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Epi Wit & Wisdom Articles
Moral Literacy in Epidemiology
By Courtney S. Campbell &
Annette M. Rossignol
In recent years, education in
ethics has come to be seen as a vital part of pre-professional
preparation for students in epidemiology. Recent survey data, as well
as professional literature, indicates that forums for ethics
discussions have increasingly moved from informal conversations to
formal instruction. Moreover, the National Institutes of Health
recently mandated, as part of its research training program,
“...instruction on scientific integrity and ethical principles in
research.”
This renewed interest in ethics
and integrity in research provides an occasion to ask several
important questions, such as:
• What are the purposes of
education in ethics for students in epidemiology programs?
• What is it reasonable and
desirable to expect such education to accomplish?
• How can formal instruction in
the ethics of a professional field be balanced with moral mentorship?
• Who should offer instruction
in the professional ethics of epidemiology?
Moral Imagination
The initial objective of ethics
education in epidemiology is to provoke and broaden the “moral
imagination” of students and trainees, by which we mean the capacity
to see a problem or a decision from a perspective other than—and
perhaps in conflict with—one’s own. Although ethics is often construed
as a problem-solving discipline, the initial task of ethics education
is to facilitate problem-recognition. In short, “problem-seeing” must
precede “problem-solving.”
The use of case studies and
roleplay is one effective pedagogical method that requires students to
assume different perspectives on moral choices. In addition,
literature is an overlooked but important educational resource for
engaging moral imagination. For example, a novel such as Albert Camus’
The Plague is particularly useful for both illustrating and eliciting
moral responses from students confronting public health policy choice.
Both of these methods enable participants to see that professional
disciplines and aspirations are situated in a web of social
relationships, and that moral convictions influence these
relationships. Since these convictions involve human valuations of
harms, benefits, freedom, choice, well-being and interests, we can
better grasp why moral conflicts typically involve such high stakes
for persons—ethics requires critical self-examination of these
formative aspects of personal integrity and self-identity.
Critical Thinking
A second desirable end in ethics
education is the development of those skills necessary to critical
thinking and analysis. These skills can certainly be honed through
education in the professional methods of the discipline, but students
need “moral literacy” to complement their science literacy. That is,
ethics education should offer an understanding of basic categories
such as “rights,” “duties,” “justice,” “virtue,” “responsibility,”
“freedom,” “respect,” “dignity,” “well-being,” and so forth. Moreover,
instruction should give students occasions to both observe the
relevance and to apply these various concepts as they pertain to
choices in epidemiological research.
Students need to be consistently
challenged by what philosophers describe as the “rule of
universality”: Are you willing to have your own rule or position
applied to your own situation? Does the public health policy or
conditions for epidemiological research that you prescribe for others
treat them in the respectful and dignified manner with which you would
want to be treated? If the answer to these questions is “no,” then the
rule, research proposal or policy, should be discarded as morally
unacceptable. This is to say that moral literacy in epidemiology at
times requires detachment from personal preferences and self-interest.
Moral Responsibility
A third aim of ethics education
is the cultivation and assumption of moral responsibility on the part
of students, including both personal and collective (professional and
civic) responsibility. Responsibility implies accountability for our
choices and actions because of the difference they make. Moral choices
make a significant difference in our own lives because they are
identity defining, and in the lives of others because they are
responsibility-creating. Ethics must, then, provide instruction and
understanding regarding the responsibility for choices that is
necessarily coupled with the freedom to choose.
The goal of cultivating and
assuming responsibility for moral choice is enhanced through a strong
and ongoing mentoring relationship. While readings from ethical
literature can sometimes display moral heroes (as well as moral
reprobates), there is really no ethical equivalent for the
professional mentor who exemplifies to students a deep commitment to
ethical responsibility and integrity in research. Ethics is not just a
cognitive, problemsolving task to determine what we should do; it also
requires motivations cultivated by mentors to enable us to assume
personal and professional responsibilities. Put another way, mentoring
reminds us that the question of what kind of
person/researcher/professional I ought to be—that is, questions of
character, virtue and integrity—are no less fundamental to ethics
education than are questions about right choices.
Closure
A final objective in ethics
education is to enable students to come to closure on morally
difficult issues and to tolerate ambiguity and uncertainty when moral
closure does not occur. The balance between moral resolution and
tolerance for moral ambiguity is a difficult line to walk. Our
contention is that it is necessary both to identify areas of agreement
and to expect disagreement. After all, disagreement/ dissent is one of
the pillars of a society committed to freedom of expression. The
question is not how to avoid disagreement, but rather what the
instructor does when disagreement inevitably emerges. This can be an
occasion for pedagogical paralysis, or for some more sustained digging
into the sources of disagreement. Often, the inability to reach moral
closure stems not from different ethical frameworks, but instead
because persons use different sets of factual assumptions or impose
different interpretations on a situation of moral choice. That is,
non-moral reasons for disagreement need to be located, clarified and
overcome through provision of additional information. Sometimes, of
course, conflicts are directly attributable to difficult ethical
values; the challenge in that circumstance is to emphasize respect and
tolerance and to encourage the parties in dispute to continue their
quest for common ground. Most often, moral compromises can be
established that permit adherents to retain their moral integrity.
We have not concentrated on the
“what” but the “why” of teaching ethics in epidemiology. Implicit in
this discussion is a recommendation that the teaching of ethics be
conducted in team-taught, