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Teachers Resources
and Notes for

A Cross
-
Cultural
Introduction to
Bioethics






Darryl R.J. Macer, Ph.D.

(Editor)






(draft version
3
,
22 January 2007
)

Eubios Ethics Institute 2006


2

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


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I
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Bangkok

Christchurch

Tsukuba Science City


T
he Eubios Ethics Institute is a non
-
profit group that aims to stimulate the discussion of ethical
issues, and how we may use new technology in ways consistent with "good life". An important
part of this dialogue is to function as an information source for
those with similar concerns.
Other publications are listed at the end of this book. The views expressed in this book do not
necessarily represent the views of the Eubios Ethics Institute or UNESCO.


Copyright © 2006 Eubios Ethics Institute

All rights reser
ved. The copyright for the complete publication is held by the Eubios Ethics Institute.
No part of this publication may be reproduced except for personal use, and non
-
profit educational use,
without the prior written permission of the Eubios Ethics Institu
te.


Cataloging
-
in
-
Publication data

Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

/ editor, Darryl R.J.
Macer.

Christchurch, N.Z. : Eubios Ethics Institute ©2006.



1 v.


100 pp. A4 size.

ISBN 0
-
908897
-
2
4
-
3


1. Bioethics. 2.
Medical ethics 3. Environmental Ethics 4. Bioethics Education 5. Genetics 6.
Neurosciences I. Macer, Darryl R.J. (Darryl Raymund Johnson), 1962
-

IV. Eubios Ethics Institute. V.
Title (
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioe
thics
).


Key Words: Asia, Biodiversity, Bioethics, Bioethics Education, Biotechnology, Body, Cloning,
Education for Sustainable Development (ESD), Economics, Energy, Environment, Environmental
Ethics, Eugenics, Genetic Engineering, Genetic Screening, Genet
ic Therapy, Human Genetic Disease,
Human Genome Project (Scientific, Ethical, Social and Legal Aspects), Medical Ethics, Medical
Genetics (Diagnosis, Treatment and Prevention), Patenting of Life, Peace, Reproductive Technology,
Surrogacy, Sustainable Devel
opment.


On
-
line version and teachers guides, references, Internet links

Project site
<http://www.unescobkk.org/index.php?id=2508>


On
-
line version of the textbook / resource book can be downloaded from

<http://eubios
.info
/ccib.htm>


On
-
line version for l
atest edition of Teacher Resources can be downloaded from

<http://
eubios.info/
BetCD/BetbkTR.doc>


Further copies can be obtained from the Eubios Ethics Institute.


c/o Darryl Macer, Ph.D.,

Director, Eubios Ethics Institute

c/o UNESCO Bangkok,

920 Sukhum
vit Road, Prakanong, Bangkok 10110, THAILAND


Tel: +66
-
2
-
391
-
0577 ext 141

Fax: +66
-
2
-
664
-
3772

Email: d.macer@unescobkk.org



The above address should also be used to send feedback forms from teachers and students!

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

3

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


Content list


Preface











5


Evalu
ation and Go
als of Bioethics Education

1: Goals of Bioethics










7

2: Evaluation











8

3: Stages in moral development








11

4: Ongoing reassessment and evaluation







14

5: Participatory Methods









16

6: References











17


Ex
planation of chapters



(Page numbers refer to the page in the textbook)

A. Bioethics and the Ethics of Science and Technology

1. Making Choices, Diversity and Bioethics







1

2. Ethics in History and Love of Life








6

3. Moral Agents










18

4
. Ethical limits of Animal Use








22

5. Ethics and Nanotechnology








27


B. Environmental Ethics




1. Ecology and Life










30

2. Biodiversity and Extinction









36

3. Ecological Ethics










40

4. Environmental Science









43

5. En
vironmental Economics









51

6. Sustainable Development









63

7. Cars and the Ethics of Costs and Benefits







73

8. Energy Crisis, Resources and Environment






78

9. Ecotourism











85

10. The Earth Charter

Initiative








93


C. Gene
tics








1. Genetics, DNA and Mutations








98

2. Ethics of Genetic Engineering








102

3. Genetically Modified Foods








107

4. Testing for Cancer Gene Susceptibility







110

5. Genetic Privacy and Information








113

6. The Human Genom
e Project








117

7. Eugenics











121

8. Human Gene Therapy









122

9. Universal Declaration on the Human Genome and Human Rights



129

10. International Declaration on Human Genetic Data





134


D. Medical Ethics




1. Informed Consent and
Informed Choice







145

2. Telling the Truth about Terminal Cancer







147

3. Euthanasia











153

4.
Brain Death











158

4

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


5. Organ Donation










164

6. Brain Death and Organ
Transplant Drama






170

7. The Heart Transplant









17
5

8. SARS (Severe Acute Respiratory Syndrome)






176

9.
AIDS and Ethics










177

10. Ethical Principles for Medical Research Involving Human Subjects



183

11. Bird Flu











188

12. Indigenous Medicines and Access to Health






189


E. Reprod
uction

1. Lifestyle and Fertility









192

2. Assisted Reproduction









198

3. Surrogacy












204

4. Choosing Your Children’s Sex and Designer Children





205

5. Prenatal Diagnosis of Genetic Disease







208

6. Female Infanticide










211

7. Human Cloning










214

8. United Nations Declaration on Human Cloning






215

9. Human Genome Organization (HUGO) Ethics Committee Statement on Stem Cells

222


F. Neurosciences







1. Advances in Neuroscience and Neuroethics






224

2. Le
arning to Remember: The Biological Basis of Memory





229

3. The Neuroscience of Pleasure, Reward and Addiction





235


G.

Social Ethics

1. Revisiting the Body









241

2. Child Labour










251

3. Peace and Peace
-
keeping









253

4. Human R
ights and Responsibilities







269




Movie Guides and Questions (Samples)







277


Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

5

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


Preface


This teacher’s guide is available for use to accompany the textbook,
A Cross
-
Cultural
Introduction to Bioethics
, which is available in both hard copy or as a
soft copy to download
without charge from the Internet. The teach
ing resources and notes include

academic
references, further reading, Internet sites and other information that supplements the
text/resource book. This book may be useful for teachers as the
y teach bioethics, and for
students who wish to write reports and do their own research on the topics in the textbook.


The first section is a general introduction to evaluation of bioethics that I have written to
help teachers examine what bioethics is. T
here are many goals of bioethics and they are
discussed here.


