AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

2017 Conley Ethics Essay Contest

Established by the John Conley Foundation for Ethics and Philosophy in Medicine, this annual essay contest was administered by the Journal of the American Medical Association until 2004, and since then by the AMA Journal of Ethics.

Each spring, a question in ethics and professionalism is posed as the topic for the contest. Essays are judged on clarity of writing, responsiveness to questions posed in the essay prompt, and applicability to decisions presented in the case. Authors of the best essay in each of two categories (medical student or resident/fellow) receives a $3,000 winning prize and two honorable mention winners in each category receive $1,000. Authors of winning essays must be willing, if needed, to revise their essays at the request of AMA Journal of Ethics editorial staff in order to have their work published in the journal.

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Eligibility Requirements

Currently enrolled US medical students (MD and DO), resident physicians or fellows are eligible to submit essays for consideration. Essays must not have been previously published in print or electronic format and must not have been submitted to any other publication.

Format Requirements

Essays must not exceed 1,800 words, excluding references. Essays must be written by a single author, typed, double-spaced, and include the authorís name, address, telephone number, e-mail address, medical school (and year in medical school) or training program (and year in training program) on the cover page only; essays including authorsí names on pages of the essay will not be reviewed.

Submission Requirements

Essays must be submitted as one Word document file attached to an e-mail to Mr. Kelly Shaw at kelly.shaw@ama-assn.org. The first page of the document file must be the cover page. The document file name must be the authorís last name only. All materials must be received by 5 PM central time on September 25, 2017, as marked by email time-stamp when received by the AMA. Authors who have waited until 4:55 PM, for example, to submit materials have occasionally been disappointed, due to transmission delays, so please plan accordingly.

Case

A 28-year-old man is involved in a motor vehicle collision. He was driving a sport utility vehicle and restrained by a seatbelt. According to witnesses, the driver appeared to lose control of the vehicle while driving over an icy overpass. Emergency medical service (EMS) professionals found the patient obtunded and hypotensive, for which he was emergently intubated; his passenger was pronounced dead at the scene. Shortly after intubation, the patient suffered a cardiac arrest. EMS performed eight minutes of cardiopulmonary resuscitation before his spontaneous return of circulation. The patient was brought via helicopter to a level I trauma center.

In the trauma bay, the team performs a primary survey (specific, targeted exam done in the trauma bay to identify life threatening injuries) during which, the patient requires bilateral thoracostomy tube insertion and central line placement. After placement of the left chest tube, a liter of blood immediately drains into the deviceís collection chamber. After further examination, the team finds evidence of severe chest trauma: severe chest wall bruising, air under the skin that suggests traumatic injury to the lung, and extensive bilateral rib fractures. An abdominal ultrasound reveals no intra-abdominal fluid collections, however, he has what appears to be a left hemothorax (large collection of blood). Massive transfusion protocol is initiated, and the trauma team needs to conduct an exploratory thoracotomy to identify and treat a suspected intra-thoracic injury. As the trauma team begins coordinating with members of the operating room staff, the on-call chaplain approaches the attending physician, with a request. The patientís wife insists on seeing her husband, if only for a few seconds, before he is taken to surgery.

The attending physician looks at her patient and at members of the trauma team engaged in a flurry of activity as they prepare the patient for immediate transport to the operating room. With multiple tubes protruding from the patient and a pool of blood beneath his stretcher, the attending physician wonders how to respond to the chaplain.

Essay Prompt

Which are the most important ethically and aesthetically relevant criteria for determining if family presence in the trauma bay is appropriate and who should decide? If family members are allowed to be with patients in trauma care settings, should they be accompanied, by whom, and why? How do public perceptions of emergency care environments affect such determinations, and what should family members of emergency care patients (and perhaps patients themselves) know about such environments?