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IM29.1-26 | The Role of the Physician in the Community — Assignment

CLINICAL SCENARIO

This assignment asks you to select ONE real or plausible ethical dilemma that you have encountered or could encounter as a final-year MBBS student or intern in a clinical setting in India. You will analyse the dilemma using the four-principle framework (non-maleficence, autonomy, beneficence, justice), situate it within the Indian medico-legal context, arrive at a reasoned and defensible ethical decision, and reflect critically on what this dilemma reveals about the challenges of professional practice. The dilemma must involve a genuine conflict between two or more ethical obligations — not a simple case of right versus wrong behaviour. Suggested scenarios include: a patient refusing a life-saving blood transfusion on religious grounds; a colleague suspected of substance impairment during duty; a request to omit a diagnosis from documentation; a family insisting on continuing treatment that a competent patient has refused; or a research participant being pressured by family to withdraw consent they have already given.

Instructions

Write a structured reflective analysis in the five sections below. Use clear, professional language. Apply the four-principle framework explicitly — do not write a general essay on 'ethics.' Cite Indian legal authorities accurately, including the year and the specific holding. Do not copy SDL text verbatim. Word limit: 1,000–1,200 words.

Length: 1,000–1,200 words across all sections

What to Submit

Section 1: Describe the Dilemma and Identify the Conflict

Guidance: Describe the clinical situation clearly and concisely. Identify all parties affected (patient, family, colleague, institution, public). Name the two or more ethical principles that are in genuine conflict. Explain why this is a true dilemma — why you cannot fully honour both obligations simultaneously. Approximately 200 words.

Section 2: Apply the Four-Principle Framework and Indian Legal Context

Guidance: Apply each of the four prima facie principles (non-maleficence, autonomy, beneficence, justice) to your scenario in turn. For each principle, state what it requires in this situation. Identify which Indian judicial authority, regulatory standard, or professional guideline is most directly relevant (choose from: Samira Kohli v Dr Prabha Manchanda 2008; Common Cause v Union of India 2018; Mr X v Hospital Z 1998; ICMR National Ethical Guidelines 2017; or professional conduct regulations). State the holding accurately. Approximately 350 words.

Section 3: Arrive at a Reasoned Ethical Decision

Guidance: State clearly what you would do and why. Identify which principle or obligation prevails, and provide a structured justification — not just a conclusion. Acknowledge the cost of overriding the competing obligation (what is lost when you choose this course?) and explain why the prevailing obligation is proportionate given the specific facts. Approximately 250 words.

Section 4: Documentation and Process Safeguards

Guidance: Describe what documentation and process steps you would take to record your decision and protect all parties. Include: what you would write in the medical record (content, timing, signatures), who you would consult (supervisor, ethics committee), how you would communicate the decision to the patient or family, and what follow-up is required. Apply the documentation standard from IM29.13 explicitly. Approximately 150 words.

Section 5: Reflective Learning

Guidance: Reflect on one specific assumption you held about medical ethics — or about the 'rules' of clinical practice — that this dilemma challenged. What does this dilemma teach you about the difference between knowing what is right and being able to act on it? Approximately 150 words.

Grading Rubric — Ethical Dilemma Reflective Analysis Rubric

Criterion	Points	Full-marks descriptor
Identification and Framing of the Ethical Dilemma (Section 1): Clearly identifies the ethical dilemma; names all principles in conflict and the specific stakeholders affected; articulates WHY this constitutes a genuine conflict (not a simple case of misconduct).	15 pts	Dilemma precisely identified; all competing principles named correctly; stakeholders fully enumerated; clearly explains why two or more prima facie obligations genuinely conflict in this case.
Application of the Four-Principle Framework and Indian Legal Context (Section 2): Applies all four principles systematically; correctly cites the applicable Indian judicial or regulatory authority (Samira Kohli, Common Cause, Mr X, ICMR 2017, or relevant conduct regulations) with accurate holdings.	25 pts	All four principles applied with specific reference to the facts; at least two Indian legal/regulatory authorities cited with accurate holdings; no factual errors in legal citations.
Reasoned Ethical Decision and Justification (Section 3): Arrives at a defensible ethical decision; provides a structured justification explaining which principle prevails and why; acknowledges the cost of overriding the competing obligation.	25 pts	Clear, defensible decision stated; justification explains both the prevailing principle and the cost of overriding the competing obligation; reasoning is proportionate and specific to the case facts.
Documentation and Process Standards (Section 4): Identifies what documentation and procedural safeguards should accompany the decision; correctly applies medical record standards (IM29.13) to protect both patient and physician.	20 pts	Documentation requirements stated with specificity: timed and dated entries, persons consulted, reasons documented, patient communication recorded; process safeguards (ethics committee, supervisor consultation) correctly applied.
Critical Reflection on Personal Professional Values (Section 5): Reflects authentically on how this dilemma challenged a personal assumption or professional value; demonstrates genuine intellectual engagement with the difficulty of ethical practice.	15 pts	Reflection is specific, personal, and credible; names a particular assumption challenged; demonstrates understanding that ethical difficulty does not imply ethical ambiguity.

PEER REVIEW

Review your peer's assignment using the rubric provided. For each section, assign a score and write one specific comment. For Section 2, verify that the Indian legal authority is cited with the correct year and that the holding stated is accurate — check specifically whether Samira Kohli is correctly attributed to the reasonable-doctor (Bolam) standard and not the prudent-patient standard. For Section 3, check whether the student acknowledges the cost of the ethical override — a strong submission recognises what is lost, not just what is gained. Complete your review within 72 hours.