The order of the teaching resources and notes for each chapter follows the same order as
in the textbook. This book will be regularly updated on
-
line. Please refer to the textbook itself
for th
e authors who contributed to the chapters, and who have compiled reference lists for
those who wish to examine the background behind the chapters. The student and teacher
feedback forms are printed in the textbook, and can be downloaded with the preface of

the
book. The on
-
line version of that book can be downloaded from <http://
eubios.info
/ccib.htm>


Bioethics could be defined as the study of ethical

issues and decision
-
making associated
with the use of living organisms.
Bioethics

includes both medical eth
ics and environmental
ethics. Bioethics is learning how to balance different benefits, risks and duties. Concept
s of
bioethics can

be seen in literature, art, music, culture, philosophy,

and religion
, throughout
history
.

Every culture has developed bioethi
cs, and in this book there is a range of teaching
resources that can be used that are written from a cross
-
cultural perspective by a variety of
authors.


In order to have a sustainable future, we need to promote bioethical maturity. We could
call the bioe
thical maturity of a society the ability to balance the benefits and risks of
applications of biological or medical technology. It is also reflected in the extent to which
public views are incorporated into policy
-
making while respecting the duties of soci
ety to
ensure individual's informed choice. Awareness of concerns and risks should be maintained,
and debated, for it may lessen the possibility of misuse of these technologies. Other important
ideals of bioethics such as autonomy and justice need to be pr
otected and included when
balancing benefits and risks.


Bioethics

is not about thinking that we can always find one correct solution to ethical
problems.
Ethical principles and issues need to be balanced. Many people already attempt to
do so unconsciousl
y. The balance varies more between two persons within any one culture than
between any two. A mature society is one that has developed some of the social and
behavioural tools to balance these bioethical principles, and apply them to new situations
raised
by technology.



The objectives of this guide and the on
-
line multilingual resources at UNESCO
Bangkok website and the teaching pack on the Eubios CD are to provide a free on
-
line
resource teachers and students can use to learn about bioethics, and think m
ore widely about
life. A variety of styles are used, and we would like feedback from teachers, students, anyone
who wishes to use it.


6

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


List serves function in English for educators and students, and persons from a wide
range of countries have tried these
resources, and contributed to this project over the past three
years.

Internet site <http://www.unescobkk.org/index.php?id=2508>

Internet site <http://
eubios.info
/betext.htm>

Education listserve <http://groups.yahoo.com/group/Bioethicseducation/>

Student l
istserve
<http://groups.yahoo.com/group/ Bioethics_for_students/>


Teaching Guides, References, Internet links (this document)

<
http://
eubios.info
/BetCD/BetbkTR.doc
>


This project aims to produce free on
-
line teaching materials for bioethics education in
different countries. The main products will be: 1) Materials for teaching bioethics; 2) A
textbook that could be used in school and university classes to teach about bioethical issues;
and 3) A network of teachers in different countries.


The Eubios Ethics

Institute website has over 2000 files available for download,
including the UNESCO/IUBS/Eubios Living Bioethics Dictionary, and regular News updates.
Further copies of chapters and updates, teaching guides, evaluation sheets, etc. are available
upon reque
st. We are also interested in assembling student projects and different teachers'
materials in a global site that all can use, and can inform us all. We welcome improvement and
additions to this project.


The project described herein will continue
under t
he framework of

a Bioethics
Education Textbook Project of UNESCO Bangkok, continuing to gather more teaching
resources in multiple languages from around the world

and make them openly available.
A
network of educators to improve global bioethics education
has been developed under the
International Bioethics Education Network. The lessons from the project
need to be developed

in the context of policy and curriculum in a number of countries.









Darryl Macer, Ph.D.







Editor

All suggestions to

Darryl
Macer, Ph.D.,

Director, Eubios Ethics Institute

c/o UNESCO Bangkok,

920 Sukhumvit Road, Prakanong, Bangkok 10110, THAILAND

d.macer@unescobkk.org

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

7

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


Evaluation and Goals of Bioethics Education

1:
Goals of Bioethics


There can be several goals of bioethics ed
ucation, and each could be associated with
different measures in evaluation.
There does not exist a consensus in the academic literature
and teaching community on the
most important goals to measure nor on the
best criteria to
assess

whether the education
is successful
. For more than 60 years it has been recorded that
both quantitative and qualitative data are important in social science research, as was said by
Merton and Kendall (1946), "Social scientists have come to abandon the spurious choice
between q
ualitative and quantitative data: they are concerned rather with the combination of
both which makes use of the most valuable features of each. The problem becomes one of the
determining at which points they should adopt the one, and at which the other, ap
proach". Thus
an appropriate methodological tool should contain methods to utilize and assess both types of
data.

The goals of bioethics that were important to measure were found to include: 1)
Increasing respect for life; 2) Balancing benefits and risks o
f Science and Technology; 3)
Understanding better the diversity of views of different persons; 4) Understanding the breadth
of questions that are posed by advanced science and technology; 5) Being able to integrate the
use of scientific facts and ethical p
rinciples and argumentation in discussing cases involving
moral dilemmas; 6) Being able to take different viewpoints such as biocentric and ecocentric
perspectives. We do not need to achieve all goals to consider a class to be successful, and
different tea
chers and schools put a different amount of emphasis on each goal.

One important goal of

teaching about bioethical issues is to get students to critically
evaluate the issues (Conner, 2003). In a Mexican case (Rodriguez, 2005), bioethics classes
were used

as a way to improve the general behaviour and study aptitude of students.
Each
institution is likely to put a different amount of emphasis on each goal. Also, different activities
are likely to enable some goals to be met and not others (Macer, 2004c). Th
erefore we do not
need to assess all the institutional objectives when evaluating the success of the trials. Instead,
case studies of how students and teachers responded were also sought to give a wider
descriptive account of various approaches.

One of the

goals of this project was
to examine criteria that could be used to measure
the success of bioethics education, and the effectiveness of different forms of education for
making mature citizens.
There is a consensus among many
Western
scholars that the bal
ancing
of four main bioethical principles, which are Autonomy, Justice, Beneficence and non
-
maleficence, is central to making better decisions (Beauchamp and Childress, 1994). These
principles are introduced in chapter 1 of the text. Autonomy includes ide
as such as respect for
privacy, respect for personal choice. Justice is to respect the autonomy of others, and to treat
persons equally. Beneficence is to try to do good, and non
-
maleficence is to avoid harm.
When solving or trying to reach a consensus
about bioethical problems, these four main
principles can be a good guide in balancing which ideas should be mostly weighed. One
measure of bioethics education could then be whether students are able to use these principles
in decision
-
making, which was e
xamined by presence of these keywords in discourse (oral or
written). In the future the use of principles as expressed in the UNESCO Universal Declaration
on Bioethics and Human Rights (2005) will also be analyzed to broaden the description of
bioethical r
easoning.

