Activity: Recognition of ethical principles in practice

Learning outcomes

By the end of the activity, students should be able to:

• Understand the fundamental principles of bioethics and their application in professional situations
• Argue positions based on evidence for resolving ethical dilemmas in professional practice.
• Empathize and understand the theoretical foundations that underpin the different positions that converge in the face of an ethical conflict.
• Reflect on the impact of personal beliefs and judgments when generating arguments and positions in the context of an ethical conflict.

As regards transversal skills, students should be able to:

Interpersonal and socio-emotional skills:

• Express ideas clearly and fluently
• Use non-verbal communication and active listening and/or show empathy (if possible according to the assigned role)

• Work cooperatively with others
• Facilitate conflict resolution, remain calm under pressure, and control their emotions in conflict situations

 

Critical and creative thinking:

• Identify and deal creatively with unexpected, unforeseen, and complex situations that can be exploited, and to evaluate different solutions
• Collectively analyse complex systems; to think of how systems are embedded within different domains (society, environment, economy, etc.) and different scales (local to global); and to deal with uncertainty
• Acquire, process, produce, and evaluate information critically and from the perspectives of different fields and decisions, considering both individual and community perspectives

 

Learning to learn:

• Use prior knowledge to plan a strategy for approaching a new task, and to transfer what they have learned from one context to another, or from a previous task to a new task
• Recognize learning possibilities (outside of formal studies) and reflect on them as learning outcomes in relation to their own profession

 

Brief description of the activity

Students are split into two to four groups with an equal number of participants. Ethically polemic case scenarios are presented to the groups. Then, half of the students of each debate group advocate for a solution to the case and the other half advocate for the contrary solution. They should perform a brief literature review to build their arguments and then start a debate moderated by the teacher(s). Two randomly-selected students act as external observers of each debate. After the debates end, the observers explain to the whole group the debated scenario and the different points of view that emerged in the discussion. An open reflection and discussion follows. 

 

Activity plan: step by step

 

Before the activity

For the implementation of this activity, it will be necessary to create scenarios or starting cases in advance that include the content you wish to work on. Here are some examples:

Case 1. Mathias, a 35-year-old man, suffered a duodenal ulcer bleeding and lost much blood. He is agitated, feels dizzy and weak, but is oriented and answers the questions that the professional team asks him. The best chance to save his life is an urgent blood transfusion, as well as a surgery intervention to stop the internal bleeding. Mathias refuses the transfusion because he is a Jehovah’s Witness and his religious principles don’t allow it. Yet, he demands the operation. He claims that he understands and accepts the significant risk of a surgery intervention with no blood transfusion. The surgeon who would carry out the intervention protests and claims that s/he doesn’t want to perform an intervention under such conditions since s/he would feel personally responsible for the patients’ death. 

Case 2. You work in an emergency surgery room where all operating rooms are occupied. In one of them, a 73-year-old man with a mesenteric embolism confirmed by CT was just admitted. He came to the hospital only after 5 days of pain that he ignored. You suspect that he already has extensive gangrene in his abdomen and is likely to die. Of course, to be sure that you have complied with hospital regulations in the event of an almost inevitable fatal outcome, you need to have an official certificate of unwellness, which can only be obtained through an abdominal inspection. He is currently being prepared for anaesthesia. At the same time, a 21-year-old girl who was in a car accident and who is suspected of having serious internal bleeding was brought to the reception. She needs urgent exploratory surgery and you can see from her symptoms that she has already lost a lot of blood. You have the option of postponing the man’s operation and bringing in the girl. 

Case 3. Sarah, a 45-year-old woman, has been battling a rare and aggressive form of terminal cancer for the past two years. Sarah’s condition rapidly deteriorated, causing her excruciating pain and leaving her bedridden. Despite various medical interventions, her suffering continues unabated, severely impacting her quality of life. Sarah has always advocated for autonomy and expressed her desire to have control over the end of her life if her pain becomes unbearable. The medical professionals, bound by their ethical obligations, are divided on the matter. Some doctors believe that euthanasia should be considered a viable option, arguing that it aligns with the principles of patient autonomy and compassion. They argue that, by granting Sarah’s wish for a peaceful and dignified death, her suffering can be alleviated, and her final moments can be more bearable. However, other medical professionals hold firm to the belief that euthanasia violates the sanctity of life and contradicts the ethical principles of the medical profession. They advocate for providing the best palliative care possible to manage Sarah’s pain while ensuring that a supportive and compassionate environment surrounds her.

