CELearning Activities

Project: Medical Ethics Collage


Health Care Ethics


3.Describe aspects of ethical decision making in health care.

Recommended Resources

Document: Medical Ethics – Basic Foundations (at end of assignment)

Developed by:

Kari Slade, BS Health Science, MA Public Health
Roosevelt High School Health Careers Program, Minnesota

Potential Uses

Written Paper

Group Work



X (Collage)





Medical Ethics Collage


  1. You will be developing a medical ethics collage. 
  2. Review the Ethical Principles Document.
  3. Choose to complete Option 1 or Option 2:

Option 1: You will choose at least 2 different medical ethics and present them visually in your collage, using symbolism, you will show how the two principles interact, and visually bring your audience to a new understanding about your ethical principles of choice.

Option 2 (Cases found at end of this document). You will choose a case, and in images and symbolism, show the ethical issues involved in the case. The entire collage should show images that connect to the core issues of the case, its stakeholders, the ethical principles, and be based on one ethical theory of choice to create a foundation for how you will examine the case.

  1. You will also need to choose one ethical theory that you most agree with or connect to, and include it in your collage in some way.
  2. Medical Ethics Collages: What do I need to include? Aim for level 3 on the grading rubric!


Rubric for Grading:  Aim for Level 3!

Areas of evaluation









Collage has some connection to case, but does not create a deep understanding of, or reflect issues within the case such as ethics and theory. Pictures do not strongly connect with underlying issues and are more a statement of the facts of the case.

Collage is based on ethical case, but falls short on either ethical principles, or has missed the addition of theory in the creation of the collage. Collage is based on the student’s perspectives of the case and does not explore the case from multiple dimensions.

Collage is clearly based on ethical case, the artist has chosen 2 or more ethical principles and a theory to tell the story of this case through collage. Multiple perspectives from various stakeholders can be seen in the piece.






Collage has white space showing through the  (not fully collaged), edges are frayed or, ripped, and images seen to be simply put on the paper v. thoughtfully laid out. When mod podged, images bubble and continue to come off due to lack of glue.

Collage is laid out in a way that images are glued to the surface, but may be placed in ways that display but do not show that time was taken for a thoughtful design. When mod podge is done, some bubbling can be seen.

Collage uses some of the elements of art – color, shape, line to create a cohesive composition. Images are glued down completely, and care has been taken to place images together in a thoughtful way. Edges are clean, and glued down to surface. When it is mod podged, the images do not bubble due to well made collage.









Collage is in complete, and includes few images (4 or less). Artist did not take time to create a visual story, and pictures are literal and laid out in a way that a glimpse of the case can be seen, but the viewer is not able to go any deeper due to limited effort or creativity.

Collage is done with 4-8 images, but is mostly literal and does not involve creation of new meaning through the connection of images. Collage tells the story of the case, but in a way that is expected and reads similar to a summary of facts.

Collage is creatively done including 8-10 images placed together to create new meaning in relation to the case. Many images are symbolic, and let the viewer speculate or guess as to the meaning of the piece in relation to the case.

Artist uses color, line, shape, to convey mood, emotion or meaning.




Case Studies for Option #2

You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao

gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises.

You debate whether or not you should call Child Protective Services and report the mother.







Sussana Levy was a 16 year old girl who lived with both her parents and one younger brother.Her and her friend (whose name was not mentioned in article) went to a party on Saturday night to celebrate their friends 18th birthday. They got very drunk to the point where they couldn't walk in a straight line and laughed at everything.


A guy friend of theirs offered to take them home even though he was also drinking that night. Sussana's Friend remembers "He took the my car keys and I just laughed, no seat belts or anything, I don't think he was even going the right way because we passed a hill that I never go through to get to my house."


The 3 teens in the car were not paying attention to the road and did not notice that they were on the wrong lane and he quickly turned the car but unfortunately went down the hill. Sussana's realized what has happened and called the ambulance right away and then called her parents and Levy's parents.


They were quickly rushed to the hospital. Dr. Glenn J. diagnosed Sussana with a Traumatic Brain Injury (TBI). Dr. Glenn took some Neuropsychological assessments to check where exactly was the damage and how long rehabilitation would be.


Levy’s father was a very old time fashioned parent who didn’t like the idea of her daughter taking classes to regain her speech again when she already had it in the first place, including everything else that Sussana needed to help her regain her actions again. He quickly demanded that the neurosurgeon give her all her meds and tests and then take her out of there. The doctors pointed out that she needs therapy classes to help her little by little. He refused and took Levy home.


In my culture, this is common in some places in Mexico. Not everyone thinks this way but you do hear of this from time to time. It’s sort of like a pride thing. He doesn’t want everyone to see what his daughter had done and does not want everyone to see his 16 year old daughter being treated like a baby. The father is trying to protect their name.


It’s very cruel and unfair for the patient. Unfortunately Sussana died of the traumatic brain injury, malnourishment and bad treatment due to the lack of doctor’s appointment.


