2020 Conley Ethics Essay Contest

Background

Established by the John Conley Foundation for Ethics and Philosophy in Medicine, this annual essay contest has been administered by the AMA Journal of Ethics since 2004.

Each spring, the AMA Journal of Ethics poses a question in ethics and professionalism 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. The author of the best essay receives a prize of $5,000. The author of the winning essay is typically contacted within six weeks of the submission deadline and must be willing, if needed, to revise the essay at the request of AMA Journal of Ethics editorial staff in order to have the work published in the journal.

Please visit here for more detailed information about the contest rules.

Eligibility Requirements

Currently enrolled US medical students (MD or DO), resident physicians or fellows are eligible to submit entries. Entries 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 1,500 words, excluding references. Essays must be written by a single author, typed in Times New Roman 12 with 1.5 spacing.

Cover Page Requirement

The first page of the single Word document file must be the cover page, which must include the author’s name, address, telephone number, e-mail address, medical school (and year in medical school) or specialty training program (and year in training program), as well as the word count of the essay (excluding cover page and references), which must be tabulated as follows: In Word, highlight the essay text only, then on the Review tab in the Proofing group, click the Word Count icon or use Ctrl+Shift+G. This information must be included on the cover page only; essays including the author’s name on other 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. The Word document file name must be the author’s last name only. All materials must be received by 5 PM central time on 25 September 2020, as marked by email time-stamp when received by the AMA. Authors who have waited even until 4:55 PM, for example, to submit materials have occasionally been disappointed, due to transmission delays, so please plan accordingly.

Case

If force is necessary, who should implement it, and how?

CC is a nurse in a skilled nursing facility caring for BB, a patient with a history of aggression, paranoia, emotional dysregulation, and schizophrenia. BB typically refuses medication when hospitalized for acute exacerbations of their illness and is unable to self-care.

DD is BB’s legal guardian and has authorized haloperidol to be orally administered to BB mixed into and hidden in their food. CC has administered oral haloperidol to BB this way, but is increasingly uncomfortable doing so.

During an interdisciplinary team meeting, CC stated, “This kind of deception is generally viewed by everyone on the team as ethically questionable, probably since it is a kind of force, but I’m the only one who’ll do it, in order to avoid what’s worse. If I don’t, or if someone doesn’t hide the haloperidol in BB’s food, BB gets an intramuscular (IM) injection, which is worse. When BB gets IM injections, administration of BB’s meds gets delayed. We have to wait for multiple security guards arrive on the unit to help restrain BB. It’s loud, disruptive, distressing, and upsetting for everyone—BB, other patients, us—especially when it happens over and over again. If using force on this patient is going to be routine, we need to be executing this better. I mean, is there even a policy or a protocol about how we should be doing this? We need a plan that doesn’t involve me being the only one relegated to doing the ‘dirty work’ deception to spare BB the repeated physical trauma.”

Members of the team wondered how to respond.

Essay Prompt

What would constitute the most compassionate use of force, when needed, to care for BB? Though physicians tend to make decisions about using force, nurses, ancillary staff, and security personnel often are the ones actually implementing or administering force. Some might argue that clinicians, not security or ancillary staff, should be responsible for administering force in clinical settings in order to minimize harm to patients. When force is needed, which clinicians should be responsible for implementing force in the most compassionate (not just minimally harmful) ways possible? Which strategies should be implemented to help preserve the character of clinicians who feel morally compromised by being the ones who implement force?