Case 4. David, a 32-year-old man, is diagnosed with severe treatment-resistant schizophrenia. David has been battling his condition for over a decade, enduring relentless episodes of psychosis, intense suffering, and a profound impact on his daily functioning. Despite exhaustive treatments, including various medications and therapies, David’s condition worsens. He experiences constant distress and debilitating hallucinations, and is tormented by his own mind. He has expressed a persistent desire to end his life, claiming that he cannot bear the unending agony and turmoil of his mental illness. As the case unfolds, David’s family members grapple with conflicting emotions, torn between their love for him and their own personal beliefs. They seek guidance from mental health professionals, religious advisors, and support groups to navigate this profound and ethically charged decision.

Things to take into account prior to the activity:   Context. You should decide how many students you want in each group of debate, as well as how many debates you want to be held simultaneously. Once this is decided, you should decide how to sort students into groups and pick the observers. All students should have basic ethics knowledge. Materials necessary for its implementation. You will probably need two to four rooms unless you believe that having the debates in the same room will not distract students from their own debate or that it will not get too noisy.  Human resources necessary for its implementation. You may need more than one teacher if you use two rooms. During the debate, they should act as debate moderators. After the debate, they should facilitate the discussion.

 

During the activity

Step 1. Description of the activity. The teacher introduces the learning objectives of the session, the content (i.e. ethical principles in healthcare) and approach. S/he forms the debate groups and picks the observers, sets the rules of the debates and timeline of the activity (15 min).

Step 3. Group organization and positions: Each group will receive a case that they must analyse. Furthermore, within each group, two subgroups will be formed, each of which will be assigned two opposing positions regarding the dilemma presented in the case (in favour and against the dilemma posed by the case).

Step 3. Literature search. Once students are aware of the case they will debate and the position they have to defend, they’ll do a brief literature search to prepare the arguments that they will use during the debate. They should gather supporting evidence and examples, anticipate counter-arguments and prepare rebuttals to these and plan the order and content of speakers. (20 min)

Step 4. Debate(s). The moderator of each debate selects the team that starts debating and sets the flow of the debate afterwards. The debate will be conducted in a structured manner: Firstly, both groups will have 2 minutes each to provide an introduction of their arguments and positions. Subsequently, the main debate interventions will follow, specifically, two alternated interventions per group (in favor – against – in favor – against). Each of these interventions will have a maximum duration of 4 minutes, and the opposing side may ask questions during the exposition. Groups may use rebuttal arguments during this main interventions. Finally, each group will have 3 minutes for closing statements in which to present the conclusions of their arguments, with no opportunity for rebuttal or interruption of the rival position.

Step 5. Whole group reassembly and observers recapitulation. External observers (they can be either other groups or the teacher) explain to the whole group the description of the case that was debated and the points of view that emerged during the discussion. They can also point out non-answered questions or topics, or also clarify misunderstood contents. (15 min)

Step 6. Reflection. Students reflect on the ethics of the cases they debated and the arguments used, as well as on their performance and how they felt advocating for a pre-set position. (20 min). Finally, students may be asked to generate arguments to position themselves as professionals.

 

After the activity

After group reflection it’s time for self-reflection, both in terms of how they functioned as a group of debate and individually. You can use the following sheet so that they can write down their impressions. 

 

