AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

2012 John Conley Ethics Essay Contest for Medical Students

Call for Entries

This year’s John Conley Foundation for Ethics and Philosophy in Medicine essay competition topic concerns experimental treatment for childhood cancer. Here is the scenario.

After experiencing morning headaches, vomiting, and increasing lethargy for about 3 months, Joey, 12 years of age, was found to have a medulloblastoma. He had surgery which was successful in removing all visible tumor. Joey had a staging workup that showed no metastasis. His treatment plan called for radiation immediately following the surgery and then chemotherapy.

Joey’s oncologist, Dr. Burnet, told his mother that an ongoing study was investigating the use of lower-than-standard doses of craniospinal radiation in a subset of children like Joey. The study was testing the hypothesis that the lower radiation dose would produce the same survival rates as the standard high radiation dosage while reducing the neurocognitive side effects.

When Joey and his mom met with Dr. Burnet, his mom told Dr. Burnet that she did not want Joey to participate in the experimental treatment regimen. Joey didn’t say anything during the meeting, but on the way home he told his mother that he wanted to be a part of the experimental treatment study. She asked him why. Joey, who had always been a curious kid, loved school, and was proud of his ability to excel at his studies, said, “Mom, they think this is going to be less toxic than what they’re doing now. I don’t want to be a cancer-free dummy… .”

Joey’s mother and father were separated, and, although Joey stayed with his mom in their home, his father remained close to both Joey’s mom and Joey and involved in his son’s life. When told of the treatment decision they were being asked to make, Joey’s dad said, “I think we should let Joey decide. He’s old enough to understand what the risks and possible benefits are. It’s his life.” The mother and father were alone, and Joey’s mom was fighting back tears. “I can’t say yes to giving him less treatment.  I just want our son to live,” she said.

The three of them went to Dr. Burnet together so that they all could hear what Dr. Burnet had to say. In the meantime, Joey and his parents learned as much as they could from the Internet, and what they were able to find confirmed what Dr. Burnet had said. This time Joey spoke up in the office, telling Dr. Burnet that he wanted to participate in the lower-dose radiation study.

“Because this regimen is experimental,” Dr. Burnet told Joey’s folks, “Joey’s assent is really important, but it’s best for everyone if all of you to agree to the treatment. I’m sure you can see why it’s critical that everyone is on board when you’re facing a possibly life-changing decision. We have a physician-ethicist on staff,” Dr. Burnet continued, “who might be able to help you sort out some of the questions you have. The key one, as I see it, is who gets to decide what is in Joey’s best interest. Would you like to meet with our physician-ethicist, Dr. Klein?”

Instructions for Entering

Essays should explore ethical aspects of the case that will inform the discussion between Dr. Klein and the three members of Joey’s family. Dr. Klein is a physician-ethicist, but not a pediatric oncologist. Essay writers are not expected to research or invent clinical facts to augment what Dr. Burnet has told Joey and his parents.

Essays will be judged on their applicability to the scenario, thoroughness of analysis , and clarity of presentation. The author of the best essay will be awarded $5,000, and the willing essay will be published in Virtual Mentor. Up to three honorable mention awards of $1,000 each will be made. Essays must be original, must not have been previously published in print or electronic format, and must not be submitted for consideration to any other journal during the review period.

All current U.S. medical students are eligible. Essays must be 2,000 words or fewer (not counting references, should there be any). Submit essays typed and double spaced, with the author’s identification (name, address, telphone number, e-mail address, and medical school class) on a separate cover sheet—not on the essay pages. Do not send the essay in a PDF file. Entries must be received as e-mail attachments by 5 p.m. CST, October 15, 2012. Submit essays to

Conley Contest Winners