Bioethics Education: III. Secondary and Postsecondary Education
III. SECONDARY AND POSTSECONDARY EDUCATION
Since the early 1970s, there has been a marked increase in bioethical reflection within the secondary and postsecondary curricula. On the high school level there is a growing movement to incorporate questions concerning public policy and values into science teaching and to raise bioethical issues in social science classes. Many colleges and universities offer courses in bioethics that are popular with students bound for the health professions and with others simply interested in the topical issues raised in such courses. There has also been a proliferation of postgraduate programs offering advanced degrees or certificates in bioethics, which has become an autonomous and accredited discipline.
High School Level
It is a rare high school that offers its students a specialized course in bioethics. Bioethical reflection, however, may be embedded within the standard science offerings. To some degree this is an outcome of what has been called the "STS" movement—the acronym standing for "science, technology, and society." This movement reflects an attempt by U.S. secondary schools to include within the science curriculum the profound ethical and policy issues raised by developments in science and technology. This movement is not without its obstacles. For example, the training of science teachers, shaped by the traditional division of science from the humanities, has often placed little emphasis on developing teaching skills for ethical reflection. Nevertheless, the integrative movement has made inroads.
For example, bioethics issues may be raised in high school biology courses, during discussions of genetics, human and animal research, or environmental science. The treatment of such topics may be limited to brief case presentations or to discussions designed to help students with values clarification. There is a growing body of opinion, however, that such strategies can be insufficient; not all opinions are of equal value, and students need to develop the critical reasoning skills to evaluate their stances in the light of scientific evidence, material implications, and logical consistency. This approach, emphasizing the evaluation of ethical positions, may eventually prove most appealing to science educators for it dovetails well with aspects of the scientific method they are trying to transmit.
Bioethics teaching on the secondary level need not be restricted to the science curriculum. The High School Bioethics Curriculum Project of the Kennedy Institute of Ethics seeks to train and support teachers in using bioethical case studies in a wide range of courses, including those in social studies, civics, history, philosophy, and religion. The project has prepared curriculum units covering topics such as neonatal ethics, organ transplantation, human subjects research, and eugenics. High school teachers are introduced to these units through workshops and are assisted with ongoing curriculum development, networking, and resource identification.
On the college level, offerings in bioethics are a well-established feature. Certain institutions offer, or allow students to construct, an interdisciplinary major in bioethics. More common is a minor or concentration in bioethics, interdisciplinary in nature or offered through a philosophy, religion, or social-science-based department.
Though most colleges have neither major or minor, they are likely to offer one or more courses in bioethics. A typical course might use one of the standard textbooks of bioethics, either written from a unitary perspective or offering an edited collection of canonical "pro" and "con" articles on bioethical issues. The instructor may choose to supplement this with a collection of cases or to replace it with an assembled course packet of the instructor's choosing.
A number of didactic approaches may be used to help students become experientially involved with the topics. Most popular is the case analysis mode where students grapple with the dilemmas raised by actual or constructed cases. Class debates can provoke spirited dialogue, and a growing library of films and videotapes vividly portrays for students the human impact of these issues. Some professors may bring in, or team-teach with, healthcare professionals, or ask students to visit a healthcare setting as part of the course. Bioethics can lend itself well to a "service-learning" approach, where student service in healthcare-related fields can be used by the instructor as a way to make bioethical issues come alive.
Most bioethics textbooks and many instructors begin from a framework of ethical theories and principles that are then applied to specific issues, such as informed consent, abortion, and euthanasia. However, this "standard approach"—and indeed the "standard issues" of bioethics— have been criticized by professionals associated with fields such as phenomenology, pragmatism, hermeneutics, feminism, casuistry, virtue ethics, and narrative theory. Critics argue, for example, that to base ethical analysis on high-level theory may obscure the richness of particular cases and the complex modes of interpretation that real-life decision makers employ. Moreover, simply to stick to recognized "ethical quandaries" is to risk overlooking the sociopolitical biases and the metaphysics of self and body that have shaped contemporary Western medical systems in ethically significant ways.
Instructors may therefore choose to supplement the medical ethics textbook with other kinds of resources. For example, a brief selection from the seventeenth-century French mathematician and philosopher René Descartes might be used to reflect on the model of body-as-machine that has powerfully influenced the doctor–patient relationship. A literary work such as "The Death of Ivan Ilyich"(1886), by the Russian novelist and philosopher Leo Tolstoy, can render vivid and lucid the experience of illness, the significance of truth telling, and the dilemmas surrounding death and dying. A work of social critique, such as a feminist history of women and medicine, can raise issues concerning the power relations embodied in medical practice and disease categories. The growing diversity of methodologies used within professional bioethics can thus "filter down" to diversify the methods and materials used in college-level teaching.
On the postgraduate level, a number of centers and universities around the country offer advanced degree programs specializing in bioethics. One popular model is the master's or Ph.D. program, often in philosophy, less frequently in religion, with a bioethics concentration. The program may include a series of courses focused on bioethical issues, some exposure to a clinical setting, and a thesis written on a topic relevant to bioethics. Such programs may attract individuals looking to pursue this field as a primary academic career. Alternatively, healthcare professionals may enter such programs, usually for the master's degree, in preparation for teaching and/or service on ethics committees, or out of personal interest. Then, too, certain programs are designed to offer joint degrees through collaborative arrangements, allowing students to complete a medical or a legal degree along with an M.A., M.P.H. (master of public health), or Ph.D. degree. While most degree programs focus on bioethics or medical ethics as such, others define themselves more broadly as teaching the medical humanities and thus may incorporate diverse disciplines such as history, sociology, anthropology, and literature.
In addition to degree programs, there are many options for those seeking more limited preparation in bioethics. A number of centers, for example, offer intensive courses in bioethics lasting from one to four weeks or involving sessions spread out over a longer period. There are continuing education courses and certificate programs in bioethics. Special bioethics fellowships are also available, often directed toward those already engaged in clinical practice.
Much of what this entry details concerning bioethics teaching on the high school, college, and postgraduate level has become available since 1978, when the first edition of the Encyclopedia of Bioethics appeared. Academic interest in bioethics has been growing apace. With the continued expansion of the healthcare industry, the constant development of new and troubling biomedical technologies, and the daily bioethics headlines in the popular press, it is likely that this interest will continue unabated.
drew leder (1995)
revised by author
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