I recently read Ercan Avci‘s 2017 paper Learning from experiences to determine quality in ethics education (International Journal of Ethics Education 2:3-16). Avci, from Duquesne University, conducted a literature review looking for shared characteristics in peer-reviewed, full text articles with “ethics education”, “ethics teaching” or “ethics learning” in the title and “ethics” or “ethics education” in the keywords during the period 2010-2015 (which the author describes as the “the last five years”, though it looks like six years to me). A total of 34 papers were examined, drawn from 11 academic disciplines and 10 countries (plus 3 international studies). As one might anticipate, the USA was the most represented geographical context, and healthcare (Nursing, Medicine, etc) was the discipline with the highest number of studies. I was a little surprised to see that none of the reports were from the UK.
As the author himself points out, this is a rather eclectic mix of settings. This might be spun either as an advantage (e.g. capturing diversity) or as a limitation (when it comes to drawing universal lessons). Notwithstanding these issues, Avci makes a number of important observations, some of which resonate with my own experience (e.g. see the Notes for the Tutor section, p16 onwards, in my contribution to the 2011 book Effective Learning in the Life Sciences).
Taking a step back, there is an initial question before examining the quality of any ethics programme, namely is ethics being taught at all? It is apparent that many courses – even in Medicine, even in the States – do not include a formal ethics component. However, a broad range of subjects are now including some ethics in their teaching.
A second fundamental dilemma concerns the definition of quality. Avci recognises that there is unlikely to be a one-size-fits-all definition and draws from two healthcare-related sources, the US Agency for Health Research and Quality (AHRQ) and the World Health Organisation (WHO). They see quality as, respectively:
- “[d]oing the right thing (getting the health care services you need), [a]t the right time (when you need them), [i]n the right way (using the appropriate test or procedure), [t]o achieve the best possible results” (AHRQ)
- For the WHO, quality in healthcare has six dimensions. It is: Effective, Efficient, Accessible, Acceptable/Patient-centred, Equitable and Safe.
Reference is also made to the four pillars of learning that emerged from the 1996 UNESCO report Learning: The Treasure Within (commonly known as the Delors Report). The pillars are: (1) Learning to Know; (2) Learning to Do; (3) Learning to Live Together; and (4) Learning to Be. The author argues that these can serve as a touchstone in evaluating the quality of any teaching, including ethics education.
The review focused on three dimensions of ethics education:
- Teaching Scope: What was the content of the ethics component of the course? How many hours in the program were given over to this aspect? When was it taught (in the overall degree schedule)?
- Teaching Method: How should ethics be taught? E.g. traditional didactic lecture? Case-studies? Assigned readings?
- Classroom Model: Should ethics education be embedded within another module or delivered as a stand-alone unit?
In addition to this, Avci also reflected on the significance of Perceptions, Performance and Efficiency in evaluating the quality of ethics teaching.
Teaching scope: The review picks up on one of the old chestnuts in ethics teaching, namely how much ethical theory is it necessary to include if the students are not majors in philosophy and/or theology? According to the author, there did appear to be general enthusiasm for inclusion of at least rudimentary consideration of ethical principles and professional codes of conduct. The most common framework shared with students was Beauchamp and Childress’ Four principles (Beneficence, Non-maleficence, Autonomy, Justice), sometimes termed “Principlism”.
Screenshot from Beauchamp and Childress Principles of Biomedical Ethics (7th Edition)
Introducing students to the Principlism approach was see as both a potential positive – it at least provides students with a workable framework for their reflections – but also as a potential negative – in that it may dissuade them from engaging in deeper critique. There was also call for ethics teaching to incorporate better understanding of cultural differences.
Teaching methods: The most widely used teaching methods in ethics education were lectures, case-based teaching and group discussions (categories which can, of course, overlap). The literature review apparently found a mixed response regarding the merits of group discussions. This does not surprise me. Firstly, different cohorts can be more or less amenable to group work based on their disciplinary norms. Secondly, there can be good and poor versions of all forms of teaching. However, this is probably most overt in the context. Generally case-based teaching was reported to be welcome, but there needs to be careful explanation of the approach, especially if it outside the cultural and/or disciplinary norms. I have certainly found this to be true with bioscience students, who are not familiar with being asked to consider the nuances of different scenarios. A role for set readings is also discussed.
I was a little disappointed that case discussions, small group debates and oral presentations were considered to be “contemporary teaching styles”. Granted that the literature review finished in 2015, but it strikes me that those approaches are actually fairly standard fare and a number of additional approaches such as video production or media criticism as an assessed task, and the rising possibilities of utilising online resources (including audiovisual materials) as well as set reading might have been considered.
Classroom model: There is some discussion of online courses in the classroom model section. As noted above, the main thrust of the debate here was, however, about the relative merits of stand-alone ethics modules versus ethics provision embedded within broader units. Importantly, Avci notes that regardless of disagreement on the structure of the program, there seems to be consensus that more ethics education would be a good thing.
Impediments to effective ethics education were noted to include limited time, shortage of appropriate educators, and lack of educator experience. “The education of educators must come first because the lack of ethics educators and educators’ experience in ethics are major obstacles to [provision of] ethics education in an effective manner” (p12). This theme has also been picked up in an editorial by Henk ten Have for a more recent volume of IJEE, and which I have quoted in a recent Twitter thread:
There is also endorsement for a combination of ethical theory with practical application, in order that students can see the relevance of the ethics component, which may not be obvious if they have a narrow view of the scope of their subject.
Avci draws a distinction between performance (i.e. was the programme conducted successfully?) and effectiveness (i.e. did the programme result in fulfilment of the intended learning?). I think this is a helpful distinction. The literature review generally suggested that case-based teaching was the most effective, though at least one example questioned this.
As the review draw to a close, Avci reflects on the big questions of ethics education. These include:
- Why: what is the aim of ethics education? I found this interesting as, in some senses, the motivations themselves can be drawn from different schools of ethical thought! Inevitably, some of the stated purposes are utilitarian in nature, e.g. to develop ethical awareness and to enhance professionalism and hence employability. Even an argument against expansion of ethics education “if recruiters do not value ethics coursework… should colleges and universities offer these courses?”, attributed to Breaux, models that type of approach. Others are more driven by virtue ethics, e.g. Giacalone and Promislo’s view that students should be motivated “to live a virtuous life and build a virtuous world”. Identifying the purpose of ethics education is foundational and needs to be considered before moving on to the other questions.
- What: Having decided on why, an educator needs to move on to determine what to include in their programme. Jensen and Greenfield are reported to put in a plea for improving “students’ ability to develop habits of mind” as a goal over and above the specifics of ethical theory, codes of practice, etc.
- How: Avci advocates a balance between ethical theory and practical cases. He also reiterates the need for more, and better trained, ethics educators.
It is a little disappointing, given the title of the paper, that the author rather fudges on real discussion of the measurement of quality, a decision justified by both the lack of consideration of that theme in the literature reviewed, and the necessity to answer the Why, What and How questions before such an evaluation can be undertaken. Nevertheless this was an informative and interesting read as I reflect on both my own teaching and prepare for various tasks, including running an invited workshop at the Federation of European Biochemical Societies conference this summer.
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