Interpersonal/socio-emotional
Let’s assess us! How did we do in terms of…
…communication Able to express ideas clearly and fluently. Able to use non-verbal communication and active listening and/or show empathy (if possible according to the assigned role).   …relationships and cooperation Able to work cooperatively with others: listens to others, incorporates what others say, encourages peers’ participation, engages in group decision making, helps peers selfishly, and accomplish shared goals.   …conflict management Is able to facilitate conflict resolution, remains calm under pressure, and control one’s emotions in conflict situations.
Things we can improve
Things we did awesome
How did I do
Critical and creative thinking
Let’s assess us! How did we do in terms of…
…problem-solving Able to identify and deal creatively with unexpected, unforeseen, and complex situations that can be exploited, and to evaluate different solutions.   …systems thinking / interdisciplinarity Able  to collectively analyse complex systems; to think of how systems are embedded within different domains (society, environment, economy, etc.) and different scales (local to global); and to deal with uncertainty.   …critical analysis Able to acquire, process, produce, and evaluate information critically and from the perspectives of different fields and decisions, considering both individual and community perspectives.
Things we can improve
Things we did awesome
How did I do
Learning to learn
Let’s assess us! How did we do in terms of…
…metacognitive skills Able to to use prior knowledge to plan a strategy for approaching a new task, and to transfer what they have learned from one context to another, or from a previous task to a new task.   …lifelong and non-formal learning Able to recognize learning possibilities (outside of formal studies) and reflect on them as learning outcomes in relation to their own profession.
Things we can improve
Things we did awesome
How did I do
Write down any other observation or thought that you may have…

Role of teacher(s)

The role that teachers will assume in facilitating and moderating debates is crucial for creating an environment conducive to learning and the development of debating skills in students. Here are some additional considerations about the responsibilities of the teacher in this context:

1. Organization of debate groups: Teachers should group students fairly and consider the diversity of opinions and skills in each group. This can promote a more enriching and constructive debate.
2. Preparation of arguments: Assisting students in preparing their arguments involves providing guidance on how to research, structure, and support their viewpoints. Teachers can provide resources, suggest readings, and offer guidelines for building strong arguments.
3. Impartial observation: During debates, teachers should maintain a neutral position and not take sides. This allows students to feel free to express their opinions and develop their argumentation skills without fear of immediate criticism.
4. Time management: Using a visible timer is an excellent way to keep the debate organized and fair. Teachers can be responsible for controlling the time allocated to each side and ensuring it is respected.
5. Tolerance for invalid or erroneous arguments: It is essential to allow students to make mistakes and express invalid arguments during the debate. These moments can serve as learning opportunities and foster critical thinking when discussed and corrected after the debate.
6. Post-debate feedback: After the debate, teachers can provide constructive feedback on students’ performance. This may include praise for strong points and suggestions for improvement in specific areas. They can also facilitate discussions about the dynamics of the debate and the theoretical foundations behind the arguments presented.
7. Encouragement of reflection: Teachers can guide students in reflecting on their experience in the debate. Questions like “What did you learn?” or “How could you improve in the next debate?” can help students internalize the lessons and develop their debating skills over time.

Evaluation tool

Transversal skills are difficult to evaluate, particularly among big groups of students. Therefore, in this section we propose a tool for students to self-assess the development of these skills. The tool is divided into three dimensions: suitability of the learning activity, level of achievement of learning outcomes, and transferability to professional settings. You can adapt the dimensions and/or indicators that you use according to your teaching-learning context and needs. 

 

Evaluation tool to self-assess the development of skills during the activity

For each of the following statements, select the best answer on a scale from 1 to 4, where 1 means “Not at all” and 4 indicates “Yes, totally”. N/A means “not applicable”.

	1	2	3	4	N/A
DIMENSION 1. Suitability of the learning activity
I found this learning activity adequate in terms of time
I found this learning activity adequate in terms of resources (material resources, physical space, etc.)
I found this learning activity adequate in terms of content
I found this learning activity engaging
I found this learning activity challenging
I found this learning activity disruptive in comparison with other learning methodologies
I found this learning activity useful to learn [add the subject]
I found this learning activity useful to retain knowledge
This learning activity motivated me to deepen my knowledge of [add subject or hard skill]
This learning activity allowed me to feel emotions that would be rather difficult to experience with other learning methodologies
I would recommend this learning activity to others
DIMENSION 2. Level of achievement of learning outcomes
This learning activity helped me to improve…
…my ability to [add a row for each learning outcome of the activity that you performed, both related to hard and transversal skills]
DIMENSION 3. Transferability to professional settings
After this learning activity…
…I will be better able to apply what I learned to my reality (everyday life, classroom, professional life)
…I feel more capable to perform in a professional setting
…I feel I can make better choices regarding professional situations
…I feel more prepared and self-confident to address professional situations
OPEN QUESTION – Use this space to explain whatever you think is remarkable from the learning activity, including strengths, weaknesses, improvements, potential uses, feelings or dilemmas you encountered during the activity.

 

Download evaluation tool in pdf here.