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Why the Topic of Bioethics in Science
Classes?
A New Look at an Old Debate
by Carolyn Csongradi
One Strategy For Solving A Moral Problem:
In his book on life in the face of death, ethicist Ernle W.D Young
describes an approach which has application outside of the hospital
setting.(42) When dealing with a moral problem, it is helpful to have
a strategy to apply in resolving the conflict. There are many
examples of moral problems and numerous approaches which can be
used to engage students in discussions. As is often the case,
the analytical process,
which needs to be developed within a meaningful context, is the
critical component. Young's strategy follows:
- Step 1. Define the problem so the dilemma is clearly
understood by all parties:
Determining whether a problem is on the one hand a matter of poor
communication, failure to appreciate cultural or religious differences,
or represents a genuine difference in values and principles means
closely examining the issues involved. Some issues are readily
addressed simply by clarifying the nature of the disagreement.
There may also be more than one problem, which means prioritizing.
- Step 2. Collect as much information about the problem
as you can before beginning to think about a solution:
Accurate, comprehensive information is important and seems at
the outset like it should be a straightforward task. However,
even the facts can prove to be contentious. Consider how different
witnesses view the same automobile accident.(1) Equally important
is to understand personal, religious, economic and cultural beliefs
which are key components of the context framing the conflict.
- Step 3. Identify the important values and principles
for you and the others who are involved:
Values are grounded in beliefs which may be held consciously or
unconsciously and are sometimes highly charged with emotion. For
instance, a belief in God may predispose one to value human life
as the most important value. Though sometimes difficult to articulate
and not necessarily derived from a reasoning process, beliefs
have a legitimate place in making a decision.
- Step 4. Reflect on personal motives and intentions
in light of different courses of action and consequences to self,
others and society. Motive can be distinguished from intention
in that motive can be thought of as the "why", and intention
the "what". What outcome is wanted and why is this desirable?
Both of these questions apply to the individual's character.
- Step 5. Prioritize conflicting values and make a responsible
decision. Consider that deciding to NOT make a decision represents
one form of choice which has real consequences. This is best demonstrated
by an example illustrating how the information is integrated and
a course of action might be chosen.
Edward Hundert, a psychiatrist and ethicist, developed a model
to assist physicians in making life and death decisions involving
patients.(21) Hundert describes a practical technique for complex
problems: He believes that each new dilemma represents a set of
conflicting values. Making a list of these relevant values helps
clarify what is important. Utilizing a scale which attempts to
equate values, a decision can be made as to whether one side has
more "weight" than the other. An example follows:
Problem: A psychiatrist must decide if a patient's mental
illness warrants being committed to a psychiatric hospital. The
moral principles involved are part of a physician's code of conduct
stating that: the primary duty of a physician is to benefit the
patient; to enable a patient to be a self-determining agent; to
do no harm. A potential list of conflicting values follows:
To Commit against the patient's will versus to Not Commit
the patient:
- Concern for the patient's welfare and safety versus patient's
right to individual liberty
- Need to relieve patient's suffering versus patient's right
to privacy
- Concern for safety of others versus modesty concerning one's
own ability to predict patient's furture actions i.e. suicide
or homicide
Most professional codes are deontological in nature. The physician
integrates a prescribed code of behavior and weighs personal values,
such as honoring the values of others, in the final choice. One
principle illustrated in this example is the concern for the patient's
welfare and safety or non-maleficence.
In the final analysis, the physician, guided by a code for ethical
behavior, decides by being consistent with personal beliefs, perspective
and professional ethical codes, which course of action is best.
Should the patient remain free and subsequently commit suicide,
this result might modify the physician's confidence in predicting
a patient's future behavior and may change the priority given
to that particular belief. The process of modifying future courses
of action is called reflection or reflective equilibrium.(35)
Such experiences may change the physician's future decisions,
but not necessarily alter the fundamental principles involved
such as beneficence and non-maleficence. The change would only
be in the prioritizing process
Teaching Moral Problem Solving Continued:
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