Still, reaching a good decision is often difficult, which also may not be the same if
made in different times and situations. Another approach that is common in education is to
teach learners to break down ethical dilemmas into manageable proble
ms, for example, the
separation of action, consequence and motives
connected to a moral decision
. This separation
8

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


is reflected on the different bioethical theories, and some of these are introduced in chapter 2.
Utilitarianism is an example of a bioethic
al theory, which looks at the consequences of an
action, and is based on the work of Jeremy Bentham and John Stuart Mill. This principle
asserts that we ought always to produce the maximal balance of happiness or pleasure over
pain, or good over harm, or
positive value over disvalue. Utilitarianism can be then broken
down into rule utilitarianism, and act utilitarianism. “A rule utilitarian may use moral rules as
authoritative instrumental rules, so the morally right action is conformity to a system of r
ules,
and the criterion of the rightness of the rule is the production of as much general happiness as
possible (Macer, 1998a)”
.

Act utilitarians on the other hand, look at the particular act only, and
object to moral rules to be only an approximate guides
, which could be broken if maximal
good is not obtained. Another example of a bioethical theory is rights based theories of
Immanuel Kant, and human rights law (Beauchamp and Childress, 1994; Macer, 1998a). The
use of utilitarian
-
style logic and rights ar
guments were also examined among the discourse.
The
evaluation tools

developed here could be extended to look for presence of other concepts
such as virtue ethics for example.

Integration of scientific facts is also important in moral reasoning. Science ed
ucators
discovered during the last few decades that the most efficient way to educate science is to
discuss the science together with examples of technology and put the facts into the social
context. This method of teaching is generally called the Science
, Technology, and Society
(STS) approach (Yager, 1990; Ramsey, 1993). Advances in biology and medicine have led to
another pressure upon educators, namely how students can be prepared to face the ethical
dilemmas that the technology often raises. Many ch
apters in the text incorporate both teaching
of biological facts and ethics. The ethical issues associated with biology are generally grouped
under the phrase "bioethics". Bioethics is one part of the approach of STS, and a survey of
bioethics teaching is

also one method to measure the extent that society issues are included
(Macer et al., 1996; Macer, 1999). In general there are less teachers using STS approaches in
Asia than in the USA (Kumano, 1991), and Australasia (Macer et al. 1996), but it is growi
ng
still. Even within one country, such as the USA, there are a diversity of views on how to effect
efficient education of social issues and even the science itself (Waks & Barchi, 1992). In the
project in Korea the partner teachers at high school level a
re a STS network of teachers
, and
the Chinese school has a STS approach to teaching biology
. In some other countries, such as
New Zealand, STS approaches are integrated into a broad participatory paradigm of education
across all subjects.


2:
Evaluation


Crucial to the exercise of development of bioethics is a method of evaluation that allows
for improvement of materials and meeting better the needs of students in different countries.
This project has looked at several methods of evaluation including: deve
lopment of specific
evaluation forms for student and teacher responses to chapters and the textbook or course;
ways to analyze the content of student essays and reports; forums where educators and
researchers can discuss and improve the content of the text
book and materials
,

and discuss
evaluation; and ways to assess various styles of student feedback from different programs.


In the text there are evaluation sheets that were developed
as an evaluation tool,
and are
included in the second edition of the Bio
ethics Text/Resource book,
A Cross
-
Cultural
Introduction to Bioethics

(Macer, 2006). The publication of this book and some translations of
the chapters in the book in several languages, including Chinese, Japanese, Korean, Tamil and
Thai, allows trials of
the textbook to
be also conducted in local language

in selected pilot
countries. Comparisons in the way which bioethics dilemmas are used in different countries are
made,
though

longer term comparisons will be required. There are also country
-
by
-
country
Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

9

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


up
date summaries included here.

In current assessment of high school students there is a trend from merely making lists
of many examples, or listing the positive and negative sides of an argument towards making
students exhibit their reasoning as well. One o
f the common goals of school education is that
students can produce a good argument.
Stephen Toulmin’s model

has become popular in
development of

students’ argumentation skills (
Toulmin et al. 1984). It is summarized in the
figure below, that an argument c
onsists of integrating the following:


A conclusion or claim


assertions or conclusions about an event or theory

Facts


data that is used as evidence to support the assertion

Warrants


the statement that explains the link between the data and the claim
s

Backing


underlying assumptions which are often not made explicit

Rebuttals


statements that contradict the data, warrant or backing of an argument



To create an argument a person needs to state their claim,
then
support it with facts
(data) that are
arranged logically. For each fact, they should give the evidence for the fact
(warrant), and for each warrant, state the quality of its validity (backing). Then for each
warrant and its backing, people should think of an opposing point of view (rebuttal).
They then
consider further possible warrants and backing for the rebuttals. At the end then they review,
having argued the rebuttals, do they need to qualify their original claim?

The mental mapping project, or human behaviourome project (Macer, 1992) iden
tified
9 classes of ideas, and attempts to explain the linkages between ideas in the construction of
moral choices by different persons (Macer, 200
2
). The practical application
s

of that model are
yet to reach a stage at which teachers could simply assess
the moral development of their
students. The Ideas, Evidence and Argument in Science Education (IDEAS) project of Osborne

et al.

in the UK [http://www.kcl.ac.uk/depsta/education/ideas.html], has as its a goal the
assistance of teachers in developing

their
skills to teach about ideas, evidence and argument in
science. The materials they wish to develop include worksheets and video clips to enable
teachers to teach children to develop and evidence scientific argument. They

suggest teachers
should focus on the

features of argument shown in the
right of the
diagram
below

and suggest
that prompt sheets, based around Toulmin’s model of argument are helpful in promot
ing
children's ability to argue.

10

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>




The I
DEAS project suggests the following criteria can be used in evaluating students’
arguments. Is there a claim? Does the argument have data to support the claim? Does the
argument link the data to the claim? Are there further justifications to support the ca
se? Is there
any anticipation of a counter argument and how it could be opposed?

