contributions to the ‘new sciences and technologies’, such as in biomedicine. The teachers’ role is in flux. It gradually changes from being bullied by a “curriculum by command”, towards a curriculum by the faculty’s design and individual teachers’ discretion. It becomes more urgent that ethics teachers enable students to cope with the real difficulties in their future jobs.
Besides many other tasks, ethics is needed to remind medicine of her larger perspective of ‘doing the right thing’, qualified by the aspiration to contribute to a good life, from the humane medical view. Modern health professionals are expected to handle different situations appropriately. They need to exercise their intellectual creativity, and refine their sense of empathy beyond the scope of paternalistic sympathy. Ultimately, they have to take responsibility and “speak up” (Dwyer 1994). Obviously, the capacities of teaching methods that ‘fill in’ students with factual knowledge and ethical theories are limited in supporting such a goal. They can be prepared through interactive, multiple and practice oriented methods that allow much freedom in learning by trial and error.
4 Education in medical ethics with respect to cultural diversity in China
I was offered the opportunity to conduct two training courses for medical ethics teachers in China, in 2002 and 2003. Each course enrolled about 30 participants, from most of the Chinese provinces. Experts in bioethics, medical ethics, philosophy and teaching ethics from China and abroad introduced a diversity of teaching methods, theories in pedagogy and ethics and main issues in contemporary medical ethics.
All participants were encouraged to actively engage in a critical and constructive process of learning, so the particular situation of students would be appreciated. It seemed important to show the extent to which ‘good teaching’ depends on the personal engagement, beyond theorising, of the humans who act as teachers and students, or, as doctors and patients, respectively. Learning to take responsibility, to develop a ‘physical’ sense of practical options, and being encouraged to use one’s practical reason creatively in ethics need to be embedded in real life’s experience. Hence the emphasis on methods, ‘how to teach’, and a ‘design under construction’ was deliberately chosen so as to bring life to ethics and ethics to life. If a slogan is taught, such as ‘medical ethics must be person centered, patient centered and problem centered’, it was illustrated how the teacher communicates with students and lets the students engage in structured discussion among each other. He should display genuine care about ethical, moral and social issues, as they are presented as of the classes concern.
Opportunity provided the course in the summer of 2003 with ‘SARS as an ethical test case’ (Dwyer). It was used as an empirical reference for multiple tasks (e.g., teaching stiles, group work; involving social, political, clinical and individual patients’ dimensions). After examination of mid-term evaluations (which had been a tool hitherto unknown to participants), we allotted more time to probe into issues that matter to participants and their students. They served as instances of concern and points of departure, in order to elaborate, ‘how to teach’ understanding and addressing such topics while teaching ethics to medical students. Hence, health problems related to pollution or environmental problems, and puzzling cases from the health system and administrative and legal modernisation were debated. It was the particular concern of the foreign lecturers to address bioethical issues that arise out of social problems and structures in China. By reacting to students‘ articulated interests and concern the lecturers build bridges that connect medical ethics, decision making and broader questions. It turned out to be easier to engage participants (implying students as well) in ‘trivial little dilemmas’ than by discussing ‘sexy cases‘ or ‘hot issues’, such as human cloning or what defines personhood. Those topics, owing to their abstract, technical or rare practical occurrence failed to mobilise considerable moral engagement beyond curiosity or prudence.
Upon analysis, the problems identified in case discussions revealed that the topics at the heart of participants’ anxiety did not differ as much between views from China or other nations as many had expected. Basic moral intuitions did not seem to be controversial. For example, there was no controversy regarding the doctor’s primary concern with the wellbeing of the individual patient, or that the doctor should consider his social responsibility. However, the