Dr Chris WillmottDept of Biochemistry

University of Leicester cjrw2@le.ac.uk

Different Approaches to Ethics Teaching

University ofLeicester

FEBS, Prague, July 2009

THE University of the Year 2008

1. Explosion of new issues

“Modern Science has placed in our hands capabilities that have aggravated long-standing ethical problems as well as introducing new quandaries”.

Stanley Grenz (moral philosopher)

Why teach ethics to bioscientists?

1. Explosion of new issues

2. Equipping students to explain key issues to friends

1999 Eurobarometer survey:“Ordinary tomatoes do not contain

genes while genetically-modified tomatoes

do”

35% agreed with the statement

30% “do not know”

Why teach ethics to bioscientists?

1. Explosion of new issues

2. Equipping students to explain key issues to friends

3. Relevance to future careers

- research?

- teaching?

- medicine?

- science communication?

Why teach ethics to bioscientists?

1. Explosion of new issues

2. Equipping students to explain key issues to friends

3. Relevance to future careers

4. It’s interesting

Why teach ethics to bioscientists?

1. Explosion of new issues

2. Equipping students to explain key issues to friends

3. Relevance to future careers

4. It’s interesting

5. In the UK, the QAA says we should

Quality Assurance Agency “Benchmarking statements”

- first edition, 2002- second edition, 2007 http://tinyurl.com/QAAbioscience07

Why teach ethics to bioscientists?

“Students should expect to be confronted by some of the scientific, moral and ethical questions raised by their study discipline, to consider viewpoints other than their own, and to engage in critical assessment and intellectual argument”

“Recognising the moral and ethical issues of investigations and appreciating the need for ethical standards and professional codes of conduct”

QAA Benchmarking for Bioscience

All students should:“Have some understanding of ethical issues and the impact on society of advances in the biosciences”

Good students should:“Be able to construct reasoned arguments to support their position on the ethical and social impact of advances in the biosciences”

QAA Benchmarking for Bioscience

Can consider issues in three categories:

1. Research integrity

2. Biomedical ethics

3. Environmental bioethics

Ethical issues for Bioscientists

Approaches • Case studies/ scenarios

• Debate and role-play

• Newspapers

• Book extracts

• TV programmes/Films/News

• Clips to convey information

• Clips as discussion starters

• Student-generated videos

Bioethics = Bio- and ethics

• Science – could it be done?

• Ethics – should it be done?

Important that both are being considered:

Science without ethics may be immoral

Ethics without science may be impossible

Case studies & scenarios • Case studies allow real-world framing of otherwise abstract ideas

• Can have a key role in opening up complex issues for students

• May be genuine or fictional (though latter work best when as close to real as possible)

Carl is a twenty-one year old builder. He is engaged to Julie, and she has recently discovered that she is expecting their first child. In 2001, Carl’s maternal grandfather died from Huntington’s disease (HD), a late-onset degenerative disease of the nervous system. HD is inherited in a dominant fashion; if you do have HD, you have a 50% chance of passing it on to your children. Carl’s mum has decided not to take the test to find out if she got the faulty copy from her father, but now that he is expecting to be a father himself, Carl is keen to find out if there is any risk that he has passed on the condition.

What are some of the issues at stake for Carl and Julie? What are the consequences of taking the test, or deciding not to? If you were Carl, what would you do?

Case study (1) – Carl and Julie

Carl can know his status and prepare accordingly

But his mum has made a conscious decision not to know, hence potential harm to her

Other consequences:- Carl’s relationship with Julie?- Carl’s relationship with baby?- Implications for Carl’s work?- Insurance implications, etc

Genetic screening

(Developed from episode of “Bitter Inheritance”)

Case study (2) – Wendy & Paul Wendy and Paul Carter have been married for twelve years.

They would love to have children. Unfortunately, Wendy had breast cancer when she was 28 and although the chemotherapy has brought total remission from the disease it also caused damage to her ovaries that has made her infertile.

Paul and Wendy have been on the waiting list at their local IVF clinic for a number of months awaiting donated eggs to try and have a baby. At present, however, there are 200 potential mothers seeking each donated egg and the couple know that realistically they may never receive a donated egg via the normal channels.

Researchers at the hospital attached to the IVF clinic have recently gained permission to carry out experimental procedures using eggs harvested from aborted foetuses. The technique is controversial, but for Paul and Wendy it may represent their only chance to receive a donated egg.

What are the issues involved in this case?

- Feel free to include aspects of the case that are likely to be issues for other people, your contributions need not be limited to your own opinions.

Case study (2) – Wendy & Paul

• This case - content is fictional but based on real

ideas and statistics

- used in Session 1 of 6 in bioethics series

- used as vehicle to introduce more philosophical aspects

Case study (2) – Wendy & Paul

Deontological (first principles, rights, duties)• Does a foetus have any rights?• Does the “mother” have any rights or say in

the upbringing of their “grandchild”?

• Should people be allowed to manipulate nature for

their own gain?

Consequentialist (outcomes)• What would be the psychological effects on

the child?

• If the child turns out to be “defective” then who is

culpable? • What is the likelihood of success?