Ratcliffe and Grace (2003) o
utline the knowledge, understanding and skills that
students studying ethical issues in science acquire and that can be used to design assessment
q
uestions. They listed several different levels of knowledge:

Conceptual knowledge:
Learners can demonstrate understanding of: underpinning science
concepts and the nature of scientific endeavour; probability and risk; the scope of the issue


personal, loc
al, national, global, political and societal context; and environmental sustainability.

Procedural knowledge:
Learners can engage successfully in: processes of opinion
forming/decision making using a partial and possibly biased information base; cost
-
benef
it
analysis; evidence evaluation including media reporting; and ethical reasoning.

Attitudes and beliefs:
Learners can: clarify personal and societal values and ideas of
responsibility; and recognize how values and beliefs are brought to bear, alongside ot
her
factors, in considering socio
-
scientific issues.

As with the above examples of questions that Kohlberg used for the linkage of student
arguments to moral stages of development, there are a number of ways that could be developed
into evaluation tools fo
r assessment of bioethics education.

One of the difficult questions in bioethics education is how to evaluate the usefulness of
the materials provided, beyond mere student or teacher satisfaction. One concept that has been
used by Macer is whether studen
ts demonstrate "bioethical maturity" in some way. “Bioethical
maturity assumes a certain level of recognition of weighing up the different arguments that can
be used to discuss an issue, the different ethical frameworks that can be used, and comparisons
an
d balancing of the benefits and risks of the dilemmas (Macer, 2002). This process also gives
an indication as to how many different ideas people have, and the way they understand the
dilemmas, and is ongoing as part of the behaviourome project (Macer, 2002
; 2004b).
Classroom observations, audio and video tape recordings, and written essays and homework
done by the students were collected. This feedback is being continually used to modify the
texts and accompanying questions and materials for teachers. Anot
her way to assess the
usefulness of the materials for developing ethical principles in making ethical decisions was to
look for key words and concepts in the answers students give to oral questions.

Evaluation must be done ethically (Alderson & Morrow, 20
03), and there are a variety
of methods in research which can be applied for evaluation depending on the style of class and
purpose (Cohen et al., 2003). It is very important to examine the future direction of bioethics
Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

11

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


education and how this might enable
people to question scientific endeavours and what impact
their moral decisions will have on them as individuals and upon their societies. The skills that
are required to do this involve the ability to identify existing ideas and beliefs, listen to others
,
be aware of multiple perspectives, find out relevant information and communicate the findings
to others. These skills cannot be ‘given’ to students through a didactic approach to teaching,
where the teacher imparts the knowledge. Instead, students need t
o experience situations that
will allow them to develop these skills through interacting with the teacher and with each other.
This project allows sharing of cases and experience in a range of cultures as well.

When bioethics is applied to professional be
haviour, such as in medical ethics, methods
to evaluate have included the way students conduct a patient examination
(
http://wings.buffalo.edu/faculty/research/bioethics/eval.htm
l
)
.

In Buffalo University Bioethics
program (Singer et al., 1993), they applied the technology of the objective structured clinical
examination (OSCE) (Cohen et al., 1991) using standardized patients to the evaluation of
bioethics. Methods to evaluate the

clinical
-
ethical abilities of medical students, post
-
graduate
trainees, and practising physicians that have been used include multiple
-
choice and true/false
questions (Howe and Jones, 1984), case write
-
ups (Siegler et al, 1982; Doyal et al., 1987;
Redmon,

1989; Hebert et al., 1990), audio
-
taped interviews with standardized patients (Miles
et al., 1990), and instruments based on Kohlberg's cognitive moral development theory (Self et
al., 1989).

The reliability and validity of these methods have seldom been

examined. Auvinen et al.
(2004) applied the use of Kohlberg’s stages of moral development to assess ethics teaching in
nursing students in Finland, and they found significantly higher ethical maturity when nurses
actually had to deal with ethical dilemmas

in their practical training in clinics.


3:

Stages in moral development


In discussions held during project meetings in 2005 there has been a consensus that the
theory of moral development developed by Lawrence Kohlberg, and what has come to be
called K
o
hlberg's stages of moral development, does not universally apply when teaching
bioethics. The problems are not only with non
-
Western students, but researchers in Australia
and New Zealand have also found that it does not serve as a model. Kohlberg's (1969
) theory
holds that moral reasoning, which he thought to be the basis for ethical behavior, has
developmental stages that are universal. He followed the development of moral judgment
beyond the ages originally studied by Jean Piaget looking at moral develo
pment thoughout life,
and created a model based on six identifiable stages of moral development (Scharf, 1978).

Kohlberg's six stages were grouped into three levels: pre
-
conventional, conven
tional,
and post
-
conventional. He claimed i
t is not possible to r
egress backwards in stages nor to
'jump' stages; each stage provides new perspective and is
considered
"more comprehensive,
differentiated, and integrated than its predecessor
s." A brief explanation follows.


Level 1: Pre
-
Conventional

The pre
-
conventional
level of moral reasoning is especially common in children, and
said to be up to the age of 9 in U.S. children he studied, although adults can also exhibit this
level of reasoning. Reasoners in the pre
-
conventional level judge the morality of an action by
i
ts direct consequences. The pre
-
conventional level consists of the first and second stages of
moral development, and are purely concerned with the self (egocentric). In
stage one

(
obedience
)
, individuals focus on the direct consequences that their actions

will have for
themselves. For example, an action is perceived as morally wrong if the person who commits it
gets punished. In addition, there is no recognition that others' points of view are any d
ifferent
from one's own view.

12

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


Stage two

is a self
-
interes
t orientation, right behavior being defined by what is in one's
own best interest. Stage two reasoning shows a limited interest in the needs of others, but only
to a point where it might further one's own interests, such as "you scratch my back, and I'll
s
cratch yours." In stage two, concern for others is not based on loyalty or intrinsic respect.
Lacking a perspective of society in the pre
-
conventional level, this should not be confused with
stage 5 (social contract
) as all actions are performed to serve o
ne's own needs or interests.


Level 2: Conventional

The conventional level of moral reasoning is typical of adolescents (age
9
+

years
) and
adults. Persons who reason in a conventional way judge the morality of actions by comparing
these actions to societal

views and expectations. The conventional level consists of the third
and fourth stages of moral development. In
Stage three
, the self enters society by filling social
roles. Individuals are receptive of approval or disapproval from other people as it refl
ects
society's accordance with the perceived role. They try to be a
good boy

or
good girl

to live up
to these expectations, having learned that there is inherent value in doing so. Stage three
reasoning may judge the morality of an action by evaluating its

consequences in terms of a
person's relationships, which now begin to include things like respect, gratitude and the golden
rule. Desire to maintain rules and authority exists only to further support these stereotypical
social roles.

