Teaching Bioethics for Undergraduates: Is It Necessary? Nahed Moustafa- MD Prof.& Head of Forensic Medicine& Clinical Toxicology Unit, FOM-SCU, Egypt Certified Trainer of Research Ethics- USA

Dr. Nahed Moustafa FOM-SCU Objectives: Bioethics for undergraduates: Why? How? When?

Dr. Nahed Moustafa FOM-SCU Definition: “Bio”: means life “Ethics”: means the development of principles, rules that give standards of good and bad, right and wrong. “Bio-shock”: might just be the word to describe the advances being made by science and technology

Dr. Nahed Moustafa FOM-SCU Why Bioethics? 1- Identify the major structural components of the country health care system 2- Identify ethical responsibilities of the physicians that serve the community 3- Identify several ethical principles& regulations that are relevant to practice of medicine

Dr. Nahed Moustafa FOM-SCU Why Bioethics? (cont.) 4- Develop strategies for resolving conflicting responsibilities( margin& mission) 5- Need of information about both the science & the ethics

Dr. Nahed Moustafa FOM-SCU Why Bioethics? (cont.) As a part of a liberal education, an undergraduate course in bioethics should aim to prepare students for life as an engaged citizen in a free society by developing skills in critical thinking and encouraging engagement in the deliberation of issues in the area of medicine and biotechnology

Dr. Nahed Moustafa FOM-SCU Fortunately, continuing development in medicine & biotechnology offer an abundance of ethical issues to debate So Teaching bioethics in the undergraduate setting is about paying attention to these debates and having a stake in their outcome Why Bioethics? (cont.)

Dr. Nahed Moustafa FOM-SCU Basic Issues of Bioethics 1- Physician patient relationship 2- Confidentiality 3- Informed consent 4- Certificates 5- Medical responsibility

Dr. Nahed Moustafa FOM-SCU Controversial Issues of Bioethics 1- Death & end of life 2- Euthanasia 3- Assisted reproduction & surrogacy 4- Abortion 5- Stem cell research 6- Human cloning (therapeutic &reproductive)

Dr. Nahed Moustafa FOM-SCU Controversial Issues of Bioethics 7- Organ transplantation 8- Genetic information & bio-banks 9- Animal experimentation 10- Research ethics

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: When? * Early or late? * Separated or integrated? * The traditional method: first the theory, then the case * The case based approach: first the case, then the theory

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? There are numerous methods that can be used to study bioethics. Here are some suggestions: 1- Case studies. 2- Debate. 3- Student led seminars. 4- Journal article writing.

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) 1- Case studies: resources such as: newspapers, law journals & can be fictional cases designed by the teacher. Student may work in small groups.

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) Choice of the case: * of current interest * authentic but anonymous * suitable for the age group * ethically provocative

Dr. Nahed Moustafa FOM-SCU Case Study: The 41-year- old woman’s brain was heavily damaged following momentary heart failure in 1990,leaving her in a persistent vegetative state for 15 years able to breathe on her own but reliant on an artificial feeding tube. Her husband (legal guardian) decided to remove his wife’s feeding tube but her parents refused.

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) 2- Debate: Choose a statement to be debated and assign students aside to argue e.g. ”Resolved genetic screening for the purpose of sex selection should not be permitted”

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) Cloning:” Is there a significant difference between cloning sheep for pharmaceutical production &cloning humans?” Fetal tissue transplantation:” Does a fetus have rights? If so, what are they & who is responsible for representing the interests of the fetus?”

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) Euthanasia:” What is the right to die? How does withdrawing or withholding treatment differ from physician assisted suicide?” AIDS:” Should developing countries be able to benefit from AIDS research when their citizens serve as research subjects?”

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) 3- Student-led seminars: Small groups of student research a particular topic then lead a one or two day class discussion. May need one day teaching about the technology involved. Then exploring the ethical questions

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) 4- Journal article writing: Have students write their thoughts down rather than voicing them in class

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) Outlines of the process Regardless of the methodology chosen, certain steps are common to bioethical discussion: 1- Articulate the dilemma: “phrased as statement or question”, should summarize the problem clearly.

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) Outlines of the process 2- Identify the stakeholders in the decision: Who has a vested interest in the outcome? Encourage students to think of as many stakeholders as possible.

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) Outlines of the process 3- Present possible solutions: Again, there is always more than one solution to an ethical dilemma. Students should be encouraged to describe as many possible outcomes as they can.

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) Outlines of the process 4- Rank the possible solutions from the best to worst. Choose the one which seems to make most sense to you as an individual

Dr. Nahed Moustafa FOM-SCU Teaching Bioethics: How? (cont.) Outlines of the process 5- Explain ( WHY) your choice seems like the best to you. WHY OR WHY NOT?

Dr. Nahed Moustafa FOM-SCU Conclusion 1- It is very important to relate teaching bioethics to real life by basing it on cases the students can recognize from their experience or which they might encounter later on in their professional life.

Dr. Nahed Moustafa FOM-SCU Conclusion (cont.) 2- Great emphasis have to be put on the importance of group work and practical exercises rather than just lectures. This would be applied both when teaching bioethics & when teaching how to teach bioethics.

Dr. Nahed Moustafa FOM-SCU Conclusion (cont.) 3- The future teachers of bioethics should put themselves in the position of the students and see how the exercises worked in practice

Dr. Nahed Moustafa FOM-SCU