Teaching Bioethics through Participation and Policy-Making

Essays on Teaching Excellence
Toward the Best in the Academy

Vol. 16, No. 4, 2004-2005

Karey A. Harwood
North Carolina State University

The teaching of bioethics is a dynamic balance between conceptual analysis and the concrete engagement of cases. Providing groups of students with the opportunity to research, analyze, discuss, and propose public policy on emerging topics in bioethics simulates the work of a "bioethics commission" and develops the traits of an engaged citizen. Because these activities are highly participatory and inquiry-guided, students are encouraged to integrate abstract concepts with concrete reality and to develop essential skills in critical reasoning.

Why Teach Bioethics to Undergraduates

Teaching bioethics to undergraduate students in the humanities and social sciences differs from teaching ethics to medical students or residents. One primary difference is that undergraduates are removed from the clinical setting, where a clinically-based case method of teaching is widely practiced and where students can develop their decision-making skills "at the bedside" through the mentoring of more senior physicians. Another difference is that undergraduates are not in training to join a profession, in this case a profession that has developed a fairly stable body of principles that are "applied" to real-life moral dilemmas (Jonsen, Siegler, & Winslade, 2002; Wear, 2002). Instead, as part of a liberal arts education, an undergraduate course in bioethics should aim to prepare students for life as an engaged citizen in a democratic society (Callahan & Bok, 1980; Kohlberg, 1981) by developing skills in critical thinking and encouraging active engagement in the deliberation of issues in the areas of medicine and biotechnology.

Critical thinking, most plainly, is the ability to make well-considered judgments. Critical thinking involves the analysis of concepts and arguments and the interpretation of concrete data or evidence (APA, 1990); but it also requires capacities for self-criticism, moral imagination, and empathy (Momeyer, 2002). It enables the discernment of better and worse arguments or better and worse courses of action, and thus rests on the premise that such judgments of value are possible. It is an essential set of skills, not because it is immediately applicable to a chosen career, but because "wide-awake, careful, thorough habits of thinking" (Dewey, 1933, p. 274) are important in all areas of human life, both individual and social.

How to Teach Bioethics

One way to foster the development of critical reasoning skills in the undergraduate setting is to provide groups of students with the opportunity to research, analyze, discuss, and propose public policy on emerging topics in bioethics. This type of activity simulates the work of a national bioethics commission and encourages students to view themselves as participants in a significant public debate. For example, a group of students might study stem cell research or international research on AIDS, acquiring enough scientific, medical, and historical background on these topics to be able to identify potential ethical questions. Some questions that might be considered include: Do the benefits of stem cell research justify the use of human embryos? Are all sources of human stem cells morally equivalent? Are the existing safeguards to protect human subjects adequate for international research on AIDS? Should developing countries be able to benefit from AIDS research when their citizens serve as research subjects?

Without necessarily working to achieve complete agreement, students try to reach enough of a consensus to propose a policy or regulation. A group might decide that allowing stem cell research from "leftover" embryos created in the context of in vitro fertilization is acceptable, for example, but that creating embryos for the sole purpose of research is not. Students must give reasons for their regulations; and, in searching for and articulating these reasons, students are encouraged to examine the moral values and commitments that underlie their positions. An in-class presentation of the group's work serves as the culminating exercise, and other students are invited to challenge and contribute to the debate about what ought to be done. Students typically relish this opportunity, seeing themselves not as a passive audience to be fed neutral information but as participants in a debate that matters. In other words, they exhibit the traits of engaged citizens.

These activities are highly participatory and inquiry-guided, which means the learning is driven by the task of solving a problem: devising a public policy. Students are invested in and motivated by the group's task and discover together what they need to learn about their topic. Included in this learning process is the integration of abstract ethical theories and concepts ideally studied throughout the entirety of the course — into the concrete details of the case at hand. It is not a matter of simply "applying" the principle of justice to the topic of international research on AIDS, for example, just for the sake of getting something done (Evans, 2000). Students must ask: what does justice look like in this case? Does conducting an experiment to see how cheaply an individual in a developing country can be treated for AIDS promote justice, as we understand it? In asking these substantive questions, students in an undergraduate bioethics course are engaged in what Callahan calls "foundational" bioethics (Callahan, 1999). They are not merely engaged in means-end reasoning: how best to achieve an already settled goal (Wear, 2002). They are examining the goals themselves, and thus considering "a multiplicity of ultimate values" (Momeyer, 2002).