Charles Cullen, Nurse Who Killed More Than 29 Patients


Cullen committed his first murder on June 11, 1988. Judge John W. Yengo Sr., had been admitted to St. Barnabas Medical Center suffering from an allergic reaction to a blood-thinning drug. Cullen administered a lethal overdose of medication intravenously. Cullen admitted to killing 11 patients at St. Barnabas, including an AIDS patient who died after being given an overdose of insulin. Cullen quit his job at St. Barnabas in January 1992 when hospital authorities began investigating who might have tampered with bags of intravenous fluid.


Cullen took a job at Warren Hospital in Phillipsburg, New Jersey, in February 1992.
He murdered three elderly women at the hospital by giving them overdoses of the heart medication digoxin. His final victim said that a "sneaky male nurse" had injected her as she slept, but family members and other healthcare workers dismissed her comments.


At his sentencing hearings in 2006, serial killer nurse Charles Cullen did explain why he killed at least 29 hospital and nursing home patients in New Jersey and Pennsylvania. Cullen said he administered overdoses to patients to spare them from being "coded" -- going into cardiac or respiratory  arrest and being listed as a "Code Blue" emergency. Cullen has told detectives that he could not bear to witness or hear about attempts at saving a victim's life. Cullen also claims that he gave patients overdoses so that he could end their "suffering" and prevent hospital personnel from "de-h umanizing" them.


http://vvww.huffingtonpost.com/201 3/04/19/charles-cullen-nurse-who-n3116750.html

http:/ lmurderpedia. orglmale. Clcl cullen-charles. htm



Case 1:
A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes it to stretch and bulge (this is very similar to what led to John Ritter's death). The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/ 50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes.


The woman is an erotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm.


She survives, and sues the hospital for millions of dollars.


Student Example
Consent or No Consent

My case was based on an event in England in 1985, where teens protested in the streets over the right of minors to request contraception from their doctor.  As I did the collage, the main ideas I want to get across are that teens need freedom to do whatever they want to do without their parents. 





Medical Ethics: Basic Foundations Document



Review of Ethical Principles

Autonomy—agreement to respect another's right to self-determine a course of action; support of independent decision making.

Beneficence- compassion; taking positive action to help others; desire to do good; core principle of our patient advocacy.

Nonmaleficence- avoidance of harm or hurt; core of medical oath and nursing ethics.

Fidelity- This principle requires loyalty, fairness, truthfulness, advocacy, and dedication to our patients. It involves an agreement to keep our promises. Fidelity refers to the concept of keeping a commitment and is based upon the virtue of caring.

Justice- Derived from the work of John Rawls, this principle refers to an equal and fair distribution of resources, based on analysis of benefits and burdens of decision. Justice implies that all citizens have an equal right to the goods distributed, regardless of what they have contributed or who they are. For example, in the US, we all have rights to services from the postal service, firefighters, police, and access to public schools, safe water, and sanitation.

What if it’s still confusing, or muddy? This is deep!

Another framework to look at cases:


Ethical Relativism- This theory holds that morality is relative to the norms of one's culture.

Example: An example, often used, is female genital circumcision. One side calls it female genital mutilation. Another group may consider this an appropriate cultural rite of passage. The ethical issue discussed—is this a cultural issue or human rights issue? Since it is performed on girls as young as seven years old, the issue of assent, consent, and culture are prominent in ethical discussions.

Feminist Theory- This theory supports ethical relativism in that it does not support universal acts. Feminist theory requires examination of context of the situation in order to come to a moral conclusion. It asks how an action affects the person, the family, and those depending upon one another (e.g. community).

Example: There are two people, who are 16 years of age, who have a new diagnosis of insulin dependent diabetes. Neither can afford the recommended insulin pump. The company will donate one pump per year as charity. Ethical relativism might help make a decision on which patient to give the pump to at no cost. Using this theory, one would take into account the patient’s culture, lifestyle, motivation, and maturity level before deciding to whom the insulin pump would be best allocated. Additionally, feminist ethics would look at how the parents of the young people are being affected by the disease, and whether a pump would make life easier or more difficult for the family. The family’s resources, both financial and emotional, would be taken into account. The context of the situation would be explored.

Deontology- This theory judges the morality of an action based on the action's adherence to rules. Whether an action is ethical depends on the intentions behind the decisions rather than the outcomes that result.

Example: Individuals would examine their intentions to determine the ethics of their actions. For example, we have begun not to use restraints on older people for their safety and to think of other measures. We do this because restraining someone against his or her will could not be considered a universal law.

Utilitarianism- This theory supports what is best for most people. The value of the act is determined by its usefulness, with the main emphasis on the outcome or consequences.

Example: In the US, our system of disaster triage is based upon the concept of utilitarianism. Health care providers triage rapidly, electing to use resources to provide the most care to the greatest number of people, as opposed to expending maximum resources on a single critically ill person who is unlikely to survive.

Source: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf