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  • BIOETHICS FORUM ESSAY

The Big Test

Over the past few months the debate about the merits of certifying those engaged in clinical bioethics has become very contentious. There has been much discussion about the need for and advantages of certification. But, surprisingly, there has been no concrete example offered of a certification examination. Based on my many years of experience in bioethics I humbly proffer a sample examination in the hope that it will help focus the certification debate.

Upon passage of this examination, you shall be awarded a certificate – “ius exercere clinical bioethics” – with all the honors, rights, and privileges thereunto appertaining in the United States of America. You will have 30 minutes to complete the exam. There will be no proctor. You are expected to be virtuous.

History

1. Many babies have been the subject of heated controversy in clinical ethics. Select the correct group:

a. Baby M, Baby Fae, the Johns Hopkins baby,

Baby K, Baby Doe

b. Baby Face Nelson, the Bambino, Johnson’s

Baby

c. Babaloo Mandel, Tyke Tolbert, Tiny Tim, Squirt

 

2. Crucial figures in the history of bioethics – match the name to achievement:

a. Daniel Callahan

b. Albert Jonsen

c. Edward Pellegrino

d. Andre Hellegers

e. Joseph Fletcher

f. Paul Ramsey

(1) He founded the field of bioethics.

(2) Other

 

Newborns, Children, and Adolescents

1. You are called in to consult on a case involving the possible separation of conjoined twins so that one might live. You should:

(a) Sagely invoke 1 Kings 3 and note that while the Solomon’s dilemma case does not really apply it illustrates the emotive power of narrative in bioethics.

(b) If you cannot find Occam’s Razor, locate Koop’s.

(c) Throw up both hands, point out merits on the one hand and then on the other.

 

2. A mentally ill 16-year-old man has been brought to the ER, having taken a hatchet to his hand. The two fingers that he removed have been brought in as well. The young man insists the devil made him remove the fingers and that they should not be reattached. The ER director is not certain what to do. You should:

a. Suggest a psych consult.

b. Rapidly review the collected writings of Hugo Chavez to establish who exactly the devil is and what he might want.

c. Ask the young man if he would assent to a transplant from a cadaver.

d. Locate a Jesuit bioethicist to help you through a half-hearted exorcism.

e. Ask the ER staff if they are mishugina and start screaming at them in a thoughtful manner to sew the kid’s fingers back on.

 

Dilemmas Involving Competent Adults

A 45-year-old single father of four – a recent convert to the Jehovah’s Witnesses driving home from his job as a part-time actuary when he runs a red light while speeding to get home in time to greet his youngest child, who is severely disabled from a birth-related mishap and being returned home by a specialized van from the public school where he is mainstreamed, much to the horror of teachers and administrators who argue he belongs in a special school that his father cannot afford since he needs to pay college tuition for his three daughters, one of whom has, unbeknownst to the newly converted father, become pregnant when the condom her partner was using (seeking to be responsible after attending a sex ed class at the state university that drew many protesters who believe that sex before marriage is morally illicit) broke, leading the young woman to wonder if she must end this pregnancy since it occurred out of wedlock and she is not prepared to marry a man whose name she cannot remember – needs directions to a hardware store. Can you help him? Should you? Explain (concisely).

 

PVS and Coma

A 40-year-old woman has suffered a massive stroke. You are asked to help explain the neurologist’s diagnosis of minimally conscious state to her family since they seem to be having a hard time grasping this concept and incorporating it into the plan for her care. Your best analogy to invoke is:

a. The state you were in when you got stoned at that Grateful Dead concert

b. The state you were in after reading John Rawls’s A Theory of Justice

c. What it would be like if you were playing tennis in your head but did not know how to play tennis

d. The state you were in when trying to log on at 2 AM to leave a question for the part-time, technology impaired instructor of your online bioethics course

e. Contemplating anything measured in QALYs

 

End of Life Care

1. POLST means:

a. A spirit, usually mischievous and occasionally malevolent, which manifests its presence by making noises, moving objects, and assaulting people and animals

b. A type of pattern run by wideouts in football games

c. Say goodbye to your butt

d. Physicians obviously lessen standard treatment

e. A grave danger to the consultation business

 

2. A 79-year-old Hispanic man with no known relatives has suffered massive cardiac arrest. Upon arrival at the hospital in Baltimore he is pronounced dead. Suddenly a man claiming to be his cousin who has driven from Fresno suspecting something might be wrong arrives at the bedside. He demands that “all that can be done be done,” or maybe he said, “what will be will be” – your Spanish is not very good. You should:

a. Call the New York City organ donor ambulance.

b. Attempt to bathe the deceased man in ice in the hope that he may yet recover.

c. Threaten to bathe the cousin in ice in the hope that he will return to Fresno.

d. Suggest a transfer to Texas where futility is never a problem.

e. Locate a silver hammer and tap the deceased on the head three times while calling out his birth name.

 

Professionalism

1. You should refer to yourself as a “bioethicist” if and only if:

a. You have earned a terminal degree in any field, have read all editions of Beauchamp and Childress, and can find any amount of consistency among them.

b. You managed to earn a master’s degree in bioethics without reading Beauchamp and Childress.

c. You have spoken on a local TV public affairs program about death panels.

d. You have paid a large sum of money to a CME group that sent you an iPad loaded with the works of Beauchamp and Childress.

e. You personally have spoke to Beauchamp or Childress during the time when they wrote the first edition of their book and thus merit “grandfathering” into the field of clinical bioethics.

 

2. Fees

Your integrity is being challenged – a couple for whom you are consulting demands to know who is paying you and how much. You should respond:

a. You get what you pay for!

b. A penny saved is a penny earned!

c. Not a penny more than Art Caplan

d. Not a penny less than Carl Elliott

e. My outside income is posted on my university’s Web site (but not my salary).

f. Paid, are you kidding me – try the coffee we have around here!

Arthur Caplan is director of the Center for Bioethics at the University of Pennsylvania, and a Hastings Center Fellow.

Published on: October 27, 2010
Published in: Bioethics

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