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Introduction to the Project on Bioethics for Informed Choices - page 57 / 115





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Bioethics Education587

According to their maturity, status, and experience in life, they may not be able to easily consider the different reactions to a dilemma of disclosing the bad news or hiding the truth to the dying patient.  Using the simple version of the telling the truth chapter, students may learn how to balance doing good against risks of doing harm and make good choices through the bioethical principles. Besides this, we hope they may also learn perspectives from different persons and these different points of views are valuable and important in resolving dilemmas.

Generally, in high school science classes, students can easily focus on the facts and the steps that humans carry out in modern technologies However, a teacher with bioethical maturity who may guide students not only to get to know the facts of science but to get around to consider the question "ought we to use this technology or carry out this procedure just because we can?" For example, when the topic is on the benefits and risks in nuclear power use, students can easily catch the points from their real life experience. In bioethics learning, the teacher should always point out the “ought” issues, and encourage students to consider every aspect of benefits and risks in this subject to find the best answer which has effects both in the present and the future. Compare to the “oughtissue “of using many new technologies, telling the truth about dying is a less remote issue in our real life. Through discussion of real life cases, students can develop their analytical, critical-thinking skills and learn strategies for solving practical problems in everyday affairs.

To compare two stages of learning in this topic, we found that there are certain difficulties in the high school context compared to that of the university. In general, exam-oriented teaching and rigid curriculum design were the most obvious problems in implementing the bioethics education project in Taiwanese high schools. Aside from this, in the subject of truth telling, a different level of thinking was also detected. For example, in the discussion question of  “If you only had a week to live, how would you like to spend that week?” High school students gave lots of fancy ideas, such as; “I would do whatever I want to do and nothing or no one can stop me. There are no moral constrictions.” However, in university, students’ answers showed deeper reflection:”to say thanks to some one who love them, to say sorry to someone they did wrong to, or have a farewell party to say good bye.”  Those descriptions conformed to the behavior of letting go which is assumed to be a necessary element of a peaceful dying process. If so, the short term targets of life education can be achieved through teaching the telling the truth chapter. In university class, many other thoughtful considerations related to terminal issues were brought up. For example, curing verse caring---which is possible to accomplish in this terminal stage? Survival rate verse quality of life---what is important for patients at moment? The truth or the art of telling the truth--- what is the more appreciated?

After the team presentations, the classroom survey showed that more than 90% of students would like to be informed if they had terminal cancer. Nevertheless, less than 30% students were sure that they would tell their mother or father the truth if she or he had terminal cancer. The ratio of supporting truth telling to oneself and to others were extremely different compared to a previous randomized survey in campus, the results of which were 65% vs. 53%. Because of this result, many would wonder about the efficacy of teaching telling the truth. I suggest reflecting upon this result from two points of views. First, how much can a quick response from a person walking in campus tell us about a hypothetical question? To believe the quantitative result of a simple survey without any consideration on the context and background of the answers is always dangerous. Second, what is the target of bioethics education? To make sure students will comply with the mainstream value system? Or to make sure about the abilities of deliberation based on bioethics maturity. Hesitating to tell the truth resulting from a thoughtful consideration should be treasured as a midterm achievement in the long-range goal of bioethics education. Although, hesitating to tell the truth, which disrupts the principle of autonomy, may bring sorrow and regret for both family and patient. Nevertheless, a careless telling, which is against the principle of do not harm and doing good, may cause more harm. We are satisfied to know that students are aware of the insufficiency of telling the truth. And we hope this bioethics topic may help them prepare

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