Representative Student Work

Case Reflection and Problem Refinement
Staying with the Problem and Working with Ethical, Clinical, and Social Complexity

Assignment Context

Case Reflections ask students to engage with complex, real-world scenarios drawn from organ donation and transplantation. While cases may involve death determination, family disagreement, consent, media scrutiny, normothermic regional perfusion (NRP), or system failure, the task is not to resolve the case.

Students are asked to identify what the problem actually is, to examine competing values and constraints, and to remain attentive to loss, uncertainty, and moral remainder. Strong reflections demonstrate disciplined diagnosis rather than decisiveness. They stay with complexity long enough for tensions to become visible, and they resist reframing disagreement as error or obstruction.

The excerpts below are anonymized exemplars selected because they show ethical seriousness, conceptual restraint, and the capacity to think clearly when resolution is unavailable.

What Counts as Death When Medicine Can Do More?

HTHSCI 3DT3 student, 2025

“Before this course, I assumed that disagreement about death determination resulted from misinformation or emotional distress. This case forced me to confront a more difficult possibility: that disagreement can persist even when all parties are informed, thoughtful, and acting in good faith.

The clinical team relied on population-level criteria and procedural safeguards, while the family relied on relational continuity and visible signs of responsiveness. Neither framework is irrational, but they are not easily reconciled. The case revealed how quickly disagreement becomes reframed as obstruction once death has been declared.

What unsettled me most was realizing that ethical responsibility does not end with determination. Acting correctly does not guarantee being experienced as careful. This case clarified that ethical practice often involves moving forward while acknowledging that trust has not yet been secured.”

Comment
This reflection demonstrates the discipline of holding irreconcilable moral frameworks without collapsing into blame or solutioning. The student identifies trust as central and names ethical remainder as something that persists beyond procedural closure.

Process Is Not Neutral: Trust as an Ethical Requirement

HTHSCI 3DT3 student, 2024

“The case initially appeared to be about whether the correct criteria for death had been met. Over time, it became clear that the more consequential issue was not the criteria themselves, but how they were introduced, explained, and defended.

By examining the legal standards alongside the family’s experience of sudden loss, I realized that process is never ethically neutral. Timing, language, and sequencing shaped how the determination was received. Even a technically sound determination can fail ethically if the surrounding process erodes trust.

This reframed my understanding of safeguards. Rather than viewing them solely as protections against biological error, I began to see them as trust-preserving commitments. When safeguards are treated as boxes to check, they risk becoming hollow.”

Comment
This excerpt shows the student treating process as ethical substance rather than administrative detail. Safeguards are reframed as moral commitments, not mere technical protections.

Normothermic Regional Perfusion and the Limits of Safeguards

HTHSCI 3DT3 student, 2025

“At first glance, normothermic regional perfusion appears to be a technical solution to a technical problem. The case revealed something more unsettling: NRP is an ethical stress test of how we understand permanence, intention, and public trust.

Safeguards such as aortic occlusion and cerebral monitoring reduce risk, but they cannot eliminate moral unease. The ethical question becomes not whether the brain will be reperfused, but whether the system can convincingly demonstrate that it cannot be, and whether that demonstration is sufficient for families and the public.

What troubled me most was the gap between professional reassurance and societal perception. Ethical defensibility cannot rest on technical explanation alone. It requires transparency, governance, and humility about uncertainty.”

Comment
This reflection integrates biomedical safeguards with social legitimacy. The student recognizes that ethical viability depends on trust, not technical precision alone.

When Consent Is Legal but Trust Is Fragile

HTHSCI 3DT3 student, 2024

“This case challenged my assumption that consent resolves ethical tension. Although consent was documented and legally valid, the family’s later expressions of doubt revealed consent as a relational process that can erode if not continually supported.

The clinical team appeared to operate from procedural correctness, while the family experienced the unfolding events as rushed and disorienting. Legal certainty obscured relational fragility.

What stood out was how quickly hesitation was reframed as resistance. Rather than asking what had shifted for the family, the system defaulted to protecting process. This raised a difficult question: What responsibilities persist when consent remains intact but trust does not?”

Comment
This excerpt demonstrates strong diagnostic discipline. The student distinguishes legal status from relational reality and names how systems defend process when trust is threatened.

Defining Death Is Easier Than Living With Its Consequences

HTHSCI 3DT3 student, 2025

“The case demonstrated that defining death is not the same as managing its aftermath. Even when determination followed established criteria, the emotional and moral consequences extended far beyond the moment of declaration.

The system was prepared to decide, but less prepared to remain present. Decisiveness was prioritized, while endurance was required. The ethical challenge was not diagnostic uncertainty, but relational stamina.

This reframed death determination for me as the beginning of ethical responsibility rather than its conclusion.”

Comment
This reflection shows ethical seriousness through attention to what persists after ‘correct’ decisions. The student identifies endurance and presence as core ethical work.

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Decision-Making Under Pressure

HTHSCI 3DT3 student, 2024

“Under acute time pressure, disagreement was framed as inefficiency. In retrospect, the disagreement signaled unresolved value conflicts rather than poor teamwork.

The failure was not delay, but the absence of a shared process for holding competing commitments.”

Comment
This concise reflection demonstrates the ability to read conflict as information rather than dysfunction and to diagnose missing structures for ethical containment.

Family Veto and Moral Distress

HTHSCI 3DT3 student, 2025

“The case revealed how moral distress often arises not from ambiguity, but from clarity without authority. Clinicians may know what they believe is right, yet be unable to act within institutional constraints.

This reframes distress as structural rather than personal, and calls into question systems that rely on individual resilience to absorb unresolved ethical tension.”

Comment
This excerpt shows conceptual clarity and restraint. Moral distress is reframed as a system-level phenomenon, not an individual failing.

Summary

These case reflections demonstrate excellence through discipline rather than decisiveness. Students stay with uncertainty, diagnose competing values, and remain accountable to loss even when procedures are correct. The work shows how ethical practice in donation and transplantation often involves acting responsibly in the presence of unresolved moral remainder.

Please Note: Attribution and Student Recognition

All excerpts are presented anonymously to protect privacy and support intellectual risk-taking. If a student recognizes their work and would like to be credited, they are welcome to contact the course instructor directly and share the original submission. With permission, attribution can be added.

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