In
Stage four
, it is
important to obey laws and social conventions because of their
importance in maintaining a functioning society. Moral reasoning in stage four is thus beyond
the need for approval exhibited in stage three, because the individual believes that society must
t
ranscend individual needs. If one person violates a law, perhaps everyone would
-

thus there is
an obligation and a duty to uphold laws and rules. As a cultural observation, this is a very
common attitude in Asian and Pacific communities.


Level 3: Post
-
Co
nventional

The post
-
conventional level, also known as the principled level, consists of stages five
and six of moral development. Realization that individuals are separate entities from society is
important in North American society where Kohlberg develope
d his theory and so he judged it
to be a higher level of morality. In that culture one's own perspective should be viewed before
the society's is considered. Interestingly, the post
-
conventional level, especially stage six, is
sometimes mistaken for pre
-
co
nventional behaviors. In
Stage five
, individuals are viewed as
holding different opinions and values, all of which should be respected and honoured in order
to be impartial. However he considered some issues
are not

relative like life and choice. Laws
are
regarded as social contracts rather than dictums, and those that do not promote general
social welfare should be changed when necessary to me
e
t the greatest good for the greatest
number of people (a utilitarian view).

In
Stage six
, moral reasoning is base
d on abstract reasoning using universal ethical
principles. Decisions are made in an absolute way rather than in a conditional way. In addition,
laws are valid only insofar as they are grounded in justice, and that a commitment to justice
carries with it a
n obligation to disobey unjust laws. While Kohlberg insisted that stage six
exists, he had difficulty finding participants who use it.


Implications

After Kohlberg's stage 4, the transition from stage four to stage five, people have
become disaffected wit
h the arbitrary nature of
law and order

reasoning and he said they
become moral relativists. This transition stage may result in either progress to stage five or in
regression to stage four. As has become clear during the bioethics education project, there

is
such a range of cultur
al, family and school value systems across the world, that students of one
Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

13

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


age in one country will most likely be in different stages at different times, even if all persons
did follow this progression from stage 1 to stage 6 in m
oral reasoning, and not revert back to
other levels.
Stage six
would correspond to a person that followed the textbook bioethics of
Beauchamp and Childress (1995). Macer (1998) has argued that bioethics is love of life, and
that principalism based on follo
wing the standard ethical principles alone is not sufficient as
an explanation of why people behave the way they do.

The role of religious values is also
obviously important, as concepts like karma and removal of oneself from the matters of the
world do a
ffect the values systems people use when approaching moral dilemmas.

Kohlberg used moral dilemmas to determine which stage of moral reasoning a person
uses. The dilemmas are short stories that describe situations in which a person has to make a
moral decis
ion, yet they provide no solution. The participant is asked what the right course of
action is, as w
ell as an explanation why. This style is

still commonly used

as case
-
based ethics
teaching. There is a
need to develop more local cases for dialogues betwe
en Asian and Pacific
cultures.

A dilemma that Kohlberg used in his original research was the druggist's dilemma:

Heinz Steals the Drug In Europe
. A woman was near death from a special kind of cancer.
There was one drug that the doctors thought might save
her. It was a form of radium that a
druggist in the same town had recently discovered. The drug was expensive to make, but the
druggist was charging ten times what the drug cost him to produce. He paid $200 for the
radium and charged $2,000 for a small dos
e of the drug. The sick woman's husband, Heinz,
went to everyone he knew to borrow the money, but he could only get together about $ 1,000
which is half of what it cost. He told the druggist that his wife was dying and asked him to sell
it cheaper or let h
im pay later. But the druggist said: "No, I discovered the drug and I'm going
to make money from it." So Heinz got desperate and broke into the man's store to steal the drug
for his wife (Kohlberg, 1969).

Should Heinz break into the laboratory to steal the

drug for his wife? Why or why not?

Like many cases of bioethics, f
rom a theoretical point of view, it is not important what the
participant thinks that Heinz should do. The point of interest is the justification that the
participant offers. Below are exam
ples of possible arguments that belong to the six stages. It is
important to keep in mind that these arguments are only examples. It is possible that a
participant reaches a completely different conclusion using the same stage of reasoning:

Stage one

(
obed
ience
): Heinz should not steal the medicine, because he will consequently be
put in prison.

Stage two

(
self
-
interest
): Heinz should steal the medicine, because he will be much happier if
he saves his wife, even if he will have to serve a prison sentence.

S
tage three

(
conformity
): Heinz should steal the medicine, because his wife expects it.

Stage four

(
law
-
and
-
order
): Heinz should not steal the medicine, because the law prohibits
stealing.

Stage five

(
human rights
): Heinz should steal the medicine, because
everyone has a right to
live, regardless of the law. Or: Heinz should not steal the medicine, because the scientist has a
right to fair compensation.

Stage six

(
universal human ethics
): Heinz should steal the medicine, because saving a human
life is a more

fundamental value than the property rights of another person. Or: Heinz should
not steal the medicine, because that violates the golden rule of honesty and respect.

One criticism of Kohlberg's theory is that it emphasizes justice to the exclusion of
other

values. As a consequence of this, it may not adequately address the arguments of people
who value other moral aspects of actions

more highly
. His theory was the result of empirical
research using only male participants (aged 10, 13, and 16 in Chicago in t
he 1960s). Carol
14

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


Gilligan argued that Kohlberg's theory therefore did not adequately describe the concerns of
women. She developed an alternative theory of moral reasoning that is based on the value of
care.
Among studies of ethics there is a tendency in s
ome studies to find females have higher
regard for ethics theories

(Ford and Richardson, 1994). Gilligan's theory illustrates that
theories on moral development do not need to focus on the value of justice. Other
psychologists have challenged the assumptio
n that moral action is primarily reached by formal
reasoning. People often make moral judgments without weighing concerns such as fairness,
law, human rights and abstract ethical values. If this is true, the arguments that Kohlberg and
other rationalist ps
ychologists have analyzed are often no more than
post hoc

rationalizations
of intuitive decisions. This would mean that moral reasoning is less relevant to moral action
than it seems (Crain, 1985).


