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...when facing the complex ethical issues that arise in clinical practice with this proven approach. Solve any clinical ethical problem with:

The Four Topics Method: An easy approach used to identify, analyze, and resolve ethical problems in clinical medicine. -Back Cover, Clinical Ethics

Jonsen, Siegler, and Winslade probably did not write the back cover of their textbook, but it does emphasize a structured approach that can be used to analyze and resolve ethical issues in clinical medicine. The Four Topics Method is a practical approach to investigating the facts relevant to Medical Indications, Patient Preferences, Quality of Life, and Contextual Features. Health Science students at Nova Southeastern University use this method to analyze ethical issues and case studies, learning the connection between principles and actual circumstances. They demonstrate an understanding of this connection through research, the use of critical reasoning skills, and sharing evidence to support a "well-reasoned” decision. But, how do you really know what is the right choice?

It is just as important to know "when” the right choice is made as it is to know what the right choice is. A recent class discussion brought this important concept to light. The topic was "New Methods of Reproduction,” and we were discussing surrogate mothers, specifically, the case of Baby M. In brief, the facts of this case involve a woman who agrees to be a surrogate mother for an infertile couple but later decides to keep the child. The adopted family sues to enforce the "contract,” and the court’s decision is based upon which parents are deemed "worthy.” The biological mother was a high school dropout married to a sanitation worker; the adopted mother was a biochemist married to a pediatrician. Of course, the real focus should be on ethical considerations of surrogacy, in general; is it payment for a service or buying a baby? But, the ethics class (just as the nightly news back in 1987) focused on a comparison of the parents’ salaries and lifestyles. These are the prominent features which seem to define the "best interest” of the child…the child? It occurred to me that, unlike most of the previous cases we studied, the case of Baby M involves real people. I realized that students were reading this case, and every other case study, as if it was frozen in time. Here was an opportunity to see how a fifth topic, The Passage of Time, might be applied to ethical analysis..

Baby M is no longer a baby. Baby M is 21 year-old Melissa Stern, and she is a junior at George Washington University. Baby M is studying religion; she wants to be minister and hopes to have her own children one day. She even took bioethics, recalling how strange it was to have the Baby M case come up in class. Referring to her adoptive parents, the Sterns, she now says, "I’m very happy I ended up with them. I love them, they’re my best friends in the whole world, and that’s all I have to say about it” (Weiss, 2007). As an adult, Baby M terminated her biological mother’s parental rights and allowed the Sterns to formally adopt her.

The consensus in my ethics class was that we didn’t know enough to decide who was worthy of parenting Baby M. Students in the allied health sciences learn to be rational and empirical, but ethics is not a science; although grounded and principled, it is not governed by rules. The Four Topic Method, as all other reason-based approaches, offers a structured approach to analyze and resolve ethical issues in clinical medicine; but, as far as making the right choice, sometimes only time will tell.

Jonsen, A.R., Siegler, M., & Winslade, W.J. (2006). Clinical Ethics: A practical approach to ethical decisions in clinical medicine. New York: McGraw-Hill

Weiss, J. (2007). Now it’s Melissa’s time. New Jersey Monthly. Retrieved September, 12, 2007, retrieved from www.njmonthly.com/issues/2007/03-Mar/babym.htm


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