BIOETHICS - An Outline for a High School Course

Jerry Devlin
1992 Woodrow Wilson Biology Institute

"The job of the natural scientist is to make the discoveries; that of the technologist to develop applications; and that of the humanist is to suggest whether, how, and under what conditions the work of the other two ought to be applied. "

Werner Heim, Biologist.

I. Description

A working definition views Bioethics as, "biology combined with diverse humanistic knowledge forging a science that sets a system on medical and environmental priorities for acceptable survival" (Potter). This course is concerned with dilemmas caused when the facts of medical-genetic research conflict with norms and needs of society. Focus will be placed on under-standing and appreciating relevant biological facts as they confront the prin-ciples and practice of ethical decision making at the level of the individual, the community, and nations.

II. Mechanics

Punahou School is scheduled on a modular variable 6 day cycle with 14 cycles to a semester. Its students are college bound. Bioethics will be offered for the first time in the Spring semester of 1993 and structured as follows:

1. A junior-senior science elective with biology as a requirement - Eighteen students are enrolled.

2. Each student is assigned to meet with this class for 4 hours every cycle;

   a) 1 large group meeting for lectures, videos, guest speakers, and student presentations (one hour).

   b) 1 large group scheduled meeting for student groups to meet, conferences, or individual research (1 hour).

   c) 2 seminar groups - the heart of this course - with 9 students each cycle (2 hours).

III. Student Expectations & Grading Value

1. Project 25% - students demonstrate individual & collaborative work

   a) Research & present the 'facts' of a scientific issue (Biotech, NRT, Environmental Crisis).

   b) Research & lead a seminar on the 'ethical dilemma' involved with the facts research.

   c) Community service options - on approval may substitute for a) & b).

2. Reading 25% - students demonstrate preparation as an ethical choice

   a) Paperbacks

   b) Handouts

3. Assertions 25% - students demonstrate written skills

   a) A one page position on a dilemma as "tickets" to seminars

   b) Due once each cycle based on assigned readings

4. Participation 25% - students demonstrate verbal thinking skills

   a) Silent - active listening is valued

   b) Vocal - the heart of participation!

5. No tests. Areas 1-4 are equal. Treat each day as a 'final exam.'

IV. General Overview & End Goals For Students & Teachers

• I. For The Student To Learn

  A. Issues of Science: "What can science do?"

  1. Nature & methods of science ('Objective' knowledge)

  2. Facts of medical & ecological research

  3. Controversy within the scientific community

  B. Issues of Society: "Ought science to do what science can do?"

  1. Principles of ethical decision making ('Subjective' knowledge)

  2. Practice of how decisions are made

  3. Controversy among the decision making community

• II. For The Teacher To Do

  A. Issues of Science: "What can science do?"

  1. Demonstrate how science comes 'to know' and how it differs from other disciplines. Is 'knowing' something different in kind from 'believing?' Discuss the significance of objective knowledge (the sciences).

  2. Focus on biotechnology, new reproductive technologies (NRT), and environmental concerns. Discern which areas need attention 'here & now' with your students. Separate the facts from fiction based on what your students know.

  3. Define what is a science related dilemma. Consider what science can offer in resolving dilemmas.

  B. Issues of Society: "Ought science to do what science can do?"

  1. Present the 'basics' of Utilitarian, Deontological, and Virtue Ethical Theory as competing global models of ethical decision making. I have chosen Virtue Theory and will dedicate more time here. Discuss the significance of subjective knowledge (the humanities).

  2. Use value clarification techniques as necessary to get to the Moral Education Model as the major vehicle for seminar.

  3. Have the seminar ('Socratic' style) as the heart of class exper-iences. Note: This is not a note taking memory class; rather it ought to be a process or inquiry experience. Students will soon see the dilemmas are often 'tragic' - you do not get to choose between good and evil (that's easy) but between competing goods or evils and no matter how you choose there is some loss.

