Essays
Teaching Bioethics by lisa m. lee , mi ldred z . so lomon , and amy g utmann
F
rom accessible and affordable health care to old or new reproductive technologies, human or animal research, and beyond, the justice and well-being of our society depend on the ability of key groups—such as scientists and health care providers—along with members of the public to identify the key issues, articulate their values and concerns, deliberate openly and respectfully, and together find the most defensible ways forward. The Presidential Commission for the Study of Bioethical Issues and The Hastings Center are committed to improving the ethical literacy of the American public in the domain of bioethics. But what are the best educational practices to spur and support these sorts of societal conversations? And where are the greatest gaps in our collective knowledge of how best to inspire and increase moral understanding, analytical thinking in the moral domain, and professional integrity? In September 2013, we issued a call for papers on teaching bioethics. We received over eighty manuscripts for consideration. In this issue of the Hastings Center Report, we publish the first set of thought-provoking essays with a focus on bioethics education for practicing clinicians, including physicians during their residency training. Other papers, which will be incorporated into future issues of HCR, will also take up bioethics education for science and technology graduate students, bioethics professionals, community health workers, and secondary school students. Taken together, these papers elucidate a broad range of considerations and point out new areas of research to discover how best to improve ethical literacy among scientists, health care practitioners, and the public. We begin this issue with a paper from a group of authors, led by Ellen Robinson, a nurse and ethicist at
Lisa M. Lee, Mildred Z. Solomon, and Amy Gutmann, “Teaching Bioethics,” Hastings Center Report 44, no. 5 (2014): 10-11. DOI: 10.1002/ hast.352
10 HASTI N G S C E N T E R R E P ORT
Massachusetts General Hospital, who describe an ethical residency for nurses. This program goes beyond knowledge acquisition to strengthen nurses’ moral agency in order to improve patient outcomes. The second paper, by authors from the Cleveland Clinic and Case Western Reserve, led by physician and ethicist Ruth M. Farrell, describes an empirical study of the mismatch between the reproductive ethics priorities of bioethics program directors and what providers of reproductive medicine face in daily practice. The authors assert that achieving better harmony between what bioethicists are prepared to deal with and what ethical dilemmas physicians are facing will better serve patients and families. In the third and final paper in this set, Divya Yerramilli, a medical student at the University of Pennsylvania, presents a dose of reality about engaging in ethical decision-making outside the classroom, beyond quintessential Amy Gutmann chairs the Presidential Commission for the Study of Bioethical Issues and is the president of the University of Pennsylvania. She is the Christopher H. Browne Distinguished Professor Political Science in the School of Arts and Sciences and professor of communication in the Annenberg School for Communication at Penn and has authored and edited sixteen books. Lisa M. Lee is the executive director of the Presidential Commission for the Study of Bioethical Issues. She is a public health ethicist and epidemiologist. Mildred Z. Solomon is president of The Hastings Center and a professor in the Department of Anaesthesia at Harvard Medical School. Her research interests include ethical issues in end-of-life care, organ transplantation, oversight of human research, and bioethics education. September-October 2014
Educating ourselves about how best to integrate ethics into science and health care will be an ongoing challenge. The stakes of success—including affordable health care and ethical scientific research with unprecedented promise—have never been higher. case studies, and in the hierarchical structure of residency and fellowship training. Yerramilli reminds us that good bioethics teaching depends on teachers, mentors, and role models who are inclusive and encourage open discussions that are respectful of multiple viewpoints. Together, these papers take us beyond traditional classrooms into the work settings where health care providers and their patients encounter real-world ethical quandaries. A source of ongoing debate among humanists and scientists alike is whether moral reasoning and moral behaviors are instinctual remnants of our biological evolution, develop naturally over time, need to be consciously taught, or are some complex combination of these factors. Contemporary neuroscience is teaching us more and more about the brain, its continued development, and its plasticity. These findings will help us understand our biochemistry and the neural circuitry we use to react to, think about, and solve problems, including moral problems. Breakthroughs in cognitive science have been pointing out that humans rely on shortcut heuristics to resolve many day-to-day problems, including ethical ones. These shortcuts are often tremendously useful in making daily choices efficiently—as well as effectively. Yet in all domains of choice, including the moral domain, these shortcuts can also undermine more careful, nuanced, and objective (logic- and data-driven) reasoning. Developmental psychology is revealing that human babies are hardwired to empathize with good actors who demonstrate helpfulness and to avoid bad actors who impede the goals of others. Human beings evince empathy and fairness at an astonishingly early age. Yet we also demonstrate
September-October 2014
morally negative behaviors, like the shunning of strangers, at a very early age. Perhaps these behaviors satisfied biological and social needs in an earlier period of human evolution, but they are poorly suited to contemporary life in pluralistic societies. Taken alone, the many impressive advances in neuroscience, cognitive science, and developmental psychology do not—and by their very nature cannot—address all of the pedagogical questions that we and other educators raise about the best ways to cultivate moral reasoning and encourage moral behavior. For that, we need proven methods of pedagogy in bioethics. These methods may already be practiced by some educators, but without anything approaching proven effectiveness. The stakes of achieving a maximally effective bioethics education are so high that our joint goal is to create the best possible social science of bioethics pedagogy. The papers on teaching bioethics published in this issue and in several upcoming issues of the Report are meant to serve as a starting point for further reflection, writing, and debate. By sharing the promising practices these authors describe, we hope to stimulate further scholarship on bioethics pedagogy—including much-needed empirical work on how best to cultivate moral sensibilities and normative reasoning skills into the institutional and individual practices of scientists and health care professionals. Good science and health care and good ethics necessarily go hand in hand. Educating ourselves about how best to integrate ethics into science and health care will be an ongoing challenge. The stakes of success—including affordable health care and ethical scientific research with unprecedented promise—have never been higher.
H AS TI N GS C EN TE R RE P O RT
11
Teaching Bioethics by lisa m. lee , mi ldred z . so lomon , and amy g utmann
F
rom accessible and affordable health care to old or new reproductive technologies, human or animal research, and beyond, the justice and well-being of our society depend on the ability of key groups—such as scientists and health care providers—along with members of the public to identify the key issues, articulate their values and concerns, deliberate openly and respectfully, and together find the most defensible ways forward. The Presidential Commission for the Study of Bioethical Issues and The Hastings Center are committed to improving the ethical literacy of the American public in the domain of bioethics. But what are the best educational practices to spur and support these sorts of societal conversations? And where are the greatest gaps in our collective knowledge of how best to inspire and increase moral understanding, analytical thinking in the moral domain, and professional integrity? In September 2013, we issued a call for papers on teaching bioethics. We received over eighty manuscripts for consideration. In this issue of the Hastings Center Report, we publish the first set of thought-provoking essays with a focus on bioethics education for practicing clinicians, including physicians during their residency training. Other papers, which will be incorporated into future issues of HCR, will also take up bioethics education for science and technology graduate students, bioethics professionals, community health workers, and secondary school students. Taken together, these papers elucidate a broad range of considerations and point out new areas of research to discover how best to improve ethical literacy among scientists, health care practitioners, and the public. We begin this issue with a paper from a group of authors, led by Ellen Robinson, a nurse and ethicist at
Lisa M. Lee, Mildred Z. Solomon, and Amy Gutmann, “Teaching Bioethics,” Hastings Center Report 44, no. 5 (2014): 10-11. DOI: 10.1002/ hast.352
10 HASTI N G S C E N T E R R E P ORT
Massachusetts General Hospital, who describe an ethical residency for nurses. This program goes beyond knowledge acquisition to strengthen nurses’ moral agency in order to improve patient outcomes. The second paper, by authors from the Cleveland Clinic and Case Western Reserve, led by physician and ethicist Ruth M. Farrell, describes an empirical study of the mismatch between the reproductive ethics priorities of bioethics program directors and what providers of reproductive medicine face in daily practice. The authors assert that achieving better harmony between what bioethicists are prepared to deal with and what ethical dilemmas physicians are facing will better serve patients and families. In the third and final paper in this set, Divya Yerramilli, a medical student at the University of Pennsylvania, presents a dose of reality about engaging in ethical decision-making outside the classroom, beyond quintessential Amy Gutmann chairs the Presidential Commission for the Study of Bioethical Issues and is the president of the University of Pennsylvania. She is the Christopher H. Browne Distinguished Professor Political Science in the School of Arts and Sciences and professor of communication in the Annenberg School for Communication at Penn and has authored and edited sixteen books. Lisa M. Lee is the executive director of the Presidential Commission for the Study of Bioethical Issues. She is a public health ethicist and epidemiologist. Mildred Z. Solomon is president of The Hastings Center and a professor in the Department of Anaesthesia at Harvard Medical School. Her research interests include ethical issues in end-of-life care, organ transplantation, oversight of human research, and bioethics education. September-October 2014
Educating ourselves about how best to integrate ethics into science and health care will be an ongoing challenge. The stakes of success—including affordable health care and ethical scientific research with unprecedented promise—have never been higher. case studies, and in the hierarchical structure of residency and fellowship training. Yerramilli reminds us that good bioethics teaching depends on teachers, mentors, and role models who are inclusive and encourage open discussions that are respectful of multiple viewpoints. Together, these papers take us beyond traditional classrooms into the work settings where health care providers and their patients encounter real-world ethical quandaries. A source of ongoing debate among humanists and scientists alike is whether moral reasoning and moral behaviors are instinctual remnants of our biological evolution, develop naturally over time, need to be consciously taught, or are some complex combination of these factors. Contemporary neuroscience is teaching us more and more about the brain, its continued development, and its plasticity. These findings will help us understand our biochemistry and the neural circuitry we use to react to, think about, and solve problems, including moral problems. Breakthroughs in cognitive science have been pointing out that humans rely on shortcut heuristics to resolve many day-to-day problems, including ethical ones. These shortcuts are often tremendously useful in making daily choices efficiently—as well as effectively. Yet in all domains of choice, including the moral domain, these shortcuts can also undermine more careful, nuanced, and objective (logic- and data-driven) reasoning. Developmental psychology is revealing that human babies are hardwired to empathize with good actors who demonstrate helpfulness and to avoid bad actors who impede the goals of others. Human beings evince empathy and fairness at an astonishingly early age. Yet we also demonstrate
September-October 2014
morally negative behaviors, like the shunning of strangers, at a very early age. Perhaps these behaviors satisfied biological and social needs in an earlier period of human evolution, but they are poorly suited to contemporary life in pluralistic societies. Taken alone, the many impressive advances in neuroscience, cognitive science, and developmental psychology do not—and by their very nature cannot—address all of the pedagogical questions that we and other educators raise about the best ways to cultivate moral reasoning and encourage moral behavior. For that, we need proven methods of pedagogy in bioethics. These methods may already be practiced by some educators, but without anything approaching proven effectiveness. The stakes of achieving a maximally effective bioethics education are so high that our joint goal is to create the best possible social science of bioethics pedagogy. The papers on teaching bioethics published in this issue and in several upcoming issues of the Report are meant to serve as a starting point for further reflection, writing, and debate. By sharing the promising practices these authors describe, we hope to stimulate further scholarship on bioethics pedagogy—including much-needed empirical work on how best to cultivate moral sensibilities and normative reasoning skills into the institutional and individual practices of scientists and health care professionals. Good science and health care and good ethics necessarily go hand in hand. Educating ourselves about how best to integrate ethics into science and health care will be an ongoing challenge. The stakes of success—including affordable health care and ethical scientific research with unprecedented promise—have never been higher.
H AS TI N GS C EN TE R RE P O RT
11
