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As all of us have, I have encountered a number of ethical dilemmas that I have had to resolve. There is one situation that stands out, for a number of reasons. At my undergraduate school, I spent a semester as an honors program seminar leader for a class of new students. My responsibilities were to help approximately nine new students become acclimated to Iowa State University, the Honors Program, and to make sure they all took and passed a simple test in library proficiency.
Other than passing the library test, the only requirement for the class was attendance. However, a failure in this class could not be erased from the record, as students were not permitted to retake the class due to severe size constraints. Thus my position was part role as teacher, part as counselor, and part as fellow student. The ethical situation I have chosen, although not directly medical, involves a student in that honors program class. It is representative of a problem that can face a medical practitioner.
This example illustrates ethical problems which can arise from the power differential or authority given to a teacher, the need to maintain proper boundaries, and the responsibility of a teacher to grade impartially while still trying to maintain a relationship to the student which will best help that student. MJ was a student in my class who was very enthusiastic and bright. At the start of the semester she was very organized and prepared for the new realities of university life. As the semester wore on, however, a number of troubling signs began to appear that warned of difficulties. MJ was quickly reaching the total number of absences that she was allowed in the honors program class without being given a failing grade. The number of absences allowed had been explained to all students at the start of class and repeated numerous times.
Additionally, the Honors Program director had indicated to me that MJ was frequently missing other classes and doing poorly in those classes. I decided to have a talk with MJ to find out the reason or reasons behind these problems, as well as re-emphasize the need to continue class attendance. When I took her aside following class she was very willing to talk about her recent academic performance and told me about a large number of stressors in her life, in addition to starting college. The main problems were family trouble between her parents and a vaguely worded illness. After talking with her for awhile about each of these situations I recommended ways for her to improve her study habits, and gave her the names of some academic and personal counselors to help her further. Overall, the session seemed to go very well, and she was very grateful for the help.
The next few weeks were fairly uneventful, but then MJ was absent for a class, bringing her up to the maximum total she could miss without failing. Talking with the Honors Program director, I discovered MJ? s attendance in her other classes had plummeted even further. The director also indicated that MJ had come to her with numerous reasons for her difficulties. One reason was that MJ had a disease in which? large areas of her brain that were dead or dying? , a bizarre explanation for which the director had, after some research, determined to be a lie.
Nowhere in those reasons had MJ given family problems as she had to me in our discussion. This time I approached MJ much more seriously. I was faced with the dilemma of knowing she was lying to both the director and myself. I had to decide whether to confront her about them or to try again to get her to talk to myself and counselors voluntarily. I met with her at an outdoor table near her dorm. Again, she was very talkative about her problems.
When I told her I had talked to the director and we were very concerned about her recent actions, she broke down and began crying. I was able to get her talking again, and eventually she assured me that she would get help. I knew that I had not reached the root of her problem, but felt I was at the end of my ability to help. Emphasizing again that she had to attend class and seek a counselor, I wrapped up our talk. At this point MJ came very physically close to me, expressed her gratitude, and asked me to come back with her to her room? for a drink? .
Her intent was clear. Unfortunately, I was not prepared in the slightest for this situation, and so I had to bumble out a poor excuse and leave. The ethical dilemma here is an obvious violation of boundaries between teacher and student complicated by the nearness of our ages and experience. Now I had to try to help MJ while reestablishing boundaries. MJ could no longer drop the Honors class and there were no other class sections that could take her, dropping the problem squarely in my lap.
After a few weeks of attendance, however, MJ finally missed the class and her grade became a mandatory failure. I was very disappointed then, wishing I had been able to prevent this circumstance. I again talked with MJ, this time in a clearly open area with people around. MJ was noticeably very downcast throughout our talk. She was not forthcoming in talking about her problems and had little reaction to her class grade. Again, I felt I had not been able to discover what was happening.
I was able to get her to promise to improve class attendance in all of her classes, including mine, even though she would still fail. MJ? s attendance for the rest of the semester in both my class and others did improve. I now had the problem of giving her a failure even though I did not want to. Discussing it with the director, I was informed by her that MJ had declined to try to make any additional effort towards passing the class when the director had approached MJ, and so I had to? fail?
her. It was very difficult signing the sheet, knowing such a large number of factors had contributed to her failure, and that she had tried to improve in some ways towards the end. I was glad that we had been able to reestablish student teacher boundaries and maintain them for the rest of the semester, but disappointed that we were not able to talk as easily as we had been earlier. Overall, MJ was an excellent ethics teacher for me.
I learned a great deal about balancing concern for someone with the need to maintain boundaries. I also learned that ethical situations are never simple? one-shot? deals, and can be ongoing, long-term situations that expand and change with time.
I know I will draw upon this experience in the future 321
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