V. STUDENTS - Specific Sequence, Readings and Timing

• I. The Realm of Ethics [Reading 1-3] Cycles 1-3

  A. What is an ethical decision?

  1. Moral as a must = rule bound

  2. Ethics as an ought = voluntary obligation

  B. What are competing ethical decision making models?

  1. Consequential Ethics

  2. Duty Ethics

  3. Virtue Ethics

  C. What, essentially, are ethical questions?

  1. Public Meanings: we are philosophical, social animals

     i) what is a 'human person?'

     ii) what are 'rights?'

     iii)what are my obligations to others?

  2. Private Meanings: we are philosophical, reflective animals

     i) what is of worth 'here & now' for me?

     ii) what finally matters for me?

     iii) what of my values is worthy for others?

• II. What is a Value? [Readings 4-6] Cycle 4

  A. Values Clarification

  1. How do I figure out which values are my own?

  2. How do I rank my values?

  3. How changeable are my values?

  B. Values Testing

  1. Does new information cause me to reconsider a value?

  2. What kinds of personal interactions cause me to reflect on my values?

  3. Are any values universally esteemed?

• III. Issues of Science in Conflict with Society [Readings 7-10] Cycles 5-13

  A. Environmental Crisis (3 cycles)

  1. The facts of science

     a) Spotted Owls or Jobs?

     b) Landfills & Hazardous Materials

     c) Intergenerational Responsibility

  2. Ethical dilemmas

     a) Case studies & simulations

     b) Student led seminars

  B. Biotechnology: Facts & Fictions (3 cycles)

  1. The facts of science

     a) Genome Project

     b) Synthetic vs Natural Food

     c) Designer Genes

  2. Ethical Dilemmas

     a) Case Studies

     b) Student led seminars

  C. New Reproductive Technologies (3 cycles)

  1. The facts of science

     a) Surrogate Parenting

     b) RU-486 - the French abortion pill

     c) Genetic screening of gamete donors

  2. Ethical Dilemmas

     a) Case studies & simulations

     b) Student led seminars

• IV. Is It Only a Contest Between the Optimists vs the Pessimists? Cycle 14

  A. Science Will Save Us Yet Again! -the optimist

  B. We Are Doomed, It's All Over! - the pessimist

  C. We Are Free To Choose! - the possibilist

VI. TEACHER - Specific Sequence, Readings and Timing

Intro...a note about strategy. Teacher and students aim to clarify and not confuse the issue by focusing on feelings and reasons, not on beliefs. The aim is not to destroy a belief but if belief crumbles in the presence of few questions perhaps the belief may not be worthy, at least in the form presented. Focus on reasoning. The vehicle for this class is the Socratic seminar. Values clarification is not the goal but a means. Moral Education (Values Testing) is the goal - there is no other 'hidden agenda.' This model does not imply "right answers" but asserts a) there are "better reasons" to moral dilemmas, b) these reasons should become more universal in application, and c) the individual is the sole responsible moral agent for all choices made. Bloom's Taxonomy of Hierarchical Thinking (cf. Ilayna Pickett & Toni Miller's module) is a logical link between Values Clarification and Moral Education. For more on the moral education model see Lois Glasscock's module.

a) There is something to be said for Kohlberg's view (known as Moral Education) that moral development is like cognitive development in that we constantly want 'better' reasons for our ethical choices. When confronted with reasoning that is more integrated or of a higher moral order, we experience moral cognitive dissidence and we demand better moral resolutions.

c) Kohlberg is not without critics. Carol Gilligan's In a Different Voice offers students a chance to consider whether her 'female-relationship ethic' is essentially different from Kohlberg's 'male justice' view.

I. The Realm of Ethics (see V. Student Ð Specific Sequence...)

[Reading #1 In class reading. Woodrow Wilson National Fellowship Foundation - Bioethic Institute handout July 1992 (=WW handout) "Rules of Seminar" + Jacob Monod on Science and Values, 3 pages. Spend the 1st seminar reinventing what the level and style of your seminar will be. Avoid students talking only to you. You are the 'guide on the side' not the 'sage on the stage' in seminar.]

