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.

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.

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:

• Is it okay to take steroids to enhance sports performance? How are they different from a high-protein diet or vitamins? How should I decide which ways of enhancing my natural abilities are permissible?
• Should I take a genetic test to determine whether I carry the gene for an illness I know is eventually fatal but there is little I could do to prevent? If I find out that I carry it, should I tell my siblings or my spouse?

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,

• Should vaccinations for all students be mandatory, even when some parents object?
• What is the fairest way to distribute lifesaving, but scarce, organs to the thousands of people who need them?

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 anyone 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:

• What is the ethical question?
• What are the relevant facts?
• Who or what could be affected by the way the question gets resolved?
• What are the relevant ethical considerations?

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:

• respect for persons
• minimizing harms while maximizing benefits
• fairness

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.

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.

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. Th e 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.