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Exploring Bioethics

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Teacher's Guide

Teaching Exploring Bioethics

What Is Bioethics?

Defining Ethics and Bioethics


The definition of ethics reflected in Exploring Bioethics is

Ethics seeks to determine what a person should do, or the best course of action, and provides reasons why. It also helps people decide how to behave and treat one another, and what kinds of communities would be good to live in.

Ethics is the activity of deciding what one should do, as an individual and a member of a community. Members of a democratic society must offer each other reasons that show why one way of dealing with a problem is better than another. Ethics is the activity of offering reasons to support a decision about what one should do.

Bioethics is a subfield of ethics that explores ethical questions related to the life sciences. Bioethical analysis helps people make decisions about their behavior and about policy questions that governments, organizations, and communities must face when they consider how best to use new biomedical knowledge and innovations.

How Are Bioethical and Scientific Questions Different?


The major difference between bioethical and scientific inquiry is that scientists seek to understand phenomena in the world—they want to describe what is—while bioethicists seek to figure out what people should do. This is an oversimplification, but by emphasizing the difference between the words is and should, you can help students grasp a main difference between scientists, who seek to describe and understand the natural world, and ethicists, who seek to determine what the best course of action should be.

Thus, a scientist might ask, “What are the physical risks of using steroids?” while an ethicist might ask, “Should athletes be allowed to use steroids?” Or, a scientist might ask, “How can we genetically modify a mouse to produce human antibodies for use as therapeutics?”—as has been done to develop treatments for colorectal cancer, rheumatoid arthritis, and asthma. An ethicist might ask, “Should we modify a mouse so that it can produce human antibodies?”

Ethical questions are also different from legal questions and from questions of personal preference, custom, or habit. You can find more information about how ethical questions differ from other kinds of inquiry under “Key Question: What Is the Ethical Question?” on page 5.

Why Teach Bioethics?


Advances in the life sciences are giving humans new capacities. New medicines, biomedical procedures, and ways of altering plants and animals are bringing benefits to millions of people. However, these same innovations also have the potential to bring harms or to raise other kinds of ethical questions about their appropriate use. All citizens—and certainly your students as they reach maturity in the next decades—will confront questions such as these:

Many of the questions students will confront, like the ones above, have to do with decisions individuals will have to make about their own lives. Other questions have to do with decisions groups will have to make that affect the lives of many individuals. These are public policy decisions. For example,

People face all these questions today. As you familiarize yourself with this curriculum supplement, you will be equipped with concepts, cases, fact sheets, and teaching strategies that will help you and your students examine these questions and others like them. The modules’ activities invite your students to grapple with new questions that no one can predict now but that society is most assuredly going to have to contend with over the coming decades, as biomedical science continues to advance.

Four Important Reasons to Teach Bioethics

  1. Advance students’ science understanding.
    Teaching bioethics can serve as a way to teach science to students who otherwise might not be engaged with the subject. Bioethics provides a real-world context for introducing and underscoring the “need to know” science concepts. Case studies help students see the relevance of the science content they are learning and motivate them to apply their science understanding to issues of social relevance. Bioethics may also inspire students to gain a deeper understanding of the scientific facts so they can make well-reasoned ethical arguments.

    Bioethical issues interest students across a range of learning abilities and inclinations. The National Science Education Standards point to the need for students to understand the role of science in society and to recognize how science influences and is influenced by economic, political, and social issues (National Research Council 1996). National standards also ask that students be able to understand and evaluate costs and benefits associated with technological advances.

  2. Prepare students to make informed, thoughtful choices.
    Studying bioethics is a way to deepen students’ understanding of medical research and its impact on society. Biomedical and clinical research has led to dramatic breakthroughs in the understanding of disease and disease prevention as well as new treatments. New knowledge requires a citizenry capable of making informed decisions to guide personal choices and public policy. This supplement gives students an opportunity to prepare for the scientific, medical, ethical, personal, and public-policy choices they will face as adults in the 21st century.

  3. Promote respectful dialogue among people with diverse views.
    Engaging in bioethics discussions helps develop students’ ability for reasoned dialogue, especially among students with different perspectives. It also encourages students to think about choices from a variety of viewpoints and interests, thus facilitating respectful discussions of potentially contentious issues. These skills are fundamental for an effective democracy.

  4. Cultivate critical-reasoning skills.
    Bioethics activities emphasize the importance of justification, a process of giving reasons for views. Research indicates that people have more difficulty reasoning in the ethical domain than in any other. Even many adults tend to rely on rules and often resist delving deeply to consider the reasons for the rules, or to see whether there are ever appropriate exceptions. Others believe that moral truths are wholly subjective, resistant to reasoned analysis, and that any one opinion is as good as any other. Exploring Bioethics gives students the chance to develop their ethical reasoning skills so that they can critically analyze problems in a more careful and nuanced way.

Thinking Like a Bioethicist


Exploring Bioethics
aims to help students develop the skills and confidence to handle a wide array of ethical issues—now and in the future—as patients, family members, citizens, and possible policy makers. The major approach of the supplement, summarized below and presented in detail in Module 1, is to help students begin to think like bioethicists by presenting some of the concepts and procedural methods bioethicists use.

First, a caveat: the phrase “thinking like a bioethicist” might imply that there is a single way to approach ethical questions, but nothing could be further from the truth. Just as there is no one way to do science, there is no one way to do ethical analysis. Nevertheless, there are key concepts and skills on which bioethicists tend to rely.