[Reading #2 due Cycle 1. Start with Plato's Meno. If you omit the sections on teaching geometry you will not miss the essence of this dialogue which is a) learning to ask probing questions such as b) What is virtue? and c) Can virtue be taught? Avoid the debate over the historical Socrates and whether or not he is only playing with (lesser?) minds. Take the dialogue literally and focus on the questions and methods used. You will find at least two seminars of work here. You may use Euthyphro on 'piety' which naturally extends to the question of 'patriotism' or the 'justice' inquiry of Republic Book I as a substitute for Meno. Note: Have students consider the 25% value of reading prep as an ethical choice they can make now and then check on how they acted at the end of the semester.]

A. What is an ethical decision?

1. 'Moral' implies the big circle of rule-bound behaviors.

   Prescriptive: What must I do? It is a general attitude toward appropriate behavior but one can be moral without being ethical.

2. 'Ethical' is the circle within the moral world.

   Reflective: What ought I to do? I voluntarily choose to do what is right. If one is ethical, one is also moral.

B. What are competing models? (I have chosen to present three models and have ignored the Relativist view as too hedonistic and the Divine Command models as too fundamentalistic.)

1. Consequential Ethics = the Rule and Act Utilitarianism. "The greatest good for the greatest number" is a powerful ethic. Good News/Bad News = reasonable but too circumstantial?

2. Duty Ethics = the Deontological position of Kant. Focused on 'categorical imperative' - you must act in such a way that your behavior becomes the model of how human beings should act. Good acts can be known in advance. Good News/Bad News = principled but too legal?

3. Virtue Ethics = Right Deliberate Action (RDA) is a personal public behavior. RDA is virtuous while Wrong Deliberate Action (WDA) is viciousness. The individual is responsible for virtuous or vicious behaviors. Good News/Bad News = responsible but too sanctimonious?

[Reading #3 due Cycle 2-3. Have students read Kieffer (WW handout, 44 pages). Sometimes as the 'sage on the stage' you will need to lecture. Kieffer's manuscript offers a concise and clear review on the competing global models but students will need your help. "How would the Duty Ethic folks decide?" "Can you see the view point of the Virtue Ethic dudes?" "How do you decide?" Which camp to you seem to be in?" "Do you switch camps depending on the situation?" "Why?"]

An assertion: The "human condition" is based on a quality, not on a structure. We are animals and with all that goes with the definition of the term but we are in a contradiction - we are aware of our own death and we want to know the what, why, and wherefore of things. We are philosophical animals. We create, discover and interpret meanings. This is our blessing. This is our curse. Our moral life becomes the history of our ethical choices. With the caveat: "All decisions are made with incomplete knowledge," I am choosing Virtue Ethics as the main ethical decision model and Moral Education as the teaching strategy for the following statements/questions/reasons:

1. Motive as guide - Who, what is being served here and now? Motivation is important but dependent on 2) and 3).

2. Means as guide - What means will I choose based on under-standing of my motivation? But some means can become ends, e.g., my pleasure, and this won't work. " What if everybody chose pleasure?

3. Ends as goal - Are there some ends that are only ends and ought not to be means?

   a) Sometimes ends can be made means; e.g., my pleasure may add to the quality of my life. This is O.K. No sweat.

   b) But human beings and human welfare are ends only and ought not be relegated to means no matter what the reason.

4. Virtue - As in the Socratic sense and not the sanctimonious "moral majority" sense.

   a) There is something to be said for "All evil is ignorance." It places a responsibility (=duty=obligation) on me for my own culpable ignorance.

   b) Since knowledge is the 'greatest good for the human mind' (what else could be for the mind - confusion, ignorance, belief, harmony don't work as 'greatest good' do they?) I have the obligation to know; a duty to remove my ignorance.

C. What are essential ethical questions?

1. Public Meanings: A purpose of philosophy is to concentrate meanings, not to dilute them. Lead a discussion so that students understand this difference. If you do that it would 'like be totally rad!' The questions of 'rights' 'or 'personhood' ought to generate both confusion and clarity in the students' minds.
2. Private Meanings: These questions will be a challenge for all but the most reflective of students!

II. What is of Value?

[Reading #4 due during Cycles 4-5. Fletcher's Situation Ethics is a clear and passionate statement of the best of the Utilitarian model. Students can hang some thoughts and feelings on his view of:

[Readings #5 & #6 due Cycle 4. WW handouts on Values Clarification techniques and Moral Development

A. Values Clarification - Your imagination is your only limitation on generating exercises to aid students to begin to see what motivates them.

