7 Jun, 16 | by Iain Brassington
Very well, then: let’s allow that the quality of argument in bioethics – and clinical ethics in particular – is not of high quality. What should be done about it?
That’s a hard question, though it’s predictable and wholly justifiable that it should be asked. And, to be honest, I don’t know offhand. I might have a few germs of ideas, but nothing that I’d be prepared to mention in public. That doesn’t mean that I can’t look at other ideas, and test them out. One such idea is mooted in this paper by Merrick et al: in essence, they propose a sort of debating competition. They begin by explaining – with some plausibility – some of the factors that make it a bit hard to get full-blooded engagement with ethics in the medical curriculum:
As educators, we have observed additional challenges medical students face in their ethics education, which echo others’ experiences. First, because of the prodigious amount of information medical students are presented with during their first two years of training, they typically adopt a strategy of selectively reading assignments, attending large lectures, and participating in small group discussions. In this context, ethics appears to be deprioritized, because, from the students’ perspective, it is both more demanding and less rewarding than other subjects. Unlike other subjects, ethics requires students to reflect on their personal moral sensibilities in addition to understanding theory and becoming familiar with key topics and cases. Yet, also unlike other courses, poor marks in ethics rarely cause academic failure, given the way performance in medical school curricula is typically evaluated. Thus, ethics is both more demanding—because of the burdens of self-reflection—and less rewarding—because excellence in ethics does not contribute significantly to grades or test scores.
Second, medical students face challenges in how they individually conceptualize the value of ethics in the medical context. Although many indicate that morality is important to them, they also suggest that it is a subject matter that relates to their personal, as opposed to professional, actions. Instead, students often conflate the domains of institutional policy and health law (especially risk management and malpractice litigation) with medical ethics. Although these domains are obviously also of essential concern for future physicians, they remain distinguishable from ethical issues likely to emerge in practice. Consequently, rigorous and effective ethics education within the medical school context faces the challenge of distinguishing ethics from other aspects of professionalism.
Too often, ethics gets run alongside communication skills training (well, it’s all about getting informed consent, isn’t it? Eh? Eh?); and I’ve lost count of the number of times I’ve been asked to prepare multiple choice questions for ethics assessment. (Standard answer: nope. It’s got to be an essay of some sort, or it’s not worth doing.)
So what to do? The paper, as I’ve already said, suggests a quasi-competitive debating competition, in which teams of students are given a problem, and a limited time to make a case in response to that problem. An opposing team then has a limited amount of time to place a counterargument. Then they swap roles, so the counterarguing team gets to make the argument, and the previous arguers now become counter-arguers. Judges can ask questions, and assign a score. “The basic aim of the MEB curriculum,” the authors say,
is to help students learn how to produce and present an argument for an ethical position in response to a realistic clinical situation.
Every now and again I get asked to help judge debating competitions – sometimes for academic institutions, sometimes for non-University bodies, sometimes for others (*cough* Instituteofideas *cough*). I used to be happy to help out. But I’m not so sure now. more…