youngest daughter, Tina, who just turned 14. After getting the impression from Karen that the acne was not that serious, Sharon gave some recommendations – but added that good skin cleaning and less makeup would actually be more helpful.
Then, three months ago, Carol and her husband were invited to the wedding of Karen’s oldest daughter. At the reception, Karen brought up Tina’s acne again, saying she felt it was worsening and that the OTCs weren’t helping at all. She asked Carol if Tina should come to see her. Carol had noticed Tina during the wedding, and then later at the reception, and could tell that her acne wasn’t that bad – not compared to the cases Carol usually saw in her office. But to help her friend out, and to save Tina a trip to her office, Carol said she would write a prescription for Renova®and give it to Karen at work on Monday. Carol explained that she prescribed this a lot for mild cases of acne, but warned that Tina’s pimples would probably get worse for about a week or so before they should start gradually improving. For the next three weeks, Carol checked with Karen to see how Tina was doing. After that, Karen did not bring up Tina, so Carol assumed the Renova® was working. However, over lunch today, Karen brought up Tina again. She said that her daughter had not been happy with the Renova®, and instead had been pestering her to get Proactive®Solution after seeing an infomercial with Jessica Simpson (Tina is a BIG fan!). Karen said she would talk to Carol about it, but then her daughter told her over breakfast this morning that she wanted to try a new drug she had found out about on the internet called Accutane®. Tina said she had discovered on an internet fan blog that Jessica Simpson’s acne had actually been cleared up using Accutane® and not Proactiv®. Karen bluntly asks Carol to write Tina a new prescription for the Accutane®.
Carol does not know what to do. Accutane® has definitely been shown to help acne, but its side effects are so serious that it is reserved for only the most severe cases – Carol herself had only prescribed it to about a dozen patients over the years. The FDA even requires patients who take it to sign a consent form first. Accutane® is known to cause birth defects in pregnant women, and at 14 there would be some concern that Tina might become sexually active – a topic that Carol would rather not get into with Karen at this point. But more concerning was the long debate about whether Accutane® has caused depression and suicidal tendencies in patients, or if it has contributed to irritable bowel syndrome and some degenerative diseases. The manufacturer has repeatedly insisted that there is no evidence to link Accutane® to such problems, and since it has been so effective, most dermatologists have continued to prescribe it for serious cases. However, Carol had just read two brand new studies that suggested the links are more likely than what had previously been thought (Bremner JD, McCaffery P., “The neurobiology of retinoic acid in affective disorders,” ProgNeuropsychopharmacol Biol Psychiatry, Feb 15, 2008;32(2):315-31, and “Decreased Plasma FolateConcentration In Young And Elderly Healthy Subjects After A Short-Term Supplementation With Isotretinoin,” J Eur Acad Dermatol Venereol, Jan 2008; 22(1):94-100). Plus, even though Tina make think her acne is terrible, Carol knows it just isn’t that bad – certainly not enough to really need such a strong product as Accutane®. On the other hand, Carol does not want to upset her friend Karen by refusing to write the prescription for Tina.
1) What are the relevant facts, values, & beliefs? 2) Who are the key people involved? 3) State the dilemma clearly: is it permissible, impermissible, or obligatory to _____
1) Are there any medical, legal, historical , or factual issues that need clarification to 1) Possible courses of action at Level I – self-interest? Reasons one might do the action: _______________________________________________ Reasons one might NOT do the action: __________________________________________ 2) Possible courses of action at Level II – social roles? Reasons one might do the action: _______________________________________________ Reasons one might NOT do the action: __________________________________________ What does Respect for Persons require of us in this case?
Summarize the case: is the proposed course of action permissible, impermissible, or obligatory?


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