B. Value Testing = The Moral Education model where values are constantly challenged to be more inclusive of a hierarchy of human beneficence: myself, friends, community, nation, world.]

III. Issues of Science in Conflict with Society

[Reading #7 due Cycle 5. Kieffer's Biotechnology, Genetic Engineering and Society. Students will find this summary and glossary as basic back-ground for understanding biotechnological ethical dilemmas.]

[Reading #8 due during Cycles 5-7. Leopold's A Sand County Almanac is a classic of philosophy, science and of caring. If this journal does not move your students to reflection and responsible action, check them for brain waves.]

The choices of topics under the three broad areas of Environmental Crises, Biotechnology, and NRT's only serve as examples. Time, Newsweek, the local newspaper and T.V. will generate many more. If your work of guiding the seminar has been done well, your students will be 'in charge of their own learning.' If not, it's time to reinvent fire!

[Reading #9 due during Cycles 8-10. Choose one paperback. Some choices to consider:

• a) Shapiro's The Human Blueprint is a student's type of book. They learn the facts without even realizing it! The significance of The Human Genome Project is explained.

• b) Lewis' Technological Risk attempts to separate fact from fiction on the cost/benefit argument of environmental degradation.

• c) Brown's The State of the World - 1992.

• d) many other titles to chose from - see WW handouts.

[Reading #10 due during Cycle 11-13. Handouts on current NRT dilemmas.]

VII. Alternate Schedule

If you feel the need for more simulation, collaborative 'lab work,' or additional directed discussion, consider taking a cycle each from Environmental Crisis, Biotechnology, and New Reproductive Technologies and use these 3 cycles for either:

A. More Simulations

The NABT Sourcebook in Biotechnology,1991, offers a variety of choices.

1. "Down and Dirty DNA Extraction." A lab for seeing visible mass of DNA.

   A hands-on 2 day lab that works! Unit IV.

2. "Selection Soil Organisms." Which bacteria can digest which mess.

   A 2 day lab that demonstrates what's needed to clean up an ecological disaster. Unit IV.

3. The 5 day simulation, "Ice-Minus Case", seems especially suited to involve students in doing library research (is this Fletcher's 'Sophia?') as the preparation for roles to be acted out in a town meeting in which a DECISION MUST BE MADE ('kairos'). Unit V.

B. Teacher Directed Discussions

The attention-grabbing neon headlines found daily in the media might not be what you want your students to deal with in class. If your question is, "What cultural trends make the 'neons' even thinkable? Or, what new (or future) technologies should be or should not be available to everybody?" consider:

1. Marvin Harris' paperbacks, Cannibals & Kings ('74) and Cows, Pigs, Wars and Witches ('76) which are sometimes hard to get but worth your effort. His theories will challenge (outrage?) students to think beyond the present and to consider how ancient civilizations 'solved' environmental concerns with the then-state-of-the-art biotechnology and NRT. Some examples covered include: deforestation & desertification of the Holy Land and what they did to the life and status of pig flesh; abortion technologies and the rise of the savage male syndrome; and the protein deficiency - cannibal connection among the precontact Aztecs will generate interest. Students do get involved with these ideas - " Trust me!"

2. For a contemporary inquiry on the issues of how cultural trends make the neon headlines actionable, try How Brave A New World by McCormick. He has many usable articles in the Hastings Reports and the Kennedy Institute of Ethical Journal and alerts us on:

   i) the depersonalization of health care by 'high tech,' cost constraints and the legal system.

   ii) the emergence of the eugenics mentality both 'negative,' the advice for damaged embryos and the 'positive,' advice for the selection of super genotypes. He views the 'positive' as the more sinister of reasons.

VIII. Student Readings (Specific due dates on published Lesson Plan)

#1. Woodrow Wilson National Fellowship Foundation - Bioethics Institute '92, handout (= WW handout, 3 pages.). "Rules for a seminar," Sawhill's essay "On Ethics," and Jacob Monod's 11-point outline on how science destroyed some values but what does it leave in their place?

