This year, McMaster medical school has done something interesting with CASPer. They have provided this year’s applicants with 4 sample CASPer videos with 3 questions each. They also state that 2 of the 4 videos will be used in the actual CASPer – however, they make no mention of whether the questions will also be re-used.

Why are they doing this? I’m not really sure, and given their propensity for testing new models and concepts, I would imagine this is also for testing purposes – I see no other reason to provide applicants with advanced knowledge unless they were trying to see whether advanced preparation affects applicant scores or something like that. Who knows?

In any case, I thought these cases were interesting. While I’m not going to write out my own answers (for obvious reasons – you should be trying yourself!), I do want to share some random thoughts that hopefully will help some of you think about the scenario in different ways. Hopefully, seeing some different perspectives on the same scenario will help you when approaching new situations in the actual CASPer.

Video 1: Affirmative Action

Scenario: Is it okay for medical school admissions to use affirmative action to “increase diversity”?

I don’t think “just for the sake of diversity” alone is a good enough reason for affirmative action to occur. However, that does not mean affirmative action is in itself unethical or bad for the admissions process.

The more important concept to think about is whether not diversity would enhance the health care system and the care delivered to patients in the long term. What’s the goal of a medical school? You could argue it is to “select the best candidates”. But the best candidates for “what”? I would argue that medical schools should select the candidates that would lead to the best long term outcomes for our health care system and the patients we will serve.

Some would argue that perhaps there are patients in minority groups that would benefit from having physicians of the same ethnicity and culture, and that if we are to properly care for all Canadian patients, we need to make sure there is enough diversity among physicians to care for patients from various backgrounds. And let’s be honest, it’s true in many cases – many patients don’t speak English and need a doctor who speaks their language. Also, in many cases, patients have specific cultural values and concerns that only people from the same background would tend to recognize and understand. I don’t think anyone would dispute that.

The question then is: how can we ethically and accurately address such issues? The truth is, if you want to do it properly, you need to do real studies that answer questions such as: Does affirmative action in theory actually work? How effective is it? What percentage of the patient population has such specific needs and from what languages, cultures, etc.?

These are very difficult questions to answer, but without doing the proper research, affirmative action is nothing more than just something that sounds good in theory. Proper motivates, planning and implementation are all needed to make affirmative action acceptable and successful.

Video 2: Bookstore

Scenario: You work in a book store that is not doing financially well. A customer wants to buy a book using the U.S. price on the back, which reflects a value of the Canadian dollar much lower than it is today – what do you do?

There are several factors to think about in this situation. The first thing that comes to my mind are legal issues – are we legally obligated to accept U.S. currency at the U.S. price on the book? Logically I want to say no, and most likely the price on the back was based on the exchange rate at the time of publication, and not reflective of the current value of the Canadian/U.S. dollars. However, the legality of such a transaction would not completely be known to me unless I looked it up. For that reason, I think it’s a strange issue to be brought up in a scenario.

The second factor they want us to consider is the poor financial state the store is in. If your store was well off, would you be more likely to just let this issue slide with the customer (perhaps assuming they will be more likely to come back in the future and be repeat customers), or do you believe the principle of the matter is more important (and risk losing future business with this customer)?

Finally, we want to consider: how could we prevent such situations from happening again in the future? One option is to have a clear policy highlighted in your store stating that you only sell in Canadian currency, and any payment offered in non Canadian currency will be converted to Canadian dollars via the current exchange rate.

Video 3: Allbrite

Scenario: You are on a jury trying to decide whether the family of a child victim should be able to sue a lighter company after their child misused a lighter and died in an accidental fire.

This type of ethical issue has been around for a long time. Who is to blame: the makers of a potentially dangerous product or those who improperly use it? There’s actually a really good movie sort of based on this issue called Runaway Jury, in which a company that produces and sells guns is being sued by families of victims of violence.

The problem with siding with the families of victims is that it brings many products into question and complicates other examples. For instance, should we sue companies that produce kitchen knives used in murders? What about if someone used a chair to hit someone else on the head?

However, there are some key factors we need to think about here. One is “intended use” – is the intended use of the product harmful? For example, a gun will always harm someone, but a chair or kitchen knife only harms if used against its intended use.

Of course, the situation presented here is complicated by the fact that the product was used by a child too young to understand its proper use. In addition, we are given no information about what role the parents might have played in this matter (i.e. was it preventable if parental supervision and education was better?). The big question we are then faced with is: what reasonable amount of injury prevention should companies be obligated to provide? And to what extent should everything else fall on the parents?

These are clearly very difficult questions to answer, but I think the important thing is to show that you recognize these types of factors and try to form the best opinion/argument you can possible with the limited information you have.

Video 4: Para-Olympics

Scenario: A para-olympian skier with prosthetic limbs wants to compete in the Olympics. You are the chair of the committee deciding on the issue.

In many ways, this is the most challenging of the 4 videos, mostly because it’s hard to determine where we draw the line between “acceptable” and “providing an artificial advantage”. Honestly, I don’t think there is anywhere near enough information to make a good decision in this situation, but that’s the nature of the CASPer beast.

So I’ll go back to what I always do and ask: what information would we need to know in order to make a good, fair decision?

We need to be able to decide what are the most “artificial additions/alterations” a human body can have and still be eligible to compete in the Olympics. Essentially, things like prostheses should need to be as similar to human body parts as much as possible, but I have no idea how hard that is. It’s quite obvious why answering these questions are not just hard for applicants, but for the key individuals actually making these decisions in the real world.

One other issue we need to recognize is that the decisions we make in cases like this set the bar for how similar cases will be judged in the future. We need to think about not just this one athlete, but for every single future athlete who will ever compete. We need to think about creating a policy, so that whenever a similar situation occurs in the future, we already have a protocol for solving it.

Conclusion

These are tough scenarios and tough questions – there is a reason these are still controversial issues in the real world. Many of these questions have no obvious “right answer”. What will be more important is showing you have insight into the various perspectives on the issue and the key factors that need to be considered with each scenario. Hopefully these thoughts will help you consider ways to look at CASPer scenarios you might otherwise not have considered.

Best of luck this week!