Case study (2) – example comments

Deontological (first principles, duties)

Consequentialist (outcomes)

Virtue ethics (importance of character)

Principlism

Vehicle for introducing philosophy

Principles of Biomedical Ethics (Beauchamp & Childress) propose 4 principles:

1. Non-maleficence Don’t do harm

2. Beneficience Do good, act in the best interests of others

3. Autonomy Maximise freedom for individual or community

4. Justice Treat equal cases equally and unequal cases differently

Making ethical decisions

Principlism

Carl can know his status and prepare accordingly (Autonomy, Beneficience)

But his mum has made a conscious decision not to know, hence potential harm to her

Other consequences:- Carl’s relationship with Julie?- Carl’s relationship with baby?- Implications for Carl’s work?- Insurance implications, etc

Genetic screening

(Adapted from episode from series “Bitter Inheritance”)

TV footage – why? • Familiar visual medium

• Can be used to:- convey information- as discussion starters

• Clips save time over full programme

What sort of programmes? • Documentaries, e.g.

- A Child Against All Odds (2006)- DNA – The Promise & The Price (2008)- The World’s First Face Transplant (2006)

• Drama e.g.- Holby City (various, esp 2006)- The Island (2005)- Million Dollar Baby (2004)

• News clips- topical- pithy summary- online?

Clips to raise issues – GATTACA GATTACA (Dir: Andrew Niccol, 1997) is set “in the

not too distant future”. Having watched the clip, consider the following questions:

1. How realistic is the genetic screening process shown in the film? Which aspects can already be done? Which are likely to be more difficult?

2. Screening of this type would be controversial. What are some of the potential benefits, and what are some of the potential problems?

3. Consider your answers to Q2. What form of ethical thinking does each represent?

4. Does this film offer any insights into current development in genetic screening?

GATTACA – Science issues Technology shown could offer selection, but not

enhancement – gene can only be included if mumor dad had it!

Current PGD? Future PGD?

Genetic determinism? How much of us as individuals is down to our genes and how much down to other factors (food intake, trauma, etc)?

GATTACA – Ethical issues Genetic discrimination – ‘Valids’ v ‘In-valids’? A

‘made-man’ v a ‘faith-birth’? A ‘vitro’ v a ‘utero’?

Insurance moratorium in UK (until 2011). Risk and social exclusion?

What would it be suitable to check for? Diseases? Gender? Physical features? Character traits?

What costs to the individual and to society are worth paying in order to select-out diseases?

What do such attitudes say about people with disabilities now?

Role of genetics in forensics?

News clip – structured activity Therapeutic Cloning

You are going to see a 3 minute video from Five News on June 16th 2004, discussing an application by a team of scientists at Newcastle University for permission to carry out “therapeutic cloning”. Read through these questions before you see the clip, so you know what to look out for.

From the video Explain how therapeutic cloning would work What is the source of the eggs to be used in this research?

What is the stated aim of the research? Thinking deeper In the clip, Professor Murdoch says: “Imagine a child, say a ten year old child, now who is diabetic who’s cells that normally produce insulin are not working properly, so that child will have to take insulin injections for the rest of their life. Possibly, in five or ten years time, we could be in a situation where we could take a tiny piece of skin from that child, do some work within the laboratory to tell that skin cell to forget that it was ever a skin cell, to learn to become a stem cell, which means that it has no background

information about what it is going to be, and then teach that stem cell to become an insulin secreting cell so that cell can be planted back into the child and then the diabetes theoretically would be cured.” Compare this with the explanation of how therapeutic cloning would work; - in what ways was it different, and - in what ways was it the same? What objections to stem cell research are mentioned in the video? What other reasons (not mentioned) may cause people to object to therapeutic cloning? What technical difficulties might make this work difficult to achieve?

• Think of as many ways as possible that you might link one or more of the following news stories to your teaching of:

(a) basic bioscience and/or (b) bioethics?

GFP Marmosets

Images from http://news.bbc.co.uk/

Using News stories in Bioscience

Cognitiveenhancement?

Face transplant

Wider debate about animals

Science of transgenics Ethical questions

What is the basis for animal rights?

GFP Marmosets

Image from http://web.princeton.edu/sites/ehs/biosafety/animalworker/pics/marmoset.jpg

Is it OK to alter monkeys in this way?

Does the fact that alteration was inherited make any difference?

What is GFP?How was the gene

transferred in?Why was it transferred in?

Do animals have rights?Sentiency?

Justice?Utility?

AbolitionistsWelfarists

3Rs (refine, reduce, replace)

Immunological

Lifestyle issues

TechnicalEthical

Psychological

Face transplants

Image from http://news.bbc.co.uk/

For patient?For potential patients?

For wider society?Face and identity? Rejection rates?

(30-50% over first 2-5 yrs)Harmful effects of immunosuppressive drugs?

Availability of donor face?Functionality of transplant?

Plan B if rejected?

Risks v BenefitsMotivation?

Media intervention?Cancer risk?

Science of enhancement

Arguments against

Therapy v Enhancement

Cognitive enhancing drugs?

Image from http://freedocere.files.wordpress.com/2009/05/ritalin-sr-20mg-full1.jpg

Safety: esp long term useFairness: will others need

to take enhancers to compete

What drugs are people taking?

What is the basis of their effect?

Can a case be made that moving someone from poor to normal is different from

normal to superior?

Arguments in favour

Autonomy“if it’s ok for kids it’s ok for

me”Others get advantage from

genes or wealthLegal = know medicine is

what it claims to beBetter productivity =

economic benefit

Helpful websites e.g. www.bioethicsbytes.wordpress.com

Helpful websites e.g. www.bioscience.heacademy.ac.uk/resources/ethicsbrief.htm

Bioethics BriefingsSix titles and

others to follow

Helpful websites e.g. www.beep.ac.uk

Helpful websites e.g. www.at-bristol.org.uk/cz/Default.htm