#2. Plato. Protagoras & Meno. Penguin Classics, Baltimore, MD. 142 pages (Euthyphro & Republic also by Penguin.)

#3. George Kieffer, 1992. "Ethical Decision Making Theories." A personal manuscript and a WW handout. 44 pages.

#4. Joseph Fletcher, 1966. Situation Ethics. Westminister Press. 176 pages.

#5 & 6. WW handouts. 20-30 pages of theory and practice on Values Clarification and Values Testing (=Moral Development). You choose.

#7. George Kieffer, 1987. Biotechnology, Genetic Engineering and Society. NABT. 85 pp.

#8. Aldo Leopold, 1949. The Sand County Almanac. Oxford University Press. 228 pages.

#9. Choose a paperback...some suggestions:

• Robert Shapiro, 1991. The Human Blueprint. St. Martins Press, NY
• H.W. Lewis, 1990. Technological Risk. Norton Co. NY.
• Brown, L. 1991. State of the World - 1992.

#10. Handouts generated by the controversies over NRT's. Your choice.

IX. Teacher Additional Readings

Ethics

Adler, M. 1975. Aristotle For Everybody. Bantam Books.

Part II is a gentle introduction to Aristotle's notion of the difference between 'ends' & 'means,' the 'good' life, and virtuous living.

Beauchamp, et al. 1989. *Contemporary Issues in Bioethics. Wadsworth Pub. CA.

Frankena, W. 1973. Ethics Englewood Cliffs, NJ.

McCormick, S.J., R. 1985. How Brave a New World: Dilemmas in Bioethics.

A Catholic scholar's view on the most complexing problems. Paul Ramsey, Professor of Religion at Princeton U., states that McCormick's writings are " truly catholic and ecumenical in spirit." Ramsey intentionally used the small 'c.'

Potter, V. 1988. Global Bioethics. Michigan St. University Press.

Rachels, J. 1986. Understanding Moral Philosophy. Random House. This review I found to be a clear and readable resource.

Munson, R. 1992. *Basic Issues in Medical Ethics. Wadsworth Pub. CA.

Shannon, T. 1987. *Bioethics. 2nd Ed. Paulist Press.

* These works have a review of philosophical models of ethical decision-making followed by 400+ pages of moral dilemmas.

Journals, Reports & Workbooks

Kennedy Institute of Ethics Journal. Johns Hopkins University Press.

The Hastings Center Reports, 255 Elm Rd., Briarcliff Manor, NY.

Jennings, et al. 1992. New Choices, New Responsibilities: Ethical Issues in the Life Sciences. A grant from Hoffmann-LaRoche Inc. NJ.

Moral Development

Duska, R. & Whelan, M. 1975. A Guide to Piaget And Kolhberg. Paulist Press.

Gilligan, C. 1982. In a Different Voice: Psychological Theory & Women's Development. Harvard University Press. Her works suggests that Kohlberg's model is 'male-justice' centered and that women's moral sense speaks in a different voice - 'female-relationship'.

Environmental Concerns

Devall, B. & Sessions, G. 1985. Deep Ecology: Living as if Nature Mattered. G.M. Smiths, Inc, Salt Lake. The ecological based philosophy supporting the Green Movements.

Sergoff, M. 1975-1992. Choose from the 50+ articles published (cf., WW handout).

Biotechnology

Suzuki, D. & Knudtson, P. 1989. Genethics: The Clash Between The New Genetics & Human Values, Harvard U. Press, MA.

OTA, 1991. Biotechnology in a Global Economy, Congress of the United States.

New Reproductive Technology

Blank, R. 1990. Regulation Reproduction. Columbia University Press, NY. Public policy questions are examined with a view toward a rational reproductive policy.

Hull, R. 1990. Ethical Issues in the New Reproductive Technologies. Wadsworth Pub., Belmont, CA. A solid review of the notion of claims followed by real case studies.

"Oh, Perfect Master," I asked, "what is the meaning of life?" Fixing me in his steady gaze, the Perfect Master replied: "My child, answer but one question: Who am I in light of whom I say I am?"

Jerry Devlin 23 July 92

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