Concepts and Skills in Bioethics


This curriculum supplement presents a set of four key questions that can be used to clarify an ethical problem. It encourages students to develop the habit of mind (or skill) to always ask the following four questions whenever they face an ethical choice:

Answers to the last question include the ethical considerations that are most relevant in a given case and how they are relevant. Exploring Bioethics encourages students to consider the relevance of three widely recognized considerations whenever they confront an ethical choice:

Many other ethical considerations exist, such as authenticity, responsibility, and intrinsic value. Students will use these considerations to come to decisions about the best course of action in a given case.

The supplement encourages students to answer all four key questions fully and comprehensively and then, in light of their responses, to come to a decision or recommendation about the ethical question raised in the cases they explore. The purpose is not to encourage group consensus, but rather to encourage each student to develop his or her own point of view based on careful reasoning. Students should refer to these questions and considerations in the justifications they provide about why their decision is the best one.

Figure 1 shows the poster that summarizes the key questions and considerations that form the inner “architecture” of the approach taken in Exploring Bioethics. Whenever you teach one of the modules, consider displaying the poster in your classroom and drawing students’ attention to it.

The purpose is not to encourage group consensus, but rather to encourage each student to develop his or her own point of view based on careful reasoning.

Figure 1: Image of the Exploring Bioethics Poster

Figure 1. The Exploring Bioethics poster reminds students that sound justifications in bioethics require attention to four key questions and to relevant ethical considerations.

Four Key Questions to Always Ask Yourself


It is important to note that these key questions do not always have to be asked in a specific order. Sometimes, the facts of the case will illuminate the critical ethical question. Similarly, thinking about stakeholders and their concerns can bring the relevant facts into focus. The process of ethical reasoning is fluid and can evolve as students consider a case more deeply.

Key Question: What Is the Ethical Question?


Identifying ethical questions is a two-part skill.

1. The ability to see the ethical dimensions of a given situation. Ethicists often refer to this skill as moral imagination or moral sensitivity, which is the ability to detect that there are ethical issues at stake. This ability keeps people from simply gliding over the surface of a situation and missing its ethical implications. Fortunately, people can develop this skill with practice.

2. The ability to distinguish an ethical question from other kinds of questions, such as legal, scientific, or personal-preference ones. People often confuse these different kinds of questions, because they are related. For example, in deciding whether to ban steroids (an ethical question), one would want to know how safe they are (a scientific question). But fundamentally, scientific and ethical questions are different, because they have different purposes and rely on different kinds of evidence for their answers. Ethical questions are also different from legal ones and from questions of personal preference, custom, or habit.

People often have a particularly hard time discerning legal from ethical questions—but keeping them separate when undertaking an ethical analysis is important. Ethical analyses should take the legal context and local laws into consideration. However, something can be illegal yet ethical. Conversely, something can be legal but unethical. With respect to enhancement and sports, some interventions could be considered unethical even if they are not yet illegal. Another difference is that the law typically sets the minimum standards to which people must adhere; ethical standards sometimes focus on ideals (more than the minimum), encouraging people to act virtuously. Although they influence each other, the law and ethics are separate enterprises.

Perhaps hardest of all to distinguish are personal-preference and ethical questions—indeed, these two realms are often confused. The culture you live in might prefer a high degree of privacy in the doctor’s office, while your friend from another culture would be unaccustomed to a private office and willing to discuss his medical affairs publicly. Your cultural attitudes toward privacy are matters of preference, custom, or habit, but they are not ethical matters. A key distinguishing feature of an ethical question—as opposed to a question of personal preference, custom, or habit—is that it typically arises when individuals or groups might be harmed, disrespected, or unfairly disadvantaged.

Ethical questions are different from scientific and legal ones and from questions of personal preference, custom, or habit.

If no one is harmed or disadvantaged by the two kinds of medical settings, then the amount of privacy in each would not be an ethical issue; however, it could become an ethical issue. For example, assume there is a patient who values privacy and yet the healthcare providers ignore this person’s wishes. Ignoring the privacy wishes of someone who values privacy would transform the matter from one of personal preference into ethics, because disregarding what someone values is a form of disrespect.

A key distinguishing feature of an ethical question is that it typically arises when individuals or groups might be harmed, disrespected, or unfairly disadvantaged.


Key Question: What Are the Relevant Facts?


Once an ethical question has been chosen, students are asked to identify the facts necessary to think carefully about it. Which scientific facts are important? Which social science facts? Are other facts needed to make a better decision?

Scientific facts are important, and they provide a critical link between bioethics and the biology curriculum. They are especially important for answering questions about harms and benefits. Before students can make a reasoned judgment about vaccination policies, for example, they need to know about the risks of getting a disease, the magnitude of harm that could occur if the disease is contracted, and the risk of suffering that harm, as well as the efficacy and side effects of the vaccines. When examining issues surrounding genetic testing, students need to be able to understand facts related to inheritance of traits and whether medicine has anything to offer to prevent the diseases that the tests diagnose.

Social science facts are equally important. What psychological, sociological, anthropological, historical, and economic facts and concepts are needed to understand the available choices? The social sciences can tell us how people may respond to disease, health-promotion medicines, or their physician’s advice, and they can provide insight into differences among groups in the view of what is ethically important and the impact of a given decision. Historical information can illustrate how people handled ethical decisions in the past, while economic information can help anticipate costs for different stakeholders.

It is sometimes impossible to make a complete inventory of all the relevant facts of a case, and students should realize that decisions must sometimes be made when information is incomplete. However, if key pieces of information necessary to make a good decision are missing, students could conduct additional research. They should consider new facts as they uncover them and address the implications of the emerging evidence in their analysis of the ethical case.

Key Question: Who or What Could Be Affected by the Way the Question Gets Resolved?


The purpose of reflecting on this question is to ensure that students think about the range of individuals, groups, or institutions that may have a stake in the outcome of an ethical situation and how these stakeholders may be affected by the decision. For example, students can consider how stakeholders are affected physically, emotionally, and economically by a decision. Stakeholders are not always human beings or human organizations; ethical decisions might also affect animals, plants, organisms, or the environment. Often, students will discover that the impact of a decision or policy affects many more people and kinds of stakeholders than they expected initially.

Students have the opportunity to practice thinking about how various solutions affect other people, thereby deepening their ability to see things from multiple perspectives. Considering stakeholders gives students a chance to “be in someone else’s shoes.” By identifying the concerns and priorities that different stakeholders bring to an issue, students can also enlarge their understanding of the broader context of an ethical problem. If it is not possible to protect the interests of all the stakeholders, students will have to prioritize—and provide a justification to favor—the interests of certain stakeholders over others. Ultimately, students may also need to grapple with which stakeholders should have decision-making power and how they should share this power.

Key Question: What Are the Relevant Ethical Considerations?


As noted above, bioethicists often reason out which choice is best by taking the core ethical considerations (respect for persons, minimizing harms while maximizing benefits, and fairness) and others (such as authenticity and responsibility) into account. The next section describes each of the three core considerations and mentions several other considerations. Each consideration is very important because each one is a different way to honor the moral standing of persons.

Core and Other Ethical Considerations

Respect for Persons


Respect for persons means not treating someone as a means to an end or goal. For example, even if one person’s organs could help five people live, it would be an ethical violation of respect for persons to kill that one person and distribute the organs to save the five who need them.

Respect for persons is also often a matter of not interfering with a person’s ability to make and carry out decisions. In some cases, it is also a matter of enabling a person to make choices or supporting them in the choices they make.

Respect means more than just listening to another person; it means hearing and attempting to understand what other people are trying to say. It also means not belittling or making fun of thoughts or feelings or perspectives that other people hold.

Minimizing Harms While Maximizing Benefits


This core ethical consideration focuses on trying to promote positive consequences by balancing harms (or burdens) and benefits. In doing so, one must consider which actions would do the least harm and provide the most benefit. This emphasis is central to the ethical approach known as utilitarianism. The root word in utilitarianism is utility, which refers to the positive uses (benefits or utilities) that will come about as a consequence of choosing one path over another. Harms and benefits come in a variety of types, including physical, emotional, economic, and social, to name a few. Utilitarians consider all types of harms and benefits in their ethical deliberations.

“First of all, do no harm” is a familiar expression of minimizing harms when practicing medicine. Even if physicians cannot help a patient directly, they should try to avoid actions that cause harm. “Do no harm” is sometimes referred to as nonmaleficence. A closely related concept, beneficence (“Do good”), stresses acting in the best interest of others and being of benefit to them.

Fairness


Students bring an inherent understanding of the concept of fairness to the classroom. Even very young children can be heard voicing their opinions on whether an action is fair or not. Fairness is an important aspect of justice. The consideration of fairness asks us to ensure that resources, risks, and costs be distributed equitably. The question of how to fairly allocate a benefit or a burden is a question of distributive justice. When such questions are applied within society at large, the question is one of social justice.

There are many acceptable ways to figure out what would be fair. Sometimes what is fair is giving each person an equal amount of something. Other times, it is providing according to each person’s need or according to each person’s merit or contribution. Please note that fairness does not necessarily entail equal shares; it usually depends on other factors, too.

Other Ethical Considerations


In addition to the three common and very important core ethical considerations discussed in this supplement, many other considerations can be equally important depending on the nature of the ethical choices. Examples addressed in Exploring Bioethics include the concepts of authenticity in individual achievement, responsibilities of individuals to their community and to the natural world, and the intrinsic value of animals.

Weighing Ethical Considerations


Students will discover that sometimes these ethical considerations clearly point out how best to act, while at other times they conflict and cannot all be satisfied. Sometimes it is not easy or even possible to act in accordance with all the relevant considerations at the same time.

For example, you might want to show respect for your grandmother by allowing her to continue driving, even when her eyesight is failing, but to minimize harm, you might feel a responsibility to take her keys away. In a case like that, it’s hard both to show respect for her desire to move around freely and to protect her and others from the harm that might be caused by a car accident. Which of these core ethical considerations should count more (respect for persons, which motivates you to allow her to keep driving, or minimizing harms, which motivates you to take her keys away)? How should you decide?

When an ethical problem arises, each individual may prioritize and choose which considerations should be favored in a different way. Often, there is no one right answer. In addition, people can emphasize different ethical considerations in the process of ethical analysis but arrive at the same decision about what should be done.

Sometimes it is not easy or even possible to act in accordance with all the relevant considerations at the same time.

