The early years of the 21st century are rife with ethical ambiguity, as technological advances call for decision-making never before imagined, and top people in many fields are making choices that don’t necessarily advance the public good. It’s happening in the business world, with the recent Volkswagen emissions scandal; the political world, where politicians in Flint, Mich., ignored lead poisoning in the water; the public education arena, where the inequitable allocation of limited resources is glaring; and the world of medicine (witness the state of Maryland’s recent debate over right-to-die legislation). Against this backdrop, Johns Hopkins professors are expanding ethics programming to prepare undergraduate students to navigate tomorrow’s complex issues.
To prepare Johns Hopkins students for tomorrow’s ethical dilemmas, professors across the university—including at the Krieger School of Arts and Sciences—are expanding ethics programming in some unexpected ways.
Why study ethics?
“Ethics is the study of what’s the right thing to do,” says Hilary Bok, associate professor in the Department of Philosophy, who directs the Krieger School’s minor in bioethics and teaches the school’s introductory bioethics course. “In thinking about how you should live your life, ethics is just doing it in a more systematic way, if done right.”
The value of a course in bioethics is clear for those planning careers in medicine or public health. But Bok and her colleagues say that all undergraduates benefit from exposure to the concepts covered in the class, and from practice using the intellectual tools involved.
Johns Hopkins bioethicist Ruth Faden notes that ethics is an important academic offering for two reasons. The first is its role in preparing undergraduates for their place in civic life, for voting or taking public positions on such matters of public deliberation and policy as federal funding of stem cell research, or the allocation of scarce resources. The second reason is to help prepare them for the health issues they will inevitably face, giving young people exposure to the reasoning that goes into such health decisions ahead of time. “Some of the most challenging issues in serious illness or injury involve ethical conflicts,” says Faden, the Andreas C. Dracopoulos Director of the Berman Institute of Bioethics and the Philip Franklin Wagley Professor of Biomedical Ethics.
Studying ethics teaches students how to diagram a problem, Faden notes. They learn to tease out how much of an issue is empirical, legal, ethical, or religious. Once they have a handle on what is at stake—what the “it” is—they are better equipped to consider the arguments for and against the various positions, and how to discern whether they are good arguments, instead of mere opinions. Such reasoning can both clarify our own positions and allow us to engage with others, Faden says, whether the occasion is a cocktail party debate about how to vote on an upcoming referendum or a family meeting about a very sick mother: Is the “it” in this case Mom’s best interests, or the family’s interests, or what Mom would want if she were conscious, or the decision’s impact on Dad?
“In personal life and public life, you have to be able to provide good reasons for the moral positions you defend, and you have to be able to recognize and evaluate the reasons put forward by others,” Faden says.
Bok especially enjoys watching undergrads realize their responsibilities in how they use their reasoning: that taking a position in one area has implications in others, and they can’t make conflicting arguments and just write it off as self-expression. Thinking more rigorously helps them recognize that arguments can be valid or invalid, and have consequences across the board.
“The fact that they previously committed themselves in one conversation means they can’t just say this other thing,” Bok says. “Some have not realized that the same intellect they bring to bear in other areas of academic study can be brought to bear in how they live life.”
A practical matter
Last year, faculty across the university were invited to submit proposals for the new Johns Hopkins Exploration of Practical Ethics program, designed to fund research, educational experiences, or other activities focusing on ethical issues across a broad variety of scholarly disciplines. In 2016, nine projects received $75,000 to $100,000 each to examine subjects including criminal justice, higher education, economics, and environmentalism.
One grant recipient, anthropologist Anand Pandian, is using the study of plastic to examine the relationships between contemporary human societies and the natural world, and how to conceive those relationships in a less antagonistic manner.
“I think of ethics as an occasion to examine how people craft their lives in relation to moral ideals and values of particular kinds, the relationship between morality and everyday life. Plastic is a good vehicle to think about ethics because it’s a pervasive feature of everyday life, but so morally charged with both utopian promise and nightmarish consequences,” says Pandian, director of undergraduate studies in the Department of Anthropology.
I think of ethics as an occasion to examine how people craft their lives in relation to moral ideals and values of particular kinds, the relationship between morality and everyday life.”Anand Pandian, Associate Professor, AnthropologyAnand Pandian, Associate Professor, Anthropology
A plastic object is so common as to be almost meaningless—we might use a fork for a few seconds—but plastic in aggregate is a problem of “horrific” scale, Pandian says; one recent study hypothesized that 90 percent of seabirds may have ingested it. So the problem of plastic becomes one of ethics, involving our relationship with things and the environment, our choices and habits, and what we do and do not pay attention to, he says.
Pandian is using his university funding to gather stories of individuals cultivating unexpected relationships with plastic—artists who comb beaches for plastic waste to use in their artwork, for example, or museum professionals who conserve disposable plastic consumer artifacts—to help people reconsider their own relationships with plastic as a catalyst for change. “I’m drawing on my anthropological training to arrive at some better sense of this problem and how we might be able to tackle it,” Pandian says.
From the beginning…
“If you go back to the beginnings of the humanities, science and the humanities were one discipline,” says Charles Wiener, professor of medicine at Johns Hopkins School of Medicine and interim director of the Krieger School’s new major in medicine, science, and humanities.
At the Krieger School, he says, “we were giving courses in the humanities that dealt with science and medicine, and [we felt] the [new] major was a great way to capitalize on all those existing resources and pull a new demographic of students into the humanities because of their preexisting interest in science.”
The major in medicine, science, and humanities, created by the Krieger School in 2015, is geared for students who want to examine medical and scientific issues “through the lens of humanities studies.” Along with taking courses in departments including languages, history, and the Writing Seminars, students can choose the introductory bioethics course to fulfill the major’s requirements. So far, about 20 students intend to major in medicine, science, and humanities. The major’s stated goal is to produce graduates equipped with “the capability to critically evaluate how medical institutions and practices interact with a culture’s beliefs and values.”
Wiener notes that very few of his physician colleagues wish they had taken more science classes as undergrads, and many regret not taking more classes in the humanities. Ethics, he says, is one component involved in placing medicine within a humanities framework. Doctors are better doctors when they can relate to the human experience, and when they have broad life experiences familiarizing them with human struggles and triumphs through the lens of a variety of art, literature, and philosophy. It’s part of what helps them communicate and empathize with patients.
“As a patient, I want a doctor who’s really smart and knows biology and biological processes, but who can also feel my pain and understand my circumstances when trying to tell me how best to restore my health. To understand ethics, you have to understand the human experience: what is fair and right and just,” he says.
Physicians also need that broad background when navigating the increasingly complicated priorities that advances in medical science make possible, he says. Informed consent has become a thorny area, for example; truly informing a patient requires relating to him as a human being as well as a doctor. The considerations involved in palliative care have roots in the discipline of elegy. And as a pulmonologist, he’s encountered situations when his role as patient advocate conflicts with his role as society’s steward.
“What is best for patients versus what is best for society is not always aligned, necessarily,” he says. “At that moment, I’m the patient’s advocate; it’s not at that moment that I am society’s representative, necessarily. Other times, I may be. How you deal with such ethical considerations is a function of not only training, but life experience.”
The road to enlightenment
Given the issues involved in the health care field today—like confidentiality, surrogacy, abortion, and physician-assisted suicide—Bok says it’s imperative that medical schools include ethics in their curricula. But, she adds, students really need that exposure when they are undergraduates, before entering medical school and facing the accompanying hard work, time-consuming activities, and sleep deprivation.
Consider the example of animal research, Bok says. In research involving humans, institutional review boards provide extra protections for those viewed as vulnerable: children, the mentally ill, the cognitively disabled. But with animal subjects, their lack of reasoning ability is considered grounds for permitting experimentation that would be impossible with humans—vaccine challenge studies, for example. Bok asks: From an ethical standpoint, why is it acceptable to apply special safeguards in one instance and disregard them in another? “Either experimentation is fine on nonhumans or it’s not, but the fact animals don’t have reasoning capacity can’t be the reason it’s OK to use them, or it would be fine to experiment on children and the disabled,” she says.
A physician needs to understand both sides of issues; there’s not a single right way to do things.”Meghana Kalavar ’15Meghana Kalavar ’15
“That’s not a good question to [tackle] when you’re sleep-deprived. It’s a good thing to have kicking around in your head already when you get to medical school,” she adds.
Medical school preparation was one reason that Meghana Kalavar ’15 took Bok’s introductory bioethics course in her sophomore year. The patient–physician relationship is very fluid, she says, and a firm grounding in bioethics provides an importantly nuanced perspective on a variety of topics. “A physician needs to understand both sides of issues; there’s not a single right way to do things,” says Kalavar, now earning her master’s in health sciences at the Bloomberg School of Public Health.
Kalavar loved the course so much that she added a bioethics minor to her public health major at the Krieger School and completed an independent study with Bok, focusing on an ongoing interest in opioids and pain management from a bioethics perspective. She also joined the board of the Johns Hopkins Undergraduate Bioethics Society, whose mission is giving undergrads an outlet to develop their bioethics skills and apply what they’ve learned in their coursework to ethical issues in medicine, biology, and other sciences through debates, lectures, films, and other forums.
Sophomore Zaya Amgaabaatar took Bok’s course the first semester of her freshman year, thinking that it fit well within the intersection of law, medicine, and policy that she plans to settle into as a medical malpractice attorney. She was so fascinated by the topics and thought processes that she went on to add the bioethics minor, along with her minor in entrepreneurship and management and majors in public health and philosophy.
“The class challenged the way I think but showed me the way I think at the same time,” she says. “It showed me how I reach values I had thought innate, made me more aware of opinions and conclusions I have.”
Pre-med or not, all students have something to gain by studying bioethics, Amgaabaatar says. For her, it was important to learn that issues she expects to face in her professional future—universal health care, for example, or abortion—appear in very black-and-white terms in legislation, but are not so simply defined from a philosophical point of view.
“Bioethics straddles the line between confusing and enlightening,” she says, “and is often both at the same time.”