4:

Ongoing reassessment and evaluation


After pilot trial
s the set of evaluation sheets that appear in the initial pages of

A Cross
-
Cultural Introduction to Bioethics

(Macer, 2006; pp. vii
-
xvii), were developed. There was a
balance in the development of specific evaluation forms for student and teacher responses

to
chapters and the textbook or course between examination of the way that the thinking
progressed and the privacy of the respondents. In the simple questions the respondents were
asked to choose from one of:
SA (Strongly agree), A (Agree), PA (Partially

agree), NA (Not
applicable), PD (Partially disagree), D (disagree), SD (Strongly disagree).
The results to date
show that the students are very positive to the materials and topics. Significant numbers
wanted to have longer to discuss the materials and to
pics, though in these trials the class times
varied. In all classes the students felt that they had enjoyed a meaningful discussion, as would
be expected given that I had tried to use participatory methods for involving students and long
question and answe
r periods during points in the reading of the written chapters.

The teachers
were un
an
i
mous in strongly disagreeing with Q8, thus judging the materials to be adequate,
and strongly agreeing with the chapter’s utility. They also wanted more time for the dis
cussion.

The comments given in the response forms are the most useful parts of the form. The
open question (Q2) asks students to list keywords, and the students usually wrote a few
keywords about the chapter, often the title plus a principle that was emph
asized during the
lecture. The open comments in Q9 looked at what the students had learned through reading the
chapter and in response to this question usually a sentence or two were written. The answers
are coded and analyzed, for example as to whether th
e comment illustrated they had learned
about both sides of view. If the questionnaire directly asked whether they had learned about
different points of view more would say so, but still most students focused on the facts

or
keywords of the chapter

in their

comments.


One of the concerns in developing cross
-
cultural materials is whether some contents
are not appropriate in a culture. This concern was also raised in Catholic schools that used the
first edition of the textbook, though they judged all the conte
nts to be appropriate. Q10 asked
whether there was any content not culturally appropriate. This is a decision teachers must make,
and feedback on this is useful as both students and teachers may have different impressions.

At the end of the questionnaire (
Q19) there was a space for student comments and
suggestions. This type of feedback was very useful for the future of the materials and the pilot
programs, and for providing feedback to the government Ministries and Boards of Education
for the increased cov
erage of bioethics. As had been called for by teachers for many years
(Asada et al. 1996; Macer et al
. 1996; Pandian and Macer, 1998; Macer and Ong, 1999), the
students also request more bioethics classes.

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

15

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


Text analysis of student reports for keywords is o
ne of the valuable ways to evaluate
students thinking also. Currently we are extending categorization methods that have been
developed (e.g. Maekawa & Macer, 2005, 2006). The abbreviations used for some of the
general coding categories are below:

Both Side
s of View

(BV): More than one side of an argument or a question being mentioned.
Sometimes the views were not clearly stated in individual sentences so the judgment of the
report containing a BV or not had to be made after the full evaluation of the report
.

Personal vs. Other Persons’ Views

(PO): The writer’s point of view (e.g., an “I think”
statement) plus other people’s point of views being stated regardless of whether they concurred
with those of the writer or not. Views/feelings of non
-
humans were not
included in this
category.

Scientific Facts

(SF): A concrete and/or detailed scientific fact more intellectually demanding
than common sense or the broad theme of the report. Generally this was not merely the citation
of sentences from reference material(s
).

Quantitative Facts

(QF): The use of statistics and/or numbers in a factual manner.

Environment and Biocentric Ideas

(EB): A statement made mentioning concerns for the
environment or ecological concerns, or for example the care or treatment of animals ra
ised as a
concern.
G
enerally
people

tend to
reason and
write from an anthropocentric
viewpoint.

Utilitarian Views

(UV): A utilitarian view is judging an act as being morally acceptable based
on the opinion that the benefits of the action to one group or in
dividual will outweigh the risks
or harm produced affecting a larger population. It is also considering the balancing of society
versus individuals .will be greater than that for an individuals, not limited to human beings.

Principles and Keywords

(PK): A
keyword denoting an ethical principle or connotation of
one regardless of whether being directly stated or not. If only the term “rights” was mentioned,
it was marked as R and not PK. Keywords included
specific bioethics principles and keywords
such as ben
efit & risk assessment, informed consent, enhancement, public welfare, autonomy,
justice
, equality of life, animal welfare etc.


Rights

(R): Clear mention of a right or a connotation of a right. This was limited to the rights
of human beings. R is a speci
alized category of PK.

Number of Ideas

(NI): An idea is a distinct message unit, statement or concept that may be
from the materials or from the writer’s own thinking. Key words and concepts were numbered
when going through the reports and the same idea wh
en repeated was not scored twice.

Main Idea

(MI): The selection of a main idea was based on the main themes of the argument.
It is related to the causal relationship between two or more ideas. Often the sentence answering
the topic question was chosen as t
he main idea.

Example comments below give some explanation of the coding:

"Animals are life as we are. I think all life should be allowed to live. So I think that they have
a right to live. " (R)

" I thought my knowing was worth dissecting without consci
ousness. " (UV)

" We have legal rights (R) which shield us from unjust things. Instead of it, we have to fulfill
duties. " (PK)

" I don’t agree to give animals legal rights. (R) But I think that we should not kill animals
uselessly (BV) and it is importa
nt we protect the environment. " (EB)

" All cells of transgenic animals have injected genes. Injected genes can be expressed in
specific tissues with proper promoters. " (SF)

"I do not want to use animal tests for the safety of cosmetics, but some other p
eople think that
it is better to have everything tested on animals." (PO)

The first quotation mentions rights, which can vary in other reports such as right to
choose, right to information, and right to death, just to mention a few. The second quotation
m
entions utilitarian views. Other utilitarian views include comments such as "If it can cure
16

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


many people, animal experiments are inevitable" or "For the progress of science there are
always some sacrifice". The third quotation is an example of a specific
bioethics principle and
keyword, "duty". The next example shows both sides of view where this person disagrees to
give legal rights to animals, but considers unnecessary killing. Also the importance of
environmental protection is mentioned for animals to

be able to live in their natural habitat,
which is a rare case. The next example shows some scientific background, SF. The last
example takes that of the writer versus other persons on animal testing, but the key point is
comparing their own opinion wit
h others.

Changes in the frequency of keywords and concepts need to be measured against
several variables, including internal factors connected to the class such as the wording of the
title, the nature of the materials used, the comments given by the teac
her, and the comments
made during the class. Results are being developed and will appear on the project listserve,
preserving student anonymity.


