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PROPOSED OUTLINE FOR ETHICAL ANALYSIS The following format is advised for the systematic analysis of the cases presented. This outline can be used whether an individual case is used over one or more sessions. This outline is taken from JC Flercher, CA Hite, PA Lombardo, MF Marshall (eds.). Inrroduction to Clinical Ethics, University Publishing Group lnc., Frederick, Md. 1995. I. Assessment l. What is the patient's medical condition and prognosis? What rrea(ment options exist? 2. Who is the appropriate decision maker? 3. What are the patient's preferences? 4. What are the preferences ofher family or surrogate decision makers? 5. Are there inrerests orher than, and potenrially conflicting with, those of the patient which need to be considered? 6. Are there institutional, legal or other factors which need to be considered? tr. Identification of the Ethical Problem(s) 7 . Whar are the ethical problems in the case? (lf appropriate, rank by magnirude.) 8. What ethical considerations arc most relevant? 9- Are there analogous cases? 10. What are the relevanr guidelines for clinicians rcgarding the problem(s)? m. Decision Making and Implementation I L What arc the ethically acceprable options? 12. What justifications can be given for the ethically preferrcd rcsolution of the case? 13. How is a satisfactory rcsolution to the case to be accomplished? Is ethics consultation necessary or desirable? Is judicial review necessary or desirable?
CODE OF PROFESSIONAL CONDUCT PREFACE The Ethics and Humanilies Subcommittee of the Practice Comminee of the American Academy of Neurology developed the Code of Professional Conducto formalize the srandards of professional behavior for neurolo=gisr members ofthe Academy The pnmary goal ofthe Code is ro promore the highest quality of neurologicare. The Code is framed 10 outline the set of professional standards that neurologists muit observe in their clinical and scientific acttvities. The Code embodies traditional medical ethical standards dating from the time ofHippocrales as well as more contemporary standards. lt includes general pnnciples of medical ethics and provides their application to the specific demands ofneurologic praciice. The Code is delineated to be generally consistent *irh,ha Ar..i"- Medical Association Code of Medicai Ethics and the American Medical Association Current Opinions of the Council on Ethical and Judicial Affairs The Code is written in relatively broad language. It is designed to be a dynamic instrumenthat can grow and change in response to future development;in the practice;d science ofneurology. While ethrcal principles do not.change with rime, developments in science, technology, and clinical practice iiay lead to a change in application of these ethical principles The Code outlines the standards ofprofessional conduct for Academy members. Violations ofthese standards may serve as the basis for disciprinary action as provided in the Bylaws ofthe Academv.
Page 1 and 2: AMERJC,{N ACADEMY OF NETJROLOGY ETI
Page 3 and 4: TABLE OF CONTENTS l. Introduction 2
Page 5: Followrng each case is a proposed o
Page 9 and 10: arrange transfer ofthe patient's ca
Page 11 and 12: items as long as this practice prov
Page 13 and 14: 2 AmericanAssociationofNeurological
Page 15 and 16: II. Case Ms. JA is a 24 year old wo
Page 17 and 18: III. Case Comments (bv Roben F. Nel
Page 19 and 20: 8. What ethical considerations are
Page 21 and 22: HUNTINGTON'S DISEASE - PRESYMPTOMAT
Page 23 and 24: PROPOSED OUTLINE FOR ETHICAL ANALYS
Page 25 and 26: 6. Are there institutional, legal,
Page 27 and 28: AMENCAN ACADEMYOF NEUROLOGY Page I
Page 29 and 30: CARE OFAN HIV.INFECTED PATIENT IN A
Page 31 and 32: The following format is advised for
Page 33 and 34: B. Idenrification ofthe Ethical Pro
Page 35 and 36: 9. t0. Are there analogous cases? W
Page 37 and 38: Ethical Role of Ncurologisrs io AID
Page 39 and 40: OPIOID TREATMENT OF CHRONIC NONMALI
Page 41 and 42: and mexilitene. Finally, Mr. Jones
Page 43 and 44: III. Case Commenb (by Glenn A. Mack
Page 45 and 46: Ponenoy has extensively reviewed ex
Page 47 and 48: defined "rescue" doses or hospitali
Page 49 and 50: 8. What ethical considerations are
Page 51 and 52: 16. Rodwin MA. Srrains in rhe fiduc
Page 53 and 54: II. Case A 25 year-old woman sustai
Page 55 and 56: III. Case Comments (by Michael P. M
Page 57 and 58:
some guidance, if they are consiste
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On the basis of this analytic appro
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80 years ago by Justice Benjamin Ca
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Although physicianshould always act
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t(, ;-)- AMERICAN ACADEMY OF NEUROL
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@ Persistent VeSetativeSlate Paticn
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1r= ) AMERICAN ACADEMY OF NEUROLOCY
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PRSISTE\TT }TGETATTVE STAIE ard chi
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PRSISTE{T VEGETATryE STATE PAGE 5 T
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PNSISTEYT ITGETATTVE STATE PAGE 7 5
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PNSISTF{T VEGETATTVE STATE PAGE 9 O
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II. Case Because of progressive dys
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III. Case Comments (by James Bernat
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mother's wishes, some of her guilt
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Special Article n"r.oro*r*,ffi* Eth
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injur5r from improper application o
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,R,, '.=--' AMERICAN ACADEMY OF NEU
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DIAGNOSIS AND EVALUAIION OF D&TBI"I
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DLTGNOSIS AND EVALUAIION OF DE\,I6|
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II. Case The patient (Mrs. M) was a
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III. Case Comments (by Alison Wichm
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usually be identified as her surrog
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with the surrogate and other family
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RAIN DEATH IN ADULTS PAGE 2 3. with
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BRAIN DEATH IN ADIJLTS PAGE 4 E. So
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PHYSICIAN-ASSISTED DYING I. Learnin
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The neurologist writes the prescrip
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Continuation Version Two when the g
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Continuation Version Four The pills
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III. Case Comments (by David Goldbl
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might have benefitted from professi
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from engaging in any acr thar direc
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II. Case @ Neurologi consultation w
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III. Case Comments (by Russell D. S
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C. Dcci.sion Mnkinp and Intplernent
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UNCOOPERATIVE PARENTS @ I. Learning
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The following format is advised for
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even though rhese needs appear to t
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CLINICAL TRIALS I. Learning Objecti
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III, Case Comments (by David Goldbl
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@ ro identify a her to enroll in th
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II. Case A 46-year-old white ntale
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III. Case Comments (by Russell Snyd
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4. The medical community needs to c
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GIFTS FROM INDUSTRY t. Learning Obj
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II. Case Dr. Daniel Barker was rece
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@ B. Identifcation of the Ethical P
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@ specialty medical associations. U
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PROFESSIONAL MISCONDUCT OF A SEXUAL
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The following format is advised for
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one class of nonsexual touching is
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