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586Challenges for Bioethics from Asia

Teaching about Truth Telling

- Dena Hsin-Chen Hsin, R.N., M.Sc..

China Medical University, Taichung, Taiwan, ROC; Graduate School of Life and Environmental Sciences, University of Tsukuba, JAPAN

Email: dena-hsin@umail.hinet.net

As part of the bioethics education project, a chapter on telling the truth about terminal cancer was used to introduce the bioethical principles of respect for personal autonomy, doing good and do no harm in order to make persons be aware of the truth and to help them to make decisions by themselves. The reflection on this bioethical dilemma can stimulate students to pay attention to the risks and benefits of decision-making and to also provide a stimulating bridge between real-life issues and factual information from medicine, sociology, psychology, culture, bioethics and other disciplines.

In Taiwan, we had bioethics teaching trials in the university and high school level. In university, it was used in first year General Education English courses. We chose five classes in the paramedical departments of a medical university; those were from the departments of Oral Hygiene, Public Health, Sport medicine, Occupation Safety and Cosmetics Pharmacy. In high school, bioethics class was used as a supplementary topic in a Science Course.

In university classes, learning from team work was encouraged as a way to approach bioethical deliberation. In accordance with the method of autonomous learning, students were grouped into several teams. Each team was given the freedom to select the chapter they felt most interesting to work on and present in class. Truth telling, which was selected by 1-2 teams in each class, was one of the most popular chapters among the 14 chapters of the Bioethics textbook material. Reasons given by students about why they chose truth telling as their topic were impressive. The most common reason was they thought it was a popular, important and intimate issue for everyone, thus choosing this would lead to more chances of success in their presentation.  Through this topic, many of them expressed that it would be help them prepare themselves in helping patients in the future. Some had experiences and deep thoughts about it and would like to share or discuss with others. They also believed that this was a way to face the truth about human life. Therefore, in many groups, members were unanimous in choosing truth telling as their topic. After they have decided on a chapter to work on, students were able to review the context, to go on reference searches and to design their class activity. During their presentations, there were various activities, including drama, cluster discussions, invited gueststalks, film show (made by themselves), and short talks from team members. The teacher would summarize and give supplement about the topic after their presentations. In general, students enjoyed this creative and autonomous way of presenting a topic like telling the truth.

In the high school, assigned readings were followed by one hour classroom discussion and a short introduction by teacher. Students also wrote down and handed in their answers of the discussion questions after class. During the classroom discussions, most students supported the stance of telling the truth to terminal cancer patients (39/42). They cited the following reasons for doing so: every individual has right to know the truth relevant to themselves, the truth is always better than a lie, people will benefit from the truth, and practically, it is impossible to hide the bad news from patients and personal concern. Many students supposed that people would be more harmed if they get to know the cruel fact at the last moment. There were a few students who shared their personal experiences as real cases to illustrate that telling the truth will benefit patient. Only one student did not support telling the truth and two students said they were not sure. They considered that patients would be harmed and they wondered who can cope with such cruel truth. For example one said: “as a human being one can never be ready for his own death”. We are not surprised to find that there were not many diverse opinions in the high school class.

. pp. 586-589 in Macer, DRJ., ed., "Challenges for Bioethics from Asia" (Eubios Ethics Institute, 2004).

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