5:

Participatory Methods


There are various other ways to assess various styles of student feedback from
diffe
rent programs. Some of these are direct participatory class feedback.
There are different
ways to describe the participation of students, for example, in the largest lecture in India 800
students and 40 teachers listened for 3 hours to a special lecture, w
hereas in smaller class
courses in China 32 students attended a series of 32 90 minute class periods involving 10
teachers. In order to teach bioethics a longer series of sustainable lectures in smaller class
groups is a better model, however, still genera
l introductions can stimulate interest in schools
for the subject.

In the case of large classes there are methods that can be used to improve the
participation of students such as talking in pairs while sitting in the class, or working in small
groups of
three or more persons to discuss particular questions from the text. Participatory
methods have been used in science education (Bryce, 2004) and in medical ethics education
(Sass, 1999).

One participatory method that can be used is to get students to stand

in a line to form a
continuum line based on their view between two extremes along a moral continuum. After
some students give their explanations for why they are standing at that point in the line then
students may move to the appropriate point in the mo
ral continuum. Then after a modified
question can be used and the students move along the continuum to their new positions. This
can include a transition from an abstract question, such as whether they support the use of
reproductive human cloning, to a pe
rsonal question, such as whether they would use
reproductive cloning if that was the only way for them to have a genetically related child.

Use of donuts (where two circles of people are made and they dialogue for 1 minute
each and then the circle shifts a
round one person so that they repeat the exercise) or fishbowls
(where you have 3 circles and the outside person is only recording and making note on the
conversations between the other two persons), are two interactive discussion methods that can
be used
in classes with many persons.

Student debates and presentation of reports can allow more in
-
depth analysis of issues
by students, whether as individuals or in small groups, and then the debates can occur within
the same class, between different classes, in
stitutions or even countries by the use of video
conferencing.


6:

References

The website of the book and teaching resources is
Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

17

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


http://www.unescobkk.org/index.php?id=2508

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A Cross
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Cultural Introduction to Bioethics

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Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


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A Cross
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Teaching Resources and Notes for A Cross
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Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


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20

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


Section A. Bioethics and the Ethics of Science and Technology

Chapter A1:
Making Choices, Diversity and Principles of Bioethics

There are numerous books and materials on bioethics, and these are written in many
languages. Often newspapers and magazi
nes have discussed these issues, and the cases in those
articles can be useful to stimulate students. In these teaching materials there are numerous
examples from different topics that can be used to show bioethics in real situations.

There are also a numb
er of institutions offering bioethics courses, and some distance
learning courses targeted to persons of particular value systems, such as the Jesuit Distance
Education Network,
Center for Online Bioethics Education

[http://www.ajcunet.edu/distanceeducati
on.aspx?bid=543].

Some of these sites offer their own
exclusive bioethics resources, but these are not openly available.

One of the new sites on bioethics education that has not adopted an open access
approach is the BioEthics Education Project [
http://www
.beep.ac.uk/content/index.php].
BEEP
is funded by the
Wellcome Trust

and is based at the
Graduate School of Education
, University
of Bristol, UK.
The introduction
reads well, saying: "
It is an interactive website and virtual
learning environment for secondary school science teachers and their students. It is a teaching
resource developed to highlight the moral, ethical, social, economic, environmental and
technologi
cal implications and applications of biology." It also is aimed at web
-
based
evaluation, "BEEP is also a research project; we aim to investigate whether online discussion
can be used successfully to support school science teachers. Thus use of the website
will be
evaluated by researchers at the University of Bristol. Data on method of use and user opinion
will be collected and documents and presentations may be published concerning the project.
However, end user contribution will be anonymised so that no in
dividual or school will be
identifiable in such publications." It provides a list of topics and ties these to several UK school
curricula. The copyright clause is restrictive however, stating: "Pages on BEEP are protected
by copyright. No images, parts of
images, or any other part of our website may be permanently
copied or reproduced in any form or reproduced on any other website or stored in or
transmitted to or from any other electronic or digital form in whole or in part without our prior
written permis
sion. In addition you may not alter, manipulate, add to or delete an image or any
part of an image. You may access and download the contents of these pages and store a copy
of them on a temporary basis for the sole purpose of viewing those pages." Thus for

teachers to
store, modify the pages to be suitable for their own local needs, use them, and place the pages
on their own websites would be breaking this copyright.


Download a copy of the UNESCO Universal Declaration on Bioethics and Human Rights, and
ma
ke an analysis of this framework that was agreed by all member countries of the world in
October 2005 for bioethics. <
http://
eubios.info
/udbhr.pdf
>


Online resources

See papers on the Eubios Ethics
Institute website, including News in Bioethics and Biotechnology
<
http://
eubios.info
/NBB.htm>

UNESCO Ethics home page

<http://www.unesco.org/ethics>

UNESCO Bangkok SHS home page

<http://www.unescobkk.org/index.php?id=1313">


There are several international
ly agreed declarations on bioethics that are useful for
Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

21

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


background, including:

UNESCO Universal Declaration on the Human Genome
a
nd Human Rights (1997; Chapter
C9)

<
http://
eubios.info
/unesco.htm>

UNESCO Universal Declaration on Bioethics and Human Rights (
19 October, 2005)

<
http://
eubios.info
/
udbhr.pdf>


UNESCO, Establishing Bioethics Committees, 2005 72pp.

<
http://
eubios.info
/
UNESCO/ebc.pdf>


Bergstrom, Philip, ed, Ethics in Asia
-
Pacific, 2004, 372pp.