Building and Assessing Strong Justifications


Once bioethicists have clearly stated the ethical question, collected all the facts, anticipated the likely stakeholders, and thought about the options in terms of the relevant ethical considerations, they are ready to make a decision or recommendation. But this is only part of the process. Sound ethical reasoning requires that people explain their recommendation: Why is your decision the best decision or the best recommendation? This is the part of ethical reasoning called justification. An important aspect of this curriculum supplement is assessing the strength of students’ justifications—as shown in Table 1 on pages 10 and 11—so they can build more effective arguments and counterarguments. (An argument includes both the student’s recommendation and the justification for that recommendation.)

Building Strong Justifications


When Exploring Bioethics with your students, a large part of your job will be eliciting students’ reasons for their positions. There are many ways to encourage deep reflection about one’s reason for holding a particular view. First, of course, you can simply remember to ask students, “Why? Why do you hold that view?” But there are other phrases and strategies that you can use to encourage students to deeply consider—and reveal—their thinking processes. Sample dialogues are in Table 2 (pages 16–19), as well as within the modules themselves.

Of course, one’s reasons should include a description of the most relevant ethical considerations and should show how the recommended course of action takes those considerations into account. It should also describe alternative decisions that may have been considered and why they were rejected.

Elements of a strong justification include

Elements of a weak justification include

The strongest justifications are those that give the best possible reasons for a particular conclusion and responses to counterarguments. Many students will be familiar with the skills needed to write a persuasive essay for language arts classes. You may wish to emphasize that an ethical justification is similar to a persuasive essay, except that the justification also focuses on bioethical concepts and considerations.

Exploring Bioethics presents many ethics cases where there is no one right answer. Students are challenged to think hard about questions over which reasonable people can disagree. The final assessment activities do not evaluate whether students came down on one side of the issue or another, but rather evaluate the quality of the justifications they provided for their choice.

A large part of your job will be eliciting students’ reasons for their positions.

Assessing Student Justifications


In Module 1, students consider the elements that contribute to a strong justification and practice evaluating justifications. Subsequent modules reinforce
those elements.

Like many of your colleagues, you may feel reluctant to assess something that seems as subjective as a student’s position on an ethical issue. The capacity to give feedback that enhances students’ ability to build justifications grows with experience.

You can assess the quality of students’ justifications using the guidelines in Table 1 (pages 10–11). It is important to assess additional factors during a discussion, such as the ability to address one another respectfully.

Table 1. Assessing Student Justifications

Element Exemplary Proficient Partially Proficient Developing

Relevance to the Ethical Question

  • The justification strongly relates to resolving the ethical question.
  • The justification relates clearly to resolving the ethical question.
  • The justification references the ethical question but may not directly address it or attempt to resolve it.
  • The justification either does not reference the ethical question or does so inaccurately.

Reference to the Important
Science and Social Science Facts

  • Factual information relevant to the case is thoroughly described.
  • Additional important information is clearly identified.
  • The student demonstrates a solid understanding of the context of the case and can distinguish between
    relevant and irrelevant facts.
  • Factual information relevant to the case is described.
  • Additional important information is clearly identified.
  • Factual information relevant to the case is described, but some key facts may be missing.
  • Additional important information is identified but may be partially incomplete.
  • Factual information relevant to the case is incompletely described or is missing.
  • Additional important information is missing.

Reference to the Potential Effects of a Decision on Others

  • A thorough and insightful description of the major stakeholders and their interests, concerns, and priorities is presented.
  • The ways stakeholders could be affected by how the situation is resolved are considered in depth.
  • A description of the major stakeholders and their interests, concerns, and priorities is presented.
  • The ways stakeholders could be affected by how the situation is resolved are considered in depth.
  • A description of the major stakeholders and their interests, concerns, and priorities is presented, but a few major stakeholders may be missing.
  • The ways stakeholders could be affected by how the situation is resolved are considered for most of the stakeholders.
  • Stakeholders are either not identified or are misrepresented.
  • The interests, concerns, and priorities of the stakeholders may be incomplete or missing for many stakeholders.
  • The ways stakeholders stand to be affected by how the situation is resolved are incomplete or missing.

Reference to Relevant Ethical Considerations

  • The justification makes connections to all relevant ethical considerations.
  • The justification makes insightful connections to selected ethical considerations, demonstrating deep understanding.
  • The justification makes connections to some of the relevant ethical considerations.
  • The justification makes connections to ethical considerations, demonstrating understanding and using terms appropriately.
  • The connection to relevant ethical considerations is not clearly stated.
  • The connections mentioned demonstrate some misunderstanding of particular ethical considerations.
  • Terms may occasionally be used inaccurately.
  • The connection to relevant ethical considerations is incomplete or inaccurate.
  • The connections mentioned demonstrate misunderstanding of particular ethical considerations.
  • Terms are used inaccurately.

Generating
Solutions and
Justifications

  • One or more possible solutions are generated.
  • For each solution, a strong justification for and a strong one against are developed. The justifications skillfully and insightfully draw on the facts of the case as well as all the relevant ethical considerations.
  • One or more possible solutions are generated.
  • For each, a justification for and one against are developed. The justifications draw on the facts of the case as well as all or most of the relevant ethical considerations.
  • One or more possible solutions are generated, but the justifications are incomplete.
  • The facts of the case may not be referenced, and ethical considerations may be missing in the discussion.
  • Solutions are
    either incomplete or missing.
  • The facts of the case are not referenced, and ethical considerations are not discussed.

