Why bioethics literacy matters

The Hastings Center and the Presidential Commission for the Study of Bioethical Issues have teamed up to publish a series of essays to highlight the best practices in teaching bioethics and to identify gaps in our knowledge of how best to inspire and increase moral understanding, analytical thinking in the moral domain, and professional integrity. The first three of these essays, which appear in the current Hastings Center Report, focus on bioethics education for practicing clinicians.

"The Presidential Commission for the Study of Bioethical Issues and The Hastings Center are committed to improving the ethical literacy of the American public in the domain of bioethics," states an introduction to the essays written by Lisa M. Lee, executive director of the Presidential commission; Mildred Z. Solomon, president of The Hastings Center; and Amy Gutmann, chair of the commission. "Taken together, these papers elucidate a broad range of considerations and point out new areas of research to discover how best to improve ethics literacy among scientists, health care practitioners, and the public."

The three published essays discuss bioethics education for nurses, doctors, and medical students.

• "Enhancing Moral Agency: Clinical Ethics Residency for Nurses" describes a program developed and run by two large northeastern academic medical centers to increase nurses' moral agency-an enhanced ability to bring about change-in order to improve patient care. An insight from the program is that having knowledge of clinical ethics is not enough to develop moral agency. In addition to classroom lectures on ethics, the program incorporated role-play and simulation, clinical mentorship, and quarterly sessions in which graduates have the opportunity to build confidence in their agency and the skills to act on their insights. Ellen Robinson, a nurse and ethicist at Massachusetts General Hospital, and her co-authors, conclude that the program met its goal of improving nurses' agency and "demonstrated early evidence of a positive effect on patient care."
• "Emerging Ethical Issues in Reproductive Medicine: Are Bioethics Educators Ready?" discusses an empirical study of educators involved in graduate-level training and physicians who deliver reproductive health care. The study revealed a mismatch between the reproductive ethics issues that the bioethics educators consider most important and the ethical dilemmas that the doctors face in daily practice. The authors, led by Ruth M. Farrell, a physician and ethicist at Cleveland Clinic and Case Western Reserve, recommend that the bioethics and medical communities work together to develop appropriate content in bioethics curricula. They also recommend fuller integration of clinical consultation into the practice of reproductive medicine.
• "On Cultivating the Courage to Speak Up: The Critical Role of Attendings in the Moral Development of Physicians in Training" uses two cases to illustrate the limitations of formal ethics education and the need for attending physicians and health care institutions to produce a cultural environment where physicians-in-training are invited to voice their views about patient care and where they will feel safe doing so. The cases come from the experience of the author, Divya Yerramilli, a medical student at the University of Pennsylvania. In the first case, the attending physician stifled discussion of an ethical dilemma in the care of a patient with widespread ovarian cancer. In the second case, the senior attending physician encouraged medical students and others to voice their views about an ethical decision involving a patient with alcoholic liver disease and liver failure. Although medical students receive classroom instruction in ethics, Yerramilli writes that without ethical discussion of patients in the clinic, and the welcoming of diverse views, the classroom ethics lessons will be unlearned.

Other papers, to be published in future issues of the Hastings Center Report, will address the teaching of pediatric ethics issues, bioethics education for science and technology graduate students, bioethics professionals, community health workers, and secondary school students. The papers are edited by Mildred Solomon and Lisa M. Lee. Lee and Solomon will lead a session on bioethics education at the annual meeting of the American Society for Bioethics and Humanities in San Diego on October 17.