Nursing Home Ethics Case Studies

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In the story, a middle-aged woman named Audrey needs a hysterectomy.

The night before her surgery, Audrey is told by a male anesthesiologist that prior to surgery she has to remove her dentures.

Nash wrote that based on the condensed form, bioethicists would likely criticize the anesthesiologist for dismissing Audrey's concerns, but he argues that there are more subtle dynamics to the story that should be considered.

Rather than this being a story about a woman with a lack of autonomy, he argues, it's a story about a woman whose male doctors are condescending toward her.

He instructs each of his students to read a short fictional story and summarize it into a case study.

He then has his students read each other's summaries and discuss how they differ.

The resident agrees to slip her dentures back in during her recovery so her husband doesn't see.

Nash then critiqued the case study using principalist ethics—a common ethical framework in medicine.

"In nearly every discussion of real ethical issues, you'll hear someone say [things such as], 'I wish I knew more about her husband,' or 'why's she so afraid of dementia,'" said Mc Nolty.

Similarly, Piecha said "people actually using [case studies] in ethics committees in hospitals" instead of exclusively in a classroom "are aware of how austere and truncated they are." According to Pjecha, ethics committees generally view case studies "as an important first step, but then you unpack it further, and it spins into a story." But Nash maintained that short stories are "more effective means of teaching students and [health care] professionals to wrestle with the mess, to pay attention to narrative perspective and detail, and to become more comfortable with ambiguity." He added, "Why continue to use ethics cases if short stories are better at inviting realistic reflection and more enjoyable to read and discuss?

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