Premed · Premed · Medical Ethics Humanities
Lecture 27: Student-Led Case Presentations II
Foundations of Medical Ethics and the Health Humanities
Learning Objectives
By the end of this lecture, students will be able to:
- Build on feedback from the first round of presentations to demonstrate deeper ethical analysis and more effective facilitation
- Identify patterns and recurring themes across multiple ethics cases, recognizing the structural and systemic dimensions that connect seemingly different dilemmas
- Engage in constructive peer critique that strengthens ethical reasoning and communication skills
- Reflect on how their own values, experiences, and biases shape their approach to ethical analysis
- Articulate the difference between resolving an ethical dilemma and living responsibly within moral complexity
Lecture Content
I. Building on the First Round
Lessons from Lecture 26. Common strengths observed in first-round presentations and areas for growth. Frequent patterns to address: Moving beyond naming principles to genuinely applying them -- what does autonomy require in this specific case, given these specific facts? Engaging with structural and systemic factors rather than treating each case as a purely individual dilemma. Facilitating discussion that goes deeper than initial reactions -- pushing the class toward harder questions. Expectations for the second round. Greater depth of analysis: presenters should demonstrate that they have engaged with the complexity of their case, not just its surface features. More effective facilitation: questions should be sequenced to build understanding -- start with what is clear, move toward what is uncertain. Integration across the course: by Lecture 27, students have the full range of course frameworks and concepts available; presentations should draw on this breadth. Self-awareness: presenters should be able to articulate how their own perspectives shape their analysis and where their reasoning may have blind spots.
II. Cross-Case Analysis: Identifying Patterns
The value of seeing across cases. Individual cases are windows into larger systems: patterns of injustice, institutional failure, and value conflict recur across different clinical settings. Cross-case analysis reveals the structural forces that produce ethical dilemmas -- dilemmas are not random; they are generated by the systems in which medicine is practiced. Recurring themes across student presentations. The tension between individual autonomy and relational/communal values. Appears in end-of-life cases, pediatric cases, cases involving cultural differences in decision-making. The Western emphasis on individual autonomy is a powerful ethical commitment but not a universal one; other traditions center family, community, or spiritual authority. Structural injustice as the root of many "individual" dilemmas. Resource allocation decisions often reflect upstream failures: poverty, racism, inadequate funding, political choices. The ethical question is not only "How should we allocate this scarce resource?" but "Why is this resource scarce in the first place?". The gap between ethical ideals and institutional reality. Physicians often know the right thing to do but are prevented from doing it by time constraints, policies, financial pressures, or organizational culture. This gap is the terrain of moral injury (Lecture 22) The limits of principles without context. Principles provide a common language but are insufficient without attention to narrative, culture, power, and history. The best ethical analyses in student presentations integrate principlist reasoning with narrative, structural, and relational perspectives.
<image>A web diagram showing connections between common themes across student case presentations. At the center: "Recurring Ethical Themes." Six nodes surround it, each connected by lines to the center and to each other where relevant. Node 1: "Autonomy vs. Relational Values" (connected to end-of-life cases, pediatric ethics, cultural humility). Node 2: "Structural Injustice" (connected to resource allocation, health disparities, language access). Node 3: "The Ideal-Reality Gap" (connected to moral injury, systemic constraints, institutional culture). Node 4: "Power and Voice" (connected to whose perspective is centered, whose is silenced, who makes decisions). Node 5: "The Limits of Cure" (connected to disability, chronic illness, palliative care, the goals of medicine). Node 6: "Technology and Dehumanization" (connected to AI, EHRs, the medical gaze, depersonalization). A note at the bottom: "The strongest ethical analyses recognize that individual cases are manifestations of systemic patterns."</image>
III. Deepening Ethical Reasoning: Advanced Considerations
Moral distress and moral residue. Moral distress: the experience of knowing the ethically appropriate action but being unable to carry it out due to institutional constraints. Moral residue: the lingering sense of moral weight that remains even after a difficult decision has been made -- the feeling that something was lost or compromised. These are not signs of failure; they are signs of moral seriousness. Physicians who no longer feel moral distress may have become desensitized -- a different kind of problem. The ethics of uncertainty. Many clinical decisions must be made with incomplete information: uncertain prognosis, unknown patient preferences, unclear facts. Ethical reasoning under uncertainty requires intellectual humility, willingness to revise, and the courage to act despite not knowing for certain. The precautionary principle, probabilistic reasoning, and the willingness to say "I don't know" are all ethical competencies. Moral courage. The willingness to act on one's moral convictions even when doing so is personally costly -- professionally, socially, or emotionally. Examples: speaking up about a colleague's error, refusing to participate in care the physician believes is harmful, advocating for a patient against institutional resistance. Moral courage is not recklessness; it is principled action taken after careful reflection, with awareness of the consequences. Ethical imagination. The ability to envision alternatives, to ask "What if the situation were different?", to consider perspectives not represented in the room. Closely related to the narrative skills developed in Lectures 21-23: the capacity to enter another's experience, to imagine what a situation feels like from inside.