Developing a Wide-awake Citizenry

As any teacher of undergraduate ethics can attest, this kind of substantive discussion of "ultimate values" or "the good" can be murky territory. The allure of moral relativism is strong and the resources for challenging it seem limited. As Momeyer observed, "Students frequently arrive in our classrooms with very limited ways of morally engaging problematic situations, by, for instance, appealing to religious dogmas or a relentless subjectivism and/or relativism, or by privileging – as well enculturated Americans seemingly must, – the exercise of individual autonomy over all other values"(p. 412). Regardless of how one explains the allure of relativism, what is clear is that undergraduates need to develop skills in critical thinking if they are to be able to make the well-considered judgments that are inevitable and necessary in life.

One benefit of a simulated bioethics commission is that it directs students' attention toward a problem of public policy, which is to say a problem of societal significance. Discussing classic cases in medical ethics that focus on an individual patient's dilemma, such as, famously, whether Dax Cowart's requests to die after suffering severe burns over most of his body should have been honored by his physicians, provide essential occasions to learn about important concepts like informed consent, competence, and respect for autonomy. Indeed, effective teaching of ethics in any setting arguably requires a dynamic balance between conceptual analysis and concrete engagement of cases. But undergraduates also need opportunities to learn that their critical thinking skills will be needed in shaping the social policies of the future.

Why is critical thinking a legitimate and valuable goal? And why is active engagement or participation in shaping social policies important? As Dewey once argued, the point of education is to teach students to think on their own because conscious thinking and participation are the hallmarks of democratic citizenship. Others have followed Dewey's pragmatic sensibilities, including the developmental psychologist, Lawrence Kohlberg, whose "just community" schools were an outgrowth of his belief that democratic participation in the making of rules for everyone in a community fosters students' moral development. The writings of Jürgen Habermas (1995) on discourse ethics have also influenced legions of teachers to examine anew the value of a consensus-seeking dialogue that is widely inclusive and highly participatory.

Conclusion

If we are to avoid living in an "administered society," where we passively receive what is handed down to us from others, it is important to develop a sense of engagement in the social policies that are made and to practice the critical reasoning skills necessary to make well-considered judgments (Bellah, et al., 1991). Fortunately, continuing developments in medicine and biotechnology offer an abundance of ethical issues to debate. Teaching bioethics in the undergraduate setting is about paying attention to these debates and having a stake in their outcome.

References:

APA Delphi Report (1990 ). Critical thinking: A statement of expert consensus for purposes of educational assessment and instruction. (ERIC Doc. No.: ED 315-423)

Bellah, R., Madsen, R., Sullivan, W., Swidler, A., & Tipton, S. (1991). The good society . New York, NY: Vintage Books.

Callahan, D. (1999, Fall). The social sciences and the task of bioethics. Daedalus . 128 , 275-294.

Callahan, D., & Bok, S. (1980). Ethics teaching in higher education. New York, NY: Plenum Press.

Dewey, J. (1933). Education in relation to form. In L. Hickman & T. Alexander (Eds.). (1998), The essential Dewey, Vol. I: Pragmatism, education, democracy. Bloomington, IN: Indiana University Press.

Evans, J.H. (2000, September - October). A sociological account of the growth of principlism. Hastings Center Report . 30 (5), 31-38.

Habermas, J. (1995 ). Moral consciousness and communicative action . Cambridge, MA: MIT Press.

Jonsen, A., Siegler, M., & Winslade, W. (2002). Clinical ethics: A practical approach to ethical decisions in clinical medicine . (5th ed.). New York, NY: McGraw- Hill.

Kohlberg, L. (1981). Essays on moral development, Vol. I: The philosophy of moral development . New York, NY: Harper & Row.

Momeyer, R. (2002). What conception of moral truth works in bioethics? Journal of Medicine and Philosophy , 27, 403- 416.

Wear, S. (2002). Teaching bioethics at (or near) the bedside. Journal of Medicine and Philosophy . 27 , 433- 446.

Karey A. Harwood (Ph.D., Emory University) is Assistant Professor of Religious Studies, Department of Philosophy and Religion, North Carolina State University.

This publication is part of an 8-part series of essays originally published by The Professional & Organizational Development Network in Higher Education. For more information about the POD Network, link to http://www.podnetwork.org .