EXERCISE FIRST

Rationale
It is easy to fall into familiar patterns with our teaching, one of the most popular is “tutor talks a bit about the topic, then there is a case study on some aspect of the topic which allows the students to voice their own opinion”. This is a perfectly good way of teaching, however more advanced students (i.e. those who have overcome their initial reluctance to talk and contribute to discussions) can be challenged further. This technique involves an element of surprise, it breaks with ‘tradition’, what has been done in previous seminars, which is a good thing as it ‘wakes up’ students who may be falling into the rut of familiarity. More importantly it allows students to reason to conclusions rather than being told what these conclusions are, so it makes it easier for them to learn. If, in the future, students have forgotten the particular points, one only need remind them of the exercise, then they can ‘run through it’ themselves and reason to the conclusions again, rather than simply being told what it is they have forgotten. You can introduce whole topics (even theoretical topics) this way by splitting up the main ideas you want the students to understand and designing exercises for each one.

What is it in a nut-shell?
Put the exercise first, before you have introduced the topic. Design an exercise which makes the point you want to make, start by giving it to the students, allow them to arrive at the point themselves, then talk about it.

Examples:

Valid Consent

It is tempting to give the students the three requirements for valid consent, but why do this when it is so easy for them to tell you! Here are three case studies each one designed to be problematic because of concerns with each one of the three requirements for valid consent. For extra interest, split the students into three groups, ask each group to look at one case study only and ‘teach’ the others what they have learn about consent from considering their case study.

Case 1: A woman presents to the casualty department where you are a doctor with fever, a stiff neck, flu-like symptoms and a sensitivity to light. You want to perform a spinal tap to rule out meningitis but she refuses, saying that it is not necessary, she perfectly fine and would like to leave. You try to explain the seriousness of the situation, but she literally laughs it off and starts singing. She wants to be discharged to return to her singing career and keeps offering to show you how well she can sing. Do you proceed with the spinal tap without consent? Why is this case problematic?

Case 2: You are on the Local Research Ethics Committee and have to decide whether to give the go ahead for a trial on a new drug for diabetes. The drug has gone through the usual tests so far and there are some indications that it has long term detrimental effects, although it is not clear whether these were isolated instances or a real problem with the drug. The drug company is proposing to run a trial using inmates from the local prison, a number of whom have already volunteered. While considering this proposal you learn that prisoners have been promised privileges and that their parole applications will be considered favourably if they participate. Do you have any concerns about this trial? Is consent possibly problematic here?

Case 3: You are a representative of Medicins Sans Frontiers (a charitable organisation of volunteer doctors) visiting a remote tribe in South America. When you arrive there you discover that a large pharmaceuticals firm is already there and has entered into an agreement with the chief of the tribe to collect blood samples from members of the tribe in exchange for building materials. The pharmaceutical firm hopes to use the samples to isolate and pattern particular genes. When you speak with the chief you discover that his language has no word for DNA or gene. Should you intervene or should you respect the chief’s consent to this procedure? Is there anything problematic about consent in this case?

Case 1 raises issues about competence. The woman's ability to make a medical decision seems to be compromised, possibly because of her illness. In this case a clinician would be justified in making decisions based on the patient's best interests on the grounds that she is incompetent to do so herself.

Case 2 is about freedom to make a decision. There are concerns that prisoners are in a vulnerable position and asking them to participate in trials may be coercive and affect their ability to freely consent to the proposed course of action.

Case 3 raises problems with information and, more importantly, understanding. It does not seem possible for the tribe members to give consent to a process that they do not understand.

The three cases should then help the students conclude that consent is not valid unless the person is competent to make the decision, is free to do so and understands all the relevant information.

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Virtue Ethics

This is a series of exercises designed to introduce the topic of virtue ethics to a group of students familiar with some other normative theories (consequentialism and deontology). I only had one and a half hours to introduce this topic so these exercises are designed to raise some distinctive features of virtue ethics. Once they had worked through each one of the exercises and we had discussed ideas, I did speak on the topic for ten minutes and at the end of the session the students were given a second handout which discussed all the ideas in details (however every time I have run the seminar the students have managed to arrive at the thoughts contained in the second handout during the seminar itself, so this second handout serves merely as a reminder and reference point).

1. Lying

According to deontologists you should never lie. Consider the following cases. For each one what would a deontologist expect you to do? Is he right in his recommendation about the moral course of action?

Bobby's case suggests that some lies are acceptable if they are part of story telling and encouraging imaginative thinking. Claudia's lie is a white lie, a lie about a small, unimportant issue, said in order to avoid a greater harm. Johan's lie is an outright lie but many would argue it is justified given the alternative. All these examples are contentious and may provoke interesting discussions about the justification of lies.

2. Doing the right thing

When we do the right thing we get credit for it, i.e. we are praised for what we did, we and other people recognise that we behaved in morally admirable ways. Consider the following cases, do the people in these examples deserve credit?

John has done the right thing but for the wrong reasons. He should have saved the boy because the boy needed saving and not for self-serving reasons such as impressing his date or being mentioned in the news. Kate has also done the right thing in giving to charity but she did it by accident which suggests that she does not merit moral praise for it. We only praise purposeful good actions. Mary is fickle which suggests that her actions, while sometimes right, do not proceed from a stable and settled disposition to do the right thing, but are the result of fleeting emotions she may or may not have on a given day. These three cases capture the Aristotelian requirement for virtue that one must do the right thing, for its own sake, purposefully and from a permanent and stable disposition.

3. Appropriateness

Are the people in the following cases behaving appropriately? If yes, why so? If not, why not?

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