Premed · Premed · Medical Ethics Humanities
Lecture 26: Student-Led Case Presentations I
Foundations of Medical Ethics and the Health Humanities
Learning Objectives
By the end of this lecture, students will be able to:
- Present a clinical ethics case clearly and systematically, identifying the central ethical question and the stakeholders involved
- Apply at least two ethical frameworks to analyze a case and articulate the strengths and limitations of each
- Facilitate a structured group discussion on a morally complex topic, managing disagreement with respect and intellectual rigor
- Provide constructive, evidence-informed feedback on peers' ethical reasoning and presentation skills
- Synthesize course concepts (principlism, virtue ethics, narrative ethics, social determinants, cultural humility) in the analysis of novel cases
Lecture Content
I. Purpose and Structure of Student-Led Presentations
Student-led case presentations shift the student from passive recipient to active moral reasoner. This format develops the skill of identifying ethical issues in clinical scenarios, a competency required throughout medical practice. It creates a learning community in which students learn from each other's perspectives, cultural knowledge, and reasoning styles. It also prepares students for the ethics rounds, morbidity and mortality conferences, and clinical ethics consultations they will encounter in medical training.
Each presenting group of two to three students has twenty to twenty-five minutes, divided between ten to twelve minutes for case presentation and ethical analysis and ten to twelve minutes for facilitated class discussion. Students select or construct a case involving at least two competing ethical principles or values. Cases may be drawn from published literature, news, clinical scenarios, or personal experience (with appropriate anonymization). The case must involve sufficient complexity that reasonable people could disagree about the right course of action.
II. Framework for Case Presentation
The presentation follows a five-step framework designed to structure ethical analysis systematically.
In Step 1, students present the case, covering the clinical facts (diagnosis, prognosis, treatment options, clinical timeline), the patient context (demographics, social situation, cultural background, values, and preferences), the stakeholders (who is involved, who has decision-making authority, who is affected), and the precipitating ethical question (what specific decision or conflict makes this an ethics case).
In Step 2, students identify the ethical issues by naming the principles, values, or rights in tension, mapping the stakeholders' perspectives and interests, and identifying any systemic, structural, or institutional factors that shape the case.
In Step 3, students apply ethical frameworks, analyzing the case using at least two frameworks such as principlism, virtue ethics, utilitarian reasoning, deontological reasoning, feminist or relational ethics, or narrative ethics. For each framework, they should articulate what it highlights, what it recommends, and what it misses.
In Step 4, students propose a course of action, explaining what should be done and why. They should acknowledge the costs, risks, and moral remainder -- what is lost even in the best decision -- and identify what additional information or resources would help.
In Step 5, students facilitate discussion by posing two to three open-ended questions to the class, inviting alternative perspectives, managing disagreement constructively, and summarizing key insights and unresolved tensions.
<image>A flowchart illustrating the five-step framework for student case presentations. Step 1 "Present the Case" (a box containing: clinical facts, patient context, stakeholders, precipitating ethical question) flows into Step 2 "Identify Ethical Issues" (a box containing: principles in tension, stakeholder perspectives, systemic factors). This flows into Step 3 "Apply Frameworks" (a box containing: at least two ethical frameworks applied, strengths and limitations of each noted). This flows into Step 4 "Propose Action" (a box containing: recommended course of action, justification, acknowledgment of moral costs and uncertainties). This flows into Step 5 "Facilitate Discussion" (a box containing: open-ended questions, invitation of alternative views, summary of insights and unresolved tensions). A feedback arrow loops from Step 5 back to Step 2, labeled: "Discussion may reveal ethical dimensions not initially identified."</image>
III. Sample Case Domains and Guiding Questions
The following domains represent the range of cases students may present, each with guiding questions to support analysis.
Cases involving autonomy and capacity might include a competent adult refusing life-saving treatment, a teenager requesting confidential reproductive care, or a patient with fluctuating capacity making inconsistent decisions. Guiding questions ask what respect for autonomy requires, how capacity can be assessed fairly, and what role family, culture, or age should play.
Cases involving justice and resource allocation might address organ transplant allocation when multiple candidates are equally medically suitable, a rural hospital with one ventilator and two patients in respiratory failure, or access to an expensive novel therapy. Guiding questions ask what principle of justice applies, how bias in allocation decisions can be avoided, and what systemic factors shape who ends up in the situation.
Cases involving end-of-life care might explore withdrawal of life support over family objection, a patient requesting medical assistance in dying whose family is opposed, or futility disputes between the clinical team and the family. Guiding questions ask who has the authority to make the decision, what the patient's known values are, and how cultural and religious perspectives inform the analysis.
Cases involving research ethics might examine a clinical trial in a low-income country for a drug that will be marketed only in high-income countries, consent in emergency research, or a participant who wants to withdraw but whose data has already been collected. Guiding questions ask whether the research design is just, who benefits and who bears the risks, and whether consent is truly voluntary and informed.
Cases involving emerging technologies might consider a hospital deploying an AI triage tool that shows racial bias, a patient requesting access to an unapproved gene therapy, or a physician asked to use a predictive algorithm they do not understand. Guiding questions ask how fairness in algorithmic medicine can be ensured, what informed consent means when neither patient nor physician fully understands the technology, and who is accountable for errors.
Cases involving disability and quality of life might address a neonatal team considering withdrawal of care for an infant with severe disabilities, an adult with a disability denied organ transplant eligibility, or prenatal diagnosis and selective termination. Guiding questions ask whose assessment of quality of life is used, how ableism shapes the decision, and what the disability rights perspective contributes.
IV. Evaluation Criteria and Expectations
Presentations are evaluated across five dimensions. Clarity and completeness of case presentation asks whether the case is presented with sufficient detail for the audience to engage and whether the clinical facts are accurate and the ethical question clearly stated. Depth of ethical analysis assesses whether multiple frameworks are applied thoughtfully rather than merely named, whether tensions and trade-offs between principles are made visible, and whether attention is paid to systemic and structural factors. Quality of facilitation evaluates whether discussion questions are open-ended and genuinely thought-provoking, whether disagreement is managed respectfully, and whether diverse perspectives are invited and taken seriously. Integration of course material considers whether the presentation draws on concepts, readings, and frameworks from across the course and whether there is evidence of original thinking. Professionalism and collaboration assesses whether all group members contribute meaningfully, whether time management is respected, and whether feedback is given and received constructively.
<image>A rubric-style diagram showing five evaluation dimensions arranged as horizontal bars, each rated from "Developing" on the left to "Exemplary" on the right. Bar 1 "Case Presentation": Developing -- case is unclear, missing key details; Exemplary -- case is vivid, complete, well-structured, and immediately engaging. Bar 2 "Ethical Analysis": Developing -- principles are named but not applied; single framework; Exemplary -- multiple frameworks applied with nuance, tensions explored, systemic factors addressed. Bar 3 "Facilitation": Developing -- discussion questions are yes/no or leading; Exemplary -- questions are open-ended, generative, and invite genuine disagreement. Bar 4 "Course Integration": Developing -- minimal connection to course themes; Exemplary -- draws on multiple lectures, readings, and frameworks with original synthesis. Bar 5 "Collaboration": Developing -- one member dominates; Exemplary -- all members contribute, transitions are smooth, time is managed well.</image>
V. Guidelines for Productive Ethical Discussion
Ground rules for class discussion establish that participants should disagree with the argument rather than the person, speak from evidence and reasoning rather than from assertion alone, listen to understand rather than just to respond, and be willing to change their mind, recognizing that moral reasoning is a process rather than a performance. Some topics are deeply personal, and issues such as abortion, assisted dying, disability, and race should be approached with care and humility.
Moral uncertainty should be expected and embraced. It is acceptable -- indeed, expected -- not to know the right answer. The goal of ethical discussion is not consensus but clarity: understanding what is at stake, what values are in tension, and what a thoughtful response requires. "Moral remainder" -- the recognition that even good decisions may involve loss -- is a sign of moral seriousness, not weakness.
Several common pitfalls should be avoided. Relativism in the form of "It depends on the culture" or "Everyone has their own opinion" shuts down analysis rather than opening it. False balance ignores the fact that not every position is equally defensible; some arguments are stronger than others, and evaluating them is the group's job. Over-reliance on a single framework limits analysis, since every framework has blind spots. Ignoring structural context produces individual ethical analysis that is necessary but incomplete.
VI. Preparing for Your Presentation
Students should start with a case that genuinely puzzles them -- if the answer is obvious, the case is not complex enough. Thorough research into the relevant clinical, ethical, and social context is essential. Practicing the presentation improves clarity and time management. Anticipating counterarguments and preparing thoughtful responses strengthens the analysis. Students should remember that they are not expected to solve the case definitively; they are expected to analyze it with rigor, humility, and insight.