Thoughtful and Logical Reasoning

  • The selected option is strongly justified, and the conclusion flows logically from the premises presented.
  • The justification demonstrates deep and thoughtful consideration of the topic.
  • The justification demonstrates exceptionally organized thinking; writing builds naturally to a strong conclusion.
  • The selected option is clearly justified, and the conclusion flows from the premises presented.
  • The justification demonstrates
    consideration of the topic.
  • Thinking is clear and organized.
  • The selected option is justified, but the conclusion may not flow logically from the premises presented.
  • The justification demonstrates awareness of the topic but little reflection on it.
  • Thinking is somewhat clear and organized.
  • The selected option is not clearly identified, is incompletely justified, or is not justified at all. The conclusion may be missing or may not flow logically from the justification.
  • The justification demonstrates little or no consideration of the topic.
  • Thinking is confused, disorganized, or stays at a very superficial level.

Source: Adapted with permission from materials developed by the Northwest Association for Biomedical Research (NWABR).

Challenges in Teaching Bioethics and How Exploring Bioethics Can Help


Exploring Bioethics offers several strategies for overcoming the challenges in teaching bioethics successfully.

Challenge #1: Science Teachers Lack Background in Bioethical Analysis


The nature of evidence is different in scientific and ethical inquiry. Most science educators have been trained only in how to build scientific justifications, which are based primarily on empirical evidence. Ethical justifications require empirical evidence (from both the sciences and social sciences), too, but in addition, one must take a set of important ethical considerations into account. Thus, teaching bioethics requires a shift in the paradigm that both science teachers and their students are accustomed to using.

Unless they have taken courses in ethics, science teachers may not have been exposed to some of the concepts and procedures ethicists use and, therefore, may feel unprepared to conduct, facilitate, and teach ethical analysis in the classroom.

How Exploring Bioethics Can Help

To address this challenge, Exploring Bioethics focuses attention on the four key questions and core ethical considerations described above. You will introduce these questions and considerations in Module 1, and students will repeatedly apply them in the subsequent modules. Easy to remember, they allow students to enter into rich conversations that do not oversimplify the ethical issues. The key questions and core ethical considerations serve as a framework for student thinking in the ethical domain. As they work through different modules, students should develop the habit of always asking these questions when confronted with ethical choices.

If you wish to read more about bioethics and the teaching of bioethics, see the Resources for Teaching Bioethics listed on page 20 of this Introduction. Also, be sure to go to the Exploring Bioethics Web site, where you will find many helpful teacher support materials and updates that will enhance your ability to teach this supplement (http://science.education.nih.gov/supplements/bioethics).

Challenge #2: Many People Have Trouble Thinking Critically about Ethical Issues


Research by cognitive psychologists, such as Kuhn, Cheney, and Weinstock (2000), indicates that very few adults, let alone adolescents, develop critical-reasoning abilities in the ethical domain. Adolescents in particular can be especially rigid in their thinking. This rigidity can come in many forms. Some people tend to rely on rules and often resist delving deeply into the reasons for the rules or exploring whether there might ever be appropriate exceptions.
The insistence on rules without reasons or exceptions is called moral absolutism.

Many people take a wholly subjective and relativistic stance, believing that it is impossible to assess whether one ethical opinion is any more justified than another. One position, which is called ethical subjectivism, is sometimes also stated this way: “It’s a free country; I have a right to my opinion, and you have a right to yours, and there is nothing more to discuss.” That statement shuts down thoughtful reflection and critical thinking. Ethical relativism is the view that the correct ethical opinion depends on, or is relative to, a particular culture or society.

Indeed, many people often confuse tolerance and respect for diversity—key features of a pluralistic society—with ethical subjectivism or ethical relativism. However, respect for diversity and critical thinking are not mutually exclusive. Individuals are free to make their own conclusions, but they should also strive to ensure that their beliefs are well informed and based on good reasons that can be explained to other people, especially people who may disagree with them.

How Exploring Bioethics Can Help

The next section, Tips for Conducting Ethics Discussions (page 14), contains many useful ideas for helping students avoid the traps of moral absolutism and ethical subjectivism or relativism. In addition, the modules include many pedagogical strategies to encourage students to think about the reasons for their choices and to engage respectfully with people who hold a broad range of views.

Challenge #3: People’s Fear that Deeply Held Religious Beliefs Will Be Attacked


Exploring Bioethics does not aim to change students’ minds or challenge their deeply held beliefs, whether those arise from their religious training or other sources. Rather, the goal is to enhance students’ ability to provide reasons for their beliefs in light of the core ethical considerations introduced here. Most bioethics concepts have arisen within the major religious traditions of the world, so there are many commonalities between religious and ethics training. Ethical analysis gives people the opportunity to reflect on the underlying ethical considerations at the heart of most, if not all, religious teachings.

How Exploring Bioethics Can Help

First, you may want to reiterate to students that the modules in this curriculum supplement do not aim to change their minds but, rather, to help them articulate the reasons for their views. Note that making solid and persuasive arguments is especially important if a student believes that everyone in society should follow his or her ethical standards. The next section of this guide, as well as Table 2 on pages 16 to 19, contains phrases you can use to encourage such reflection. In addition, all the activities include exercises and pedagogical strategies to encourage reflection.

Challenge #4: Students Invoke Rights Instead of Offering Reasons


Rights language is often heard in U.S. classrooms because students recognize that describing something as a right is a way to argue that it is very important and worthy of respect. Another reason is that U.S. culture places great emphasis on personal freedom and liberty.

Rights language can, however, sometimes obscure the impact of one’s decisions on other stakeholders or on community well-being as a whole. For example, without zoning rules that place limitations on individual landowners, some owners might believe that it is their right to do anything with their land they want to, including paving over wetlands or obstructing other people’s views. Another good example has to do with laws that prohibit smoking in public places. As research revealed the serious harms to others of second-hand smoke, public health officials advocated for laws that limit smoking in places where others could be harmed.

Clearly, in contexts like these, there are good reasons to limit or balance individual rights with community well-being. Unfortunately, in typical conversations, people often use the term right or rights in an adamant way that may cut off further ethical debate.

How Exploring Bioethics Can Help

Allowing a person to simply use rights language in an ethics discussion is usually counterproductive because too often it obscures the concern that the person is really trying to express. Encourage students to articulate their concerns in a more nuanced, descriptive way. Also, when your students assert individual rights, you should ask what the consequences may be for others.

Finally, note that philosophers usually link rights with obligations or duties. A right for a person to do or not to do something is usually seen to establish an obligation or duty for another person, group, or institution to protect that right by assisting with or refraining from interfering with that right. If students believe that something is a right, what obligations and duties do they think should be associated with that right?

Challenge #5: Teachers May Find It Difficult to Facilitate Ethics Discussions


In addition to the broad challenges just identified, other issues make conducting ethics discussions difficult.

People often try to avoid controversy and conflict. Discussions of some ethical issues can lead to controversy and even conflict. Since most people try to avoid conflict, they may wish to avoid discussion of these potentially contentious topics. Some teachers may avoid controversial discussions because they are concerned that certain students will dominate the conversation or that the discussion will get “out of control.”

Students may feel uncomfortable offering an unpopular view. Groups discussing ethical issues may fall prey to “group think,” a phenomenon that gives the impression of consensus but that, in fact, masks a broader range of views. Good teaching in bioethics finds ways to encourage the expression of unpopular opinions and to protect those who hold them.

Time for in-depth discussions is limited. Thinking like bioethicists takes time and insight, and arguments often emerge through intense discussion. Teachers have only limited opportunities to engage students in the rich, extended dialogue characteristic of the ways bioethicists do their best thinking.

How Exploring Bioethics Can Help

For all these reasons, the next section (pages 14–19)outlines strategies for conducting ethics discussions.

Tips for Conducting Ethics Discussions

Establish Guidelines for Respectful Discussion


Establishing shared guidelines sets a tone in the classroom that emphasizes civility and mutual respect. You may either offer students a set of guidelines for appropriate behavior or brainstorm them with your students. If students develop a set of guidelines as a class, they are much more likely to feel ownership of them. Sample guidelines might include

Try posting the most important guidelines in a prominent place, and discuss how the class will handle violations. After the first discussion, revisit the guidelines with the class to determine whether any were broken and to reinforce their importance. Spending the time to develop guidelines before engaging in controversial discussions often yields dividends later on.

Encourage Quieter Students to Speak Up and Outspoken Students to Listen


The
Exploring Bioethics modules provide a variety of strategies for supporting broad participation by all students. For example, having students write down their initial positions or discuss them in small groups before larger discussions take place gives quieter students a chance to share their positions in a nonthreatening way. Conversely, not allowing a free-form discussion helps limit the participation of those who monopolize the conversation.

Protect Opinions Held by Only a Few Students


A student undergoes a high degree of social risk when voicing an unpopular opinion. Students may be afraid to state their true positions because they believe that they will be ostracized or ridiculed. To protect those who hold views that differ from the majority of their classmates’, it is necessary to cultivate a sense of safety in the classroom and to model the respectful recognition of different views. You might introduce
Exploring Bioethics by saying that students will be entering into a time and space where views held by the many are not any more valuable than those held by the few. What matters is whether there is a strong justification for a view. The best way to arrive at a strong justification is to consider a variety of views, both the popular and the unpopular.

Prompt to convey that you welcome views held by only a few students

You will also signal the importance of diverse opinions if you swiftly quell inappropriate or disrespectful remarks one student makes about another’s ideas.

Despite such encouragement to speak up, it may be easier for some students to represent the views of different stakeholders publicly and then to provide their own views in a followup written assignment. This strategy has the additional benefit of getting students to consider the arguments that different stakeholders, including those with unpopular views, might have.

In an ethics discussion, everyone benefits from the opportunity to examine an issue from multiple viewpoints. All serious suggestions ought to be carefully examined, and opinions should be listened to respectfully. Exposure to others’ ideas helps refine thinking. New perspectives may reinforce or bring about change in a student’s position. Valuable insight can be gained by discussing views that are unpopular or that represent a range of stakeholder concerns.

Respond Thoughtfully to Students Who Invoke Religious Teachings


Students who come from strongly religious backgrounds may defer in a general way to the teachings of their religion saying, “That’s just the way it has to be” or “My religion says so.” You may want to ask students what general ethical considerations underlie their positions so they can see that such considerations are widely shared across different religions and cultures. Ask students who adopt positions based on religious beliefs to marshal the evidence that supports their positions, because some day, they may need to explain their positions to another person who may not have the same commitments. Note that making solid and persuasive arguments is especially important if the student believes that society at large should follow his or her ethical standards.