<
http://
eubios.info
/
UNESCO/ethap.pdf>

UNESCO, The Prec
autionary Principle, COMEST Precautionary Principle Expert Group, 2005

<
http://
eubios.info
/
UNESCO/precprin.pdf>

Report on Nanotechnology, COMEST Nanotechnology and ethics expert group, 2005

<
http://
eubios.info
/
UNESCO/nano.pdf>


UNESCO International Bioet
hics Committee, Report of the IBC on the Possibility of
Elaborating a Universal Instrument on Bioethics (2003), Giovanni Berlinguer and Leonardo De
Castro (Rapporteurs)

<
http://
eubios.info
/
UNESCO/ibc2003.pdf>

UNESCO International Bioethics Committee, Repo
rt of the IBC on Pre
-
implantation Genetic
Diagnosis and Germ
-
line Intervention (2003),

Hans Galjaard (Rapporteur)

<
http://
eubios.info
/
UNESCO/ibc2003ip.pdf>

UNESCO International Bioethics Committee, Human Genetic Data: Preliminary Study by the
IBC on its C
ollection, Processing, Storage and Use (2002), Sylvia Rumball and Alexander
McCall Smith (Rapporteurs)

<
http://
eubios.info
/
UNESCO/ibc2002.pdf>

UNESCO International Bioethics Committee, Report of the IBC on Ethics, Intellectual
Property and Genomics (2002),

Justice Michael Kirby (Rapporteur)

<
http://
eubios.info
/
UNESCO/ibc2002ip.pdf>

UNESCO International Bioethics Committee, Report of the IBC on Solidarity and
International Co
-
operation between Developed and Developing Countries concerning the
Human Genome (2
001), Mehmet Öztürk (Rapporteur)

<
http://
eubios.info
/
UNESCO/ibc2001.pdf>

UNESCO International Bioethics Committee, The Use of Embryonic Stem Cells in
Therapeutic Research (2001), Alexander McCall Smith and Michel Revel (Rapporteurs)

<
http://
eubios.info
/
UN
ESCO/ibc2001sc.pdf>

UNESCO International Bioethics Committee, Report on Confidentiality and Genetic Data
(2000), Working Group of the IBC on Confidentiality and Genetic Data

<
http://
eubios.info
/
UNESCO/ibc2000.pdf>

UNESCO International Bioethics Committee,
Ethical Considerations Regarding Access to
Experimental Treatment and Experimentation on Human Subjects (1996), Harold Edgar and
Ricardo Cruz
-
Coke (Rapporteurs)

<
http://
eubios.info
/
UNESCO/ibc1996.pdf>

UNESCO International Bioethics Committee, Food, Plant B
iotechnology and Ethics (1995),
Darryl Macer (Rapporteur)

<
http://
eubios.info
/
UNESCO/ibc1995pg.pdf>

UNESCO International Bioethics Committee, Bioethics and Human Population Genetics
22

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubios Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


Research (1995), Chee Heng Leng, Laila El
-
Hamamsy, John Fleming, Norio Fuj
iki, Genoveva
Keyeux, Bartha Maria Knoppers and Darryl Macer


<
http://
eubios.info
/
UNESCO/ibc1995pg.pdf>

UNESCO International Bioethics Committee,
Genetic Counselling (1995), Michel Revel
(Rapporteur)

<
http://
eubios.info
/UNESCO/ibc1995gc.pdf>

UNESCO Intern
ational Bioethics Committee, Ethics and Neurosciences (1995), Mr Jean
-
Didier Vincent (Rapporteur)

<
http://
eubios.info
/
UNESCO/ibc1995ns.pdf>

UNESCO International Bioethics Committee, Report on Human Gene Therapy (1994), Mr
Harold Edgar and Mr Thomas Tursz (
Rapporteurs)

<
http://
eubios.info
/
UNESCO/ibc1994.pdf>

UNESCO International Bioethics Committee, Report on Genetic Screening and Testing (1994),
Mr David Shapiro (Rapporteur)

<
http://
eubios.info
/
UNESCO/ibc1994gs.pdf>

UNESCO International Bioethics Committee
, Advice of the IBC on the Patentability of the
Human Genome, 2001.

<
http://
eubios.info
/
UNESCO/ibcpatent.pdf>


See links <

http://
eubios.info
/Info.htm>


Site:
Joint Centre for Bioethics

(University of Toronto)

WWW:
http://www.utoronto.ca/jcb/Resources/resources.html

Site:
Council of Europe Home Page

WWW:
http://www.coe.fr/oviedo/edito
-
e.htm

Site:
National Consultative Ethics Committee for Health and Life Sciences

(France)

WWW:
http://www.ccne
-
ethique.org/home.htm

Site:
Library of Bioethics and Medical Huma
nities Texts and Documents

WWW:
http://wings.buffalo.edu/faculty/research/bioethics/texts.html

Site:
National Bioethics Advisory Commission

(Former one, USA)

WWW:
http://bioethics.gov

Site:
Nuffield Council on Bioethics

WWW:
http://www.nuffield.org/bioethics/

Site:
Online Ethics Center for Engineering and Science

(Case Western Reserve University)

WWW:
http://onlineet
hics.org/index.html

Site:
Distance Learning Programs of Study

(Medical College of Wisconsin)

WWW:
http://www.mcw.edu/bioethics/depage.html


Site:
Ethics Updat
es

(University of San Diego Values Institute)

WWW:
http://ethics.acusd.edu

Site:
Syllabus Exchange Catalog

(Kennedy Institute of Ethics)

WWW:
http://www.georgetown.edu/research/nrcbl/syll
abus/

Site: Kennedy Institute of Ethics, High School Bioethics Project

WWW:
http://bioethics.georgetown.edu/hsbioethics/

Site: The University of Pennsylvania High School Bioethics Project

WWW:
http://bioethics.net/hsbioethics/

Site: National Health Museum
, Access Excellence: Issues and Bioethics

WWW:
http://www.accessexcellence.org/AB/IE/

Site: McGraw Hill General and Human Biology: Bioethics Case Studies

WWW:
http://www.mhhe.com/biosci/genbio/olc_linkedcontent/bioethics_cases/index.html


Site: Howard Hugh
es Medical Institute Bulletin

Teaching Resources and Notes:

A Cross
-
Cultural Introduction to Bioethics

23

Darryl Macer, ed.,
Teaching Resources and Notes for A Cross
-
Cultural Introduction to Bioethics

© Eubi
os Ethics Institute
2006 <

http://www.unescobkk.org/index.php?id=2508
>


WWW:
http://www.hhmi.org/bulletin/mar2002/ethics/highschool.html


Further reading


Tom Beauchamp and James Childress (2001)
Principles of Biomedical Ethics.

Fifth Edition.
Oxford University Press, Oxford.


Chapter A2:

Ethics
in history and love of life


Background

This chapter is designed to give students a more theoretical background to different theories of
ethics. It is written at a higher level than chapter A1, to give some references to ethics theories
especially for stud
ents who have not had a detailed background in ethical theories.


Further reading

Darryl Macer (1998)
Bioethics is Love of Life.

Eubios Ethics Institute.

Available on
-
line in English and Japanese translation.

<
http://
eubios.info
/
bll.htm>



Chapter A3:

Mor
al agents


Background

This chapter is designed to introduce ways to distinguish between different living organisms,