IV. Peer Feedback and Constructive Critique
The art of giving feedback on ethical reasoning. Focus on the reasoning, not just the conclusion: "I noticed you applied autonomy but did not address how the patient's poverty constrained her choices -- how might a justice analysis change your recommendation?". Offer alternative frameworks: "You analyzed this through principlism; what would a narrative ethics approach reveal?". Ask questions rather than making pronouncements: "What do you think the patient in this case would say if she could hear your analysis?". Acknowledge strengths specifically: "Your attention to the cultural context was unusually thorough and changed how I understood the case". Receiving feedback. Ethical reasoning is a skill that develops through practice and revision -- feedback is the mechanism of growth. Defensiveness is natural but counterproductive; the goal is to strengthen one's reasoning, not to be right. The ability to revise one's position in light of new evidence or a compelling argument is a mark of intellectual and moral maturity.
<image>A two-column comparison titled "Effective vs. Ineffective Feedback on Ethical Reasoning." Left column "Effective Feedback": specific ("Your application of beneficence was strong, but I noticed the patient's perspective was absent from your quality-of-life assessment"); framework-aware ("A feminist ethics lens might reveal power dynamics you did not address"); question-based ("What would change if the patient were wealthy and English-speaking?"); generous ("Your case selection was excellent and the facilitation was engaging"). Right column "Ineffective Feedback": vague ("Good presentation"); conclusion-focused ("I disagree with your answer"); dismissive ("You forgot about autonomy"); personal ("You clearly do not understand this issue"). A note at the bottom: "The goal of peer feedback is to deepen analysis and build skills, not to win an argument."</image>
V. Self-Reflection: Positionality and Ethical Analysis
How identity shapes ethical reasoning. Every student approaches ethics cases from a particular position: shaped by their own cultural background, family values, religious or secular commitments, socioeconomic status, health experiences, and identity. This positionality is not a bias to be eliminated; it is a perspective to be made visible and examined. Students should be able to articulate: "My analysis is shaped by the fact that I..." -- and then consider how someone with a different background might see the case differently. The difference between opinion and reasoned judgment. An opinion is a position held without systematic justification. A reasoned ethical judgment is a position arrived at through careful analysis, engagement with multiple perspectives, and willingness to be challenged. The course asks students to move from the first to the second -- not to abandon their values but to hold them accountably. Comfort with discomfort. Ethical reasoning often involves confronting questions that have no clean answers. The discomfort of moral ambiguity is not a failure of the analysis; it is a feature of the moral life. Learning to sit with that discomfort -- to act decisively while acknowledging uncertainty -- is a core competency for physicians.
VI. Preparing for Course Synthesis
Looking ahead to Lecture 28. The final lecture will ask: "What kind of physician will you be?". Students should begin reflecting on the arc of the course: what has changed in their thinking? What assumptions have been challenged? What commitments have deepened? The presentations in Lectures 26 and 27 are a rehearsal for the ethical reasoning they will practice throughout their careers. The question is not "Did I get the right answer?" but "Did I engage with the complexity honestly, rigorously, and with genuine concern for the people involved?".