Prompts to encourage reflection


Respond Thoughtfully to Unrelenting Ethical Relativism


You must exercise care to help students avoid confusing tolerance with subjectivism and relativism. A clear indication that a student is experiencing this confusion is when you hear this: “I am entitled to my opinion and you’re entitled to your opinion, but no one opinion is better than any other.” Another common statement that shows confusion between tolerance and relativism is, “That’s the way it is done in their culture, so who am I to judge?” That statement precludes ethical assessment of slavery or genocide.

Prompts to help students move beyond a simplistic belief that all justifications are equally strong

While you should encourage students to tolerate and respect many different views, they must recognize that not all behaviors are equally ethically appropriate and not all justifications are equally strong. In addition, students must be knowledgeable about justifications offered by other students so they can support or justify their own positions and explain how and why their views may differ. They ought to be able to explain why they themselves hold this particular position rather than another, even if they believe that all such positions are simply a matter of personal belief or cultural custom. In addition, by listening to other viewpoints, they may come to see things differently.

Students must recognize that not all behaviors are equally ethically appropriate and not all justifications are equally strong.


Respond to Students’ Blanket Insistence on Rights


During discussions, you may hear students say, “That’s just my right. It’s a free country, isn’t it?” Help students articulate the ethical considerations that underlie their belief that the intended behavior is a right. Also, help them see the implications for others.

Prompts to help students move beyond using rights as a term that may cut off further discussion


Encourage Careful Reasoning


Students may need extra support not only in providing reasons for their positions, but also in ensuring that their conclusions flow logically from their reasons. Prompt students to draw on the relevant scientific facts; the social, economic, and historical contexts; the core ethical considerations; other relevant considerations; and their own values in coming to their conclusions.

Prompts to encourage students to reflect on their reasons for a position

Table 2 is meant to help guide you through potentially difficult situations in classroom discussions of bioethics. Specific suggestions for what you might say in a particular situation are aligned horizontally. It is very important to remember that you are helping students articulate their reasons, not seeking to build consensus in the classroom or to necessarily change students’ minds.

You are helping students articulate their reasons, not seeking to build consensus or to necessarily change students’ minds.

Table 2. Tips for Conducting Ethics Discussions

Table 2a. Some students are dominating the discussion.

How You Might Respond Examples of What You Might Say

Remind the class that all students need to have their voices heard. If you and your students established norms for classroom discussion earlier, revisit those norms.

“Our discussions will be more powerful if all voices are heard. I’d like to pause and ask for contributions from people who haven’t yet had a chance to participate.”

  • If hand raising is important to you, explain why.
  • Remind students that you won’t necessarily call on the first person to raise his or her hand so that you can
    balance contributions from different students.

“I ask you to raise your hand so that there are pauses during which all students can formulate responses. Sometimes, you’ll find that you have a response right away, and other times, you’ll appreciate a few moments to stop and think. If people are calling out responses, it’s too difficult for others to thoughtfully consider a question or topic on their own.”

Give each student a certain number of plastic chips; each chip represents one chance to say something in a full-class discussion.

“You have three chips in front of you. Each time you
add something to the full-class discussion, place one chip aside. Use this as a guide so that no one dominates the class discussion.”

Set up a comment box so that students have a way to contribute without always saying their comments aloud in front of the whole class. The next day, post the comments on the wall or start the class period by reading a few aloud.

“If you have a very important fourth comment, add it, but know that you need to carefully monitor how often you speak so that everyone gets a chance to participate. Use this box to add your additional good ideas. I’ll post them for everyone to see.”


Table 2b. Some students rarely (if ever) participate.

How You Might Respond Examples of What You Might Say
  • Remember that different students are reluctant to participate for different reasons. While some students may be quiet and shy in general, for example, others may not participate because they hold an unpopular opinion.
  • Find ways for students to contribute to discussions anonymously. For example, tell them that in order to be dismissed from the classroom, each student must write down his or her (tentative) stance along with at least one reason in support of that stance. (They could place these in a comment box.) Then, you can present and discuss results at the beginning of the next class period.
  • Remind students that they will maximize their learning by considering all perspectives on the issue at hand. Encourage them to raise perspectives that may or may not reflect their own personal stances. Establish a classroom culture in which all students listen to all ideas and where ideas—not people—are critiqued.

“Let’s use the following language: ‘Someone might believe that…because….’ This will take the emphasis off what you personally believe and ensure that it feels safe to offer all possible stances on this topic. In other words, don’t identify that opinion as your own, even if it does reflect what you personally believe.”

  • Before opening into a full-class discussion, try using a think-pair-share format. First, keep the class totally silent for a few minutes and have each student think and write down a few thoughts. Then, have students share in pairs, and then begin a full-class share.
  • Direct very accessible questions to the quieter students to bring them into the discussion. After a think-pair-share, all students should have ideas ready.

Examples of accessible questions:

“Let’s brainstorm words that you associate with ‘fairness’.”

“Here’s an image that relates to this discussion. What’s something you notice in this image?” (Students think individually, and then share in pairs.) Then, “Charlie, now that you’ve had a chance to think on your own and in a pair, what is something you noticed in this image?”


Table 2c. Students with unpopular views feel vulnerable sharing them.

How You Might Respond Examples of What You Might Say

Let the class know that bioethics can’t be successful
if people discuss only one point of view.

“I won’t consider it a success if all of you agree all the time. If you hold an opinion that you think other students might not like, I hope you’ll be brave enough to share it, and I hope that the rest of us will be brave enough to hear it. Who’s willing to share a view even if it’s unpopular?”


Table 2d. Students say they already have a strong opinion because of their religion.

How You Might Respond Examples of What You Might Say

Craft a response that respects religious beliefs and makes it clear that you are not trying to build consensus within the classroom or to change students’ minds. Your response should emphasize the need for students to provide reasons to support their positions.

“It’s fine that you already have an opinion. The goal here is not for me or anyone else in this room to change your mind. However, the class discussions and activities give you the chance to express more reasons that support your opinion. We’ll be discussing ethical considerations like respect, fairness, and minimizing harms while maximizing benefits to people, and you’ll be able to use these considerations, which often arise within religious teachings, to support your opinion. By listening to other students’ opinions, you’ll be able to further develop your own thinking and provide more reasons for your own opinion.”


Table 2e. Students are stuck thinking that all positions are equally valid and that ranking them is impossible.

How You Might Respond Examples of What You Might Say

Give a very concrete example to help students confront situations that they would probably deem unfair or unacceptable—such as a teacher giving a grade of “D” to papers of all students whose name begins with a vowel. Then, after students have had a chance to respond, help them make the connection: it’s good to see that there can be a wide range of ethically accepted positions, but some positions are better justified than others.

“Suppose you’ve been waiting in line for a very long time for tickets to an event. Someone comes along and hops right to the front of the line. You voice your discontent, and the person who jumped to the front comments that ‘everyone is allowed to do what they want.’ What might you say in response to engage this person in a constructive and meaningful dialogue?” (Student responds … .) Then, “How does this ‘jumping-to-the head-of-the-line’ example relate to bioethics?”

Or, “What if I decided to assign random grades to your papers? How would you react? Are all practices really equally okay?”

“Let’s put this specific issue aside for a moment and think more broadly. Are there certain practices in the world that are ethically wrong? If so, what are some examples? Why are these ethically wrong?”

Ask probing questions to help students reconsider whether or not all arguments are equally good and how important it is to give reasons in support of a stance.

“Here are two positions on a completely different issue … . Which has better supporting evidence or reasons?”

“What does it mean for a justification or reason to be well-developed? Why is it important for your reasons to be well-developed?”

“It may not always be possible to know what is best, but it is usually possible to distinguish between ‘better’ and ‘worse’ justifications.”

Some students might think it’s rude to critique another student’s thinking. Explain that discussions and critiques are not rude as long as students focus on the reasons being discussed and do not mock them.

“It’s not rude to assess someone’s arguments; rather, judging some positions and the reasons given for them is what educated and informed people should do.”


Table 2f. Students argue that a person has a right to do or not to do something and cannot elaborate further.

How You Might Respond Examples of What You Might Say

Acknowledge that students are discussing something—an activity or state of being—that is very important to them.

“Clearly, you care deeply about this topic; either it’s very important to you, or you think it’s something very important to the person in this situation.”

Ask students whether they are asserting a legal, ethical, or social right (or some combination of the three).

“Is this right something that you know is already a law or something that should be a law? Is it simply a practical matter that the law can take care of? Or does this right also have some foundation in what’s the right thing to do from an ethical perspective?”

If students have an ethical right in mind, try to find out whether the right stems from a concern for respect for persons, a need to maximize benefits while minimizing harms, or a desire to ensure fairness for all involved in the situation.

“Can you tell me more about this right? What are its features? Are you trying to be sure that the person in the situation will receive respect for personal decisions or choices? Are you trying to be sure that this person is not harmed or receives some benefits from the situation?

Explain to students that to protect one person’s rights, another person, group of people, or institution has the obligation to help protect and enforce those rights. Ask whether students can identify who or what would bear the obligation that corresponds to the right they are articulating.

“Usually, the ability to enjoy a right to do something or not means that someone else, a group of people, or an institution has the obligation to protect or enforce that right. Who or what do you think would be responsible for helping ensure that you can enjoy the right you are describing?”

Ask what the consequence for others, or the community as a whole, would likely be if individuals acted on this right.

“It’s one thing to assert that someone has the right to do something, but it’s important to also think about the consequences for others. Who (or what) else might be affected, if all individuals had this right?”


Table 2g. Students quickly take a position but cannot provide reasons for or exceptions to it.

How You Might Respond Examples of What You Might Say

Use open-ended questions to help students elaborate on what they are thinking. This sort of question reserves judgment and simply helps students continue their thought process.

“Tell me more about that. I’d like to understand more about what you’re thinking and why you think so.”

Ask probing questions that help facilitate students’ thought processes without doing the thinking on their behalf. In other words, these questions should help students clarify their thinking and come up with reasons to support their stances. These questions should not provide reasons for students but should help students craft their own reasons.

“Would this always be the case? Can you think of any exceptions? Why would these be exceptions?”

“What makes this example different from … ?”

“You seem to be saying that … . How would your response be different if … ?”

“What questions might someone have about your stance? How would you reply?”

“Here’s the opposite viewpoint … . If you met someone with this viewpoint, how would you defend your own viewpoint?”

 

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