Cancer Analysis

MORAL AND SPIRITUAL DIMENSIONS OF HEALTH

Instructions
Each participant will write a case analysis for a mid-term evaluation. The Mid-Term Case Analysis paper must be submitted under the Case Analysis Papers module on on the due date. (Assignments sent via email will not be graded.)

Formatting
The Mid-Term Case Analysis paper should meet the following requirements:

• APA Formatted
• Adhere closely to the template
o Each paper must contain the following sections (in this order):
 Reason for the Case
 Summary of the Case
 Relevant Ethical Theories
 Analysis
 Recommendations

• 3 – 4 double-spaced, typed pages
o Front matter (such as a title page or outline) as well as the bibliography do not count toward the total number of pages.
o Times New Roman font, 12-point size
• Left and right margins no larger than 1.25 inches; top and bottom margins no larger than 1 inch

• All sources must be cited using parenthetical citations
o A Bibliography page using APA formatting should appear at the end of the paper
• Paper saved with a .doc or .docx file extension
o First and Last name of the participant should be in the file name
 FirstLastMidTerm.doc

Grading Rubric
The instructor will grade papers in the following areas:

• Formatting (5 points)
o Is your paper formatted according to the guidelines above?
• Spelling, Grammar and Citations & References (5 points)
o Are all your sources cited? Did you use the appropriate style format?
• Coherence (5 points)
o Are your sentences structured properly? Do your arguments follow logically?
• Organization (5 points)
o Are your sections clearly labeled? Does each section address the appropriate subject matter?
• Timeliness (5 points)
o Did you submit your paper by the due date/time?
• Relevance to the Course (25 points)
o Have you addressed all the ethics issues in the case? Does your paper reflect material covered in the course?
• Ethical Issue Recognition (25 points)
o Have you recognized the ethical issues in the case? Can recognize interrelationships among the issues?
• Application of ethical principles and theories (25 points)
o Have you stated a position (recommendations)? Did you apply accurately ethical principles and theories to support the position?

Please note: A complete rubric (with grading scale) is posted to Brightspace.

Reminder
The Mid-Term Case Analysis paper is to be completed individually.
Any attempt to ask for assistance (for any reason) or provide assistance (for any reason) is a violation of Felician University’s Policy on Academic Honesty and should be turned over to the professor immediately.

As per the syllabus, a plagiarized paper will result in an automatic failure on the assignment. This includes the use of any AI or grammar editing tools.

All papers will be submitted to Turnitin, which checks for plagiarism and use of AI.

Use of AI (such as ChatGPT, Grammarly, etc.) to write and/or improve a paper is strictly prohibited.

Mid-Term Case Analysis Template

Reason for the Case:
[Put one sentence here describing the reason(s) for the case. Language from the course should be used.]
(Approximate length: 1 sentence)

Summary of the Case:
[Summarize the relevant details of the case here. After reading this section, the reader should have a good sense of the facts and what ethical issues are apparent in the case. This section is primarily descriptive and sets the tone for the rest of the paper.]
(Approximate length: 4 – 5 sentences)

Relevant Ethics Theories:
[Define the relevant ethics principles and theories (at least 4) to which one might appeal or need in the analysis of the case. This section should include clear definitions of principles and theories based on course data. Definitions should be based on the course text, including clear references to the readings with proper citations. Lectures and other course tools may be used as secondary sources. (These also must be properly cited.) Each definition should be well-developed, including the textbook definition and your own synthesis of the principles and theories. There won’t be any mention of the case in this section. This section just defines the principles and theories which will be applied to the case in the next section. Principles appear throughout the textbook and include concepts such as autonomy, truth-telling, and spirituality. Theories appear in Chapter 2 in the textbook and include concepts such as utilitarianism and deontological ethics.]

Analysis:

(Approximate length: 1 – 2 pages)

[Analyze the principles and theories (described above) in light of the case. This section should relate directly to the previous section. (How and Why are the principles and theories defined above relevant to the ethical issues found in the case.) This section should relate course information in a clear, concise manner to the case. That is, there should be a clear connection between the case, the relevant principles and theories (from the previous section) and the analysis. This section begins the process of prescriptive ethics work.]
(Approximate length: 2 – 3 pages)

Recommendations:
[Provide recommendations in the form of action items, points of consideration, and/or suggestions for addressing the ethical issues found in the case. These recommendations should follow logically and coherently from the analysis in the previous section (that is, the reader should easily recognize the rationale for these in the previous section). This section highlights the prescriptive process of ethics and, therefore, should contain several clear, concise “ought statements.”]
(Approximate length: 4 – 5 sentences)

The Case

Miriam Patel, a 68-year-old woman, has been battling metastatic liver cancer, which has spread to her lungs and pancreas. Over the years, she has been in and out of hospitals and recently relocated from Oregon to New Jersey to be closer to her daughter. Miriam has a Physician’s Orders for Life-Sustaining Treatment (POLST) form from Oregon, explicitly stating that she does not want cardiopulmonary resuscitation (CPR) or any life-prolonging treatments. Unusually, she has also requested to forgo pain medication. The document, signed by both her and her physician, dates to the time of her cancer diagnosis.

During her time in Oregon, an oncology resident once asked why she hadn’t considered Physician-Assisted Death, as she met the state’s legal criteria. Miriam’s response was striking: “God is punishing me for my past mistakes and the way I treated my body. I deserve this.”

Now hospitalized in New Jersey, her primary care physician frequently offers her pain relief, as Miriam is often heard moaning and seen writhing in distress. Each time, she refuses, saying only, “Pain for purification and penance.”

Miriam’s daughter, Priya, has been visiting regularly and is deeply troubled by her mother’s suffering. She respects Miriam’s decision to have a Do Not Resuscitate (DNR) order but struggles to understand why she is rejecting palliative care. Priya suspects that her mother’s profound guilt may stem from a past pregnancy loss, which ultimately contributed to her divorce. Since that time—25 years ago—Miriam has struggled with alcoholism and gradually distanced herself from religious practice.

The medical team is now grappling with serious ethical and clinical concerns. Some caregivers question whether Miriam has the decision-making capacity to refuse pain management, suspecting that she may be suffering from clinical depression. A psychological evaluation confirmed that she is depressed, yet she refuses to take antidepressants. This has raised concerns about the validity of her POLST form and whether her wishes truly reflect her well-being. Additionally, efforts to obtain her original advance directive from the long-term care facility in Oregon have been met with logistical challenges.

Further complicating the situation, Miriam’s visible suffering is distressing to both the care team and other patients. Nurse Manager Elijah Green has approached you for guidance on how to ethically handle this case.