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Case Analysis: Ethical Dilemma (Essay Sample)


Dr. Smith, a family medicine physician, is preparing for a full day of patient appointments. She is looking over
the chart of Stephanie, a new patient, who is here for an annual physical. Stephanie is 30 years old and has
autism. Dr. Smith notices that Stephanie has had regular uneventful periods but has never had a pap smear. Dr.
Smith knows that pap smears are recommended for all women starting at the age of 21, so she makes a
mental note to ask specifically about any previous pap smears and enters the room to meet Stephanie, who is
sitting quietly in the corner, looking intently at one of the pictures hanging on the wall.
Dr. Smith first introduces herself by saying, “Hi Stephanie, my name is Dr. Smith, but you can call me Julie. Nice
to meet you.” Stephanie looks up and nods but does not say anything. Dr. Smith introduces herself to
Stephanie’s caseworker, Hannah, then turns back to Stephanie and asks, “Tell me how you have been doing
over the past year, Stephanie.”
Stephanie waves her hand, expressing “so-so,” and Hannah explains, “She’s nonverbal, but you can ask me
any questions you need to know. I have her whole file and know her well.” As the conversation progresses, Dr.
Smith learns that Stephanie has lived in a group home for about 15 years. She struggles with some behavioral
problems at the home and has difficulty communicating her needs to the staff.
Dr. Smith remarks, “I notice that Stephanie has never had a pap smear before, at least according to our
records. I wanted to check and make sure that information is accurate, since we would typically recommend
this important screening for a patient of her age.”
Hannah responds, “Yes, that is correct. It has been discussed in the past, but we have always been concerned
that a pap smear would be too distressing for her. Stephanie is very sensitive to sensory stimuli, especially
anything painful. She’s required to get a flu shot every year to live in the group home, and it’s always so awful
for her. I am not sure that a pap would be worth her distress, especially because she is not sexually active.”
Dr. Smith wonders if this is true. She asks, “Have there ever been any concerns about sexual abuse with
Hannah answers, “Certainly not since she has been in the group home. She is very well supervised, and we
have never had any problems with abuse among our staff. But we have very little information about her life
prior to coming to the group home. She does not have any family involved in her care at this time.”
Dr. Smith replies, “Screening recommendations are indeed recommendations and not requirements, so I am
open to discussion about the pap smear for Stephanie. However, given her unclear history I am inclined to err
on the side of doing one. There is a high rate of sexual abuse in patients with intellectual disabilities. Since we
do not know much about her previous history, I would rather be safe than sorry.”
Hannah sighs and says, “Well, Stephanie has dental work done under sedation every year, so perhaps she
could just have her pap smear done at the same time. She wouldn’t even have to know it was done. We have
done it before with some of the other residents, and it was a great solution.”
Dr. Smith considers Hannah’s suggestion, but she feels uncomfortable performing such an invasive procedure if
it can only be done by deceiving the patient and by using a sedative as a chemical restraint. Dr. Smith feels
that doing a vaginal exam and cervical test without Stephanie’s knowledge or consent to be more ethically
problematic than doing a routine dental exam. She worries that performing the pap without permission of a
sedated patient borders morally on rape. Even though Hannah is Stephanie’s official decision maker, Dr. Smith
wonders whether it is ethical to leave Stephanie out of the decision entirely.
PHL 314 Winter J Term 2021
Case Analysis 1
Deadline: Monday June 7 at 10pm EST
(grace period without


Step one: Recognizing and responding to a dilemma
An ethical dilemma refers to a problem in the decision-making process, where there are two possible competing options. One of these options is more acceptable ethically, while the other alternative is morally acceptable but unethical. The decision-maker is therefore faced with the challenge of deciding which option to follow.
In this particular case, Dr. Smith is faced with the dilemma of performing a pap smear on a thirty-year-old patient without her knowledge, despite the caregiver giving the consent. Hannah, the caregiver, proposes that the procedure be done to Stephanie, the patient, while sedated. This suggestion appears correct since other residents in the group home have undergone the same procedure under sedation by different physicians. The Doctor believes this is ethically unacceptable and needs to ponder other ways to convince the patient to consent for the procedure to be done on her.
Hannah's response of sedating residents in the group home to undergo the procedure bothers Dr. Smith. It appears normal to Hannah not to involve Stephanie, something the Doctor disagrees with.
Step two: Relevant Facts and Values
Stephanie has been described as autistic and nonverbal. She cannot express herself verbally but can make gestures in response to questions asked. It is expressed by her nodding and waving her hand while the Doctor talks to her. She has uneventful periods and is yet to have a pap smear. The caregiver acknowledges that other residents in the group home undergo the pap smear procedure while sedated without giving consent.
Doctors are governed by ethical values that they are supposed to uphold (Riddick, 2003). In this case, it proves challenging to Dr. Smith since she has to ensure that she protects her patient from any form of abuse. It can be either mentally, physically, socially, or even psychologically. She is bound to be compassionate to her patients and practice integrity while discharging her duties as a doctor. Above all, she has to be just to her patients no matter the consequences of her actions. These are the values that she needs to uphold as she faces this dilemma.
Step three: Ethical Conflicts: Clashing Perspectives, Justifications, and Dilemma Due to Mutual Violations
The competing perspective, in this case, includes the proposal to conduct the pap smear procedure to Stephanie without her knowledge and the Doctor's view on how unethical it is to leave the patient out of the decision (Annas,1992). Hannah is Stephanie's official decision-maker and has the legal ability to make all the decisions about the welfare of Stephanie.
Dr. Smith insists that the patient should be aware that she will be sedated so as the principle of beneficence ethically and morally justifies the procedure to be carried out. This principle gives doctors an obligation to act or make decisions that benefit the patient, make sound decisions for the patients with disabilities and also defend the rights of others. On the other hand, the caregiver is justified to have her client sedated before carrying out this painful procedure to protect her from pain and, after that, from being distressed. The action is justified and backed up by the principle of Nonmaleficence that explains no human should be subjected to pain while undergoing a medical procedure (Annas,1992).
The ethical principles are used and helpful in making decisions regarding the health of different patients and also help in avoiding instances of abuse in experimental procedures that involve human beings. Choosing the principle of beneficence over Nonmaleficence denies the patient the right of not being subjected to pain that the principle of nonmaleficence advocates. Therefore, the two principles are directly conflicting with one another, causing another dilemma for the decision-makers.
Step four: Propose Potential Next Actions.
Regarding the dilemma faced in this case, the decision-maker has to develop other ways to do the procedure to solve the patient's medical needs. She is waiting until her dental procedure appointment seems to delay her medical treatment at the right time. The alleged and subsequent actions could be engaging other medical experts, administering the group home where the patient lives, and human rights activists.
Despite having the following potential action, they come with advantages and disadvantages that might hinder or act as a catalyst in the options needed to solve the dilemma. In

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