2021 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 essays 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 contest rules.

Eligibility Requirements

Currently enrolled US medical (MD) students and osteopathic (DO) students, resident physicians, or fellows in ACGME-accredited or AOA-accredited programs 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 submitted by a single author in Times New Roman 12 with 1.5 spacing.

Cover Page Requirements

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 24 September 2021, as marked by email timestamp 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

MJ is a 33-year-old transgender man who transitioned with hormone therapy during college. His parents immigrated from Mexico in their early 20s, settled in suburban Texas, and retain views about gender identity that MJ has, for many years, experienced as oppressive.

Recently diagnosed with advanced colorectal cancer, MJ has been hospitalized several times during the past year. His physicians recently conveyed to MJ that no curative options remain. MJ’s family members are distraught, blame MJ for bringing this upon himself and his family through his “lifestyle choices,” and insist that MJ denounce his gender identity. MJ expresses to Dr R, hospitalist attending physician directing MJ’s inpatient hospice care, and Dr S, resident physician, that he fears he will die alone, without anyone at his side, if he does not do as his family members ask.

Dr R reiterates the importance of family visits while MJ goes through the dying process and suggests that his gender identity, at this point in his life, should probably be regarded as less significant than his comfort and sense of family belonging. When alone with MJ, Dr S, who disagrees with Dr R, considers telling MJ, “There is no need to compromise your identity. Be who you are to the end. We will be here with you and you will not be alone when you die.”

Dr R considers whether to speak these words.

Essay Prompt

When clinicians’ speech or actions toward patients with minoritized and marginalized identities exacerbate those patients’ experiences of oppression, according to which criteria should such harm be considered iatrogenic? Also, when, if ever, should we conceive iatrogenic influence as extending beyond a patient’s experience (eg, to patient’s loved ones)?

References

Cloyes KG, Hull W, Davis A. Palliative and End-of-Life Care for Lesbian, Gay, Bisexual, and Transgender (LGBT) Cancer Patients and Their Caregivers. Semin Oncol Nurs. 2018;34(1):60-71. doi:10.1016/j.soncn.2017.12.003.

Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. https://doi.org/10.17226/13128.

Sterling J, Garcia MM. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Transl Androl Urol. 2020;9(6):2771-2785. doi:10.21037/tau-20-954.

Health of lesbian, gay, bisexual, and transgender populations. Lancet. 2011;377(9773):1211. doi:10.1016/S0140-6736(11)60482-0.

Nisly NL, Imborek KL, Miller ML, Kaliszewski SD, Williams RM, Krasowski MD. Unique Primary Care Needs of Transgender and Gender Non-Binary People. Clin Obstet Gynecol. 2018;61(4):674-686. doi:10.1097/GRF.0000000000000404.