Structuring Bioethics Education: The Question, the Disciplines, and the Integrative Challenge

Abstract

This paper introduces and recommends a particular approach to the structuring of courses of bioethics education, an approach that has the merits of being both relevant to a wider nonprofessional audience and readily applicable to the circumstances in which ordinary people are called upon to make bioethical decisions. As an explanatory preamble, the first part of this paper analyzes the process of a notable ethics committee as it addressed the topic of medical futility. This paper draws attention to the merits of the committee's structuring a response to its complex bioethical challenge in a particular interdisciplinary fashion. The next section of this paper then applies lessons from the analysis of the ethics committee process to the field of ethics education more generally, and attention is given to the practicalities of ethics course design and implementation. The educational functions of a central question, discrete disciplinary elements, and culminating interdisciplinary integration are explained. An illustrative example of one ethics course designed according to the suggestions of this paper is presented. The paper ends by indicating the merits of this approach to bioethics education, given the current cultural circumstances.

Keywords:

• bioethics
• education
• interdisciplinary
• design
• ethics committee

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. The committee was created under the auspices of the Harvard Ethics Leadership Group and functions as a part of the nonprofit Community Voices in Medical Ethics, Inc., established in 2011 in order to enhance the CEC's mission to bring the issues of medical ethics into the community as well as to include the community's voice in the dialogue already occurring in healthcare institutions, government, and academia. Some of the following material on the CEC and its medical futility deliberations is based on Powers et al. (2013).

2. Medical Futility: Strategies for Dispute Resolution When Expectations and Limits of Treatment Collide. http://www.medicalethicsandme.org/p/publications-of-cec.html.

3. See Powers et al. (2013).

4. One of the committee's recommendations is that healthcare institutions implement training that is focused on cultural literacy and sensitivity to patient and family ethnic, religious, and cultural belief systems.

5. This conception of interdisciplinary understanding is based on the analyses in Boix Mansilla, Miller, and Gardner (2000) and Boix Mansilla and Dawes Duraising (2007).

6. One may well not be forced to choose between approaches. A bioethics unit of the kind described below may be profitably included within the context of a different kind of bioethics education effort.

7. The Department of Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania is one well-recognized example of a center for interdisciplinary bioethics education.

8. See Boix Mansilla and Dawes Duraising (2007, 228–229).

9. Boix Mansilla and Dawes Duraising (2007, 225–228).

10. The first module of the National Institutes of Health (2009) biology curriculum supplement Exploring Bioethics introduces bioethical concepts and reasoning at the high school level.

11. Among other possibilities, of special promise are those involving use of online educational and research resources and collaborative use of software such as Google Docs. A discussion of interdisciplinary teaching practices can be found in Wentworth and Davis (2002) and Bystrom (2002).

12. H. M. Curtler applies the techniques of critical thinking to an array of scenarios, thereby showing how one discipline—philosophy—can improve ethical decision making by, inter alia, helping one avoid logical fallacies (see Curtler 2004). Attempts at interdisciplinary integration can be evaluated by reference to canons of reasonableness and consistency, but it is nonetheless true that ‘objectivity’ is harder to come by here.

13. A given bioethics education effort may offer a combination of different thematic approaches, and there are certainly areas of thematic overlap between some approaches outlined here. Lehmann et al. (2004) and Goldie (2000) demonstrate the diversity of approaches to medical ethics education that exists at medical schools in Canada and the USA.

14. Mattick and Bligh (2006) surveys UK medical schools' ethics teaching, finding the integration of ethics with other course areas to be most valued by teachers and students alike over against ‘dry’ ethical theory. Ashcroft et al. (1998) is a seminal consensus statement in the UK context: ‘Teaching Medical Ethics and Law within Medical Education: A Model for the UK Core Curriculum’.

15. Beauchamp and Childress (2008).

16. Barrows (1996). See also Siegler (2001).

17. One leading exponent of this approach in the professional education context is The Institute for Professionalism and Ethical Practice at Children's Hospital Boston. See Browning et al. (2007) and also Meyer et al. (2009).

18. For an example of the first, see Browning and Solomon (2005) and Solomon et al. (2010). For an example of the second, see Ellman and Fortin (2012).

19. As with the problem-based comparison above, it may be that relationship-based approaches can incorporate these elements to some degree. See footnote 6—one is not always forced to choose between approaches.

20. Rachels and Rachels (2011).

21. Harris (2012).

22. Boix Mansilla and Dawes Duraising (2007).

Additional information

Funding

This work was supported by the E. E. Ford Foundation.