Clinical Crossroads Worksheet
Clinical Crossroads
Medical Ethics Case Studies
Bioethics Unit: 10th Grade Psychology
Student Name
Date
Essential Terminology
Advance Directive: A written statement of a person's wishes regarding medical treatment, often including a living will.
Health Care Proxy: A person appointed to make medical decisions for a patient who is unable to do so.
Mature Minor: A legal concept allowing some minors to make their own medical decisions if they show sufficient maturity.
Case Study 1: The Silent Directive
Autonomy vs. Family
"Evelyn, age 78, has a legally binding living will that clearly states she does not wish to be kept on life support if she enters a persistent vegetative state. After a major stroke, doctors confirm Evelyn will not recover consciousness. However, her adult children, who were not aware of the living will, are demanding that the medical team use every possible measure to keep her alive."
1. Who has the primary legal and ethical right to decide Evelyn's care?
2. How should the medical team approach the family's distress while respecting Evelyn's wishes?
Case Study 2: The Unspoken Path
Proxy Responsibility
"Marcus, age 45, is in a coma following a car accident. He never signed an advance directive. His wife, Sarah, is his legal health care proxy. The doctors explain that Marcus has a 5% chance of regaining awareness, but will require 24-hour nursing care. Sarah must decide whether to continue intensive care or transition to comfort-only measures."
1. What factors should Sarah consider when making this decision "on behalf" of Marcus?
2. If you were Sarah, what information would you want from the medical team before deciding?
Case Study 3: Quality or Quantity
Terminal Care
"Robert is 82 and has stage 4 lung cancer. His oncologist offers aggressive chemotherapy that might extend his life by 3 months, but it causes severe side effects. Robert prefers to stop treatment and enter hospice care to be at home, but his wife feels he is 'giving up.'"
1. How does Robert's definition of "Quality of Life" differ from his wife's perspective?
2. What is the role of a palliative care team in a situation like Robert's?
Case Study 4: The Teenager's Choice
Adolescent Autonomy
"Leo is 16 and has been battling leukemia for three years. After a recent relapse, doctors suggest a second bone marrow transplant with a 20% success rate. Leo is exhausted by the side effects and wants to stop treatment to focus on 'living while he can.' His parents, desperate to save him, insist he undergoes the procedure, arguing he is too young to make such a permanent decision."
1. At age 16, should Leo have the right to refuse life-saving treatment?
2. How does adolescent brain development (psychology) complicate this ethical dilemma?
Case Study 5: The Safety Struggle
Dementia & Safety
"Martha is 85 and has moderate dementia. Ten years ago, she made her daughter promise she would 'never be put in a home.' Now, Martha frequently forgets to turn off the stove and has wandered out of the house twice. Her daughter, who works full-time, can no longer ensure Martha's safety. Martha is adamant about staying in her home, but her doctor recommends a memory care facility."
1. Which is more important: Martha's past promise or her current safety?
2. Is it ethical to go against a patient's prior wishes if their cognitive state has changed?
Clinical Crossroads Teacher Guide
Clinical Crossroads
Facilitator's Discussion Guide
Teacher Resource
End-of-Life Medical Ethics
Learning Objectives
- • Identify the four pillars of medical ethics: Autonomy, Beneficence, Non-maleficence, and Justice.
- • Analyze the impact of Advance Directives on family systems and medical providers.
- • Evaluate the psychological conflict between extending life and maintaining quality of life.
Psychology Connection
Focus on Erikson’s Psychosocial Stage: Integrity vs. Despair and Adolescent Brain Development (Prefrontal Cortex vs. Amygdala). Consider how cognitive decline in late adulthood shifts the ethical weight from autonomy to beneficence/safety.
Case 1: The Silent Directive
Autonomy vs. Family
Legal/Ethical Key
Evelyn’s Living Will is legally binding. Autonomy (the patient's right to choose) supersedes the family's desire.
Discussion Prompt
"How can doctors show empathy for the family while still following the document?"
Case 2: The Unspoken Path
Proxy Responsibility
Legal/Ethical Key
Proxy must use Substituted Judgment: choosing what the patient would have wanted, not what the proxy wants.
Discussion Prompt
"Is 5% 'enough' of a chance to keep someone on life support indefinitely?"
Case 3: Quality or Quantity
Terminal Care
Legal/Ethical Key
Focus on Beneficence vs. Non-maleficence. Robert is competent; he has the right to prioritize quality over quantity.
Discussion Prompt
"Define 'Quality of Life.' Is it different for an 82-year-old vs. a teenager?"
Case 4: The Teenager's Choice
Mature Minor Doctrine
Legal/Ethical Key
The Mature Minor Doctrine suggests that if Leo understands the consequences, he should have a say. However, legally, parents often maintain authority until 18.
Psychological Lens
Adolescents focus on "Identity vs. Role Confusion." Leo's desire for control over his life/body is a key developmental task.
Case 5: The Safety Struggle
Dementia & Safety
Legal/Ethical Key
This is a conflict between Autonomy (Martha's wish) and Beneficence (her safety). When competence declines, beneficence often takes priority.
Discussion Prompt
"Is a promise made by a healthy person still binding once they can no longer understand the danger they are in?"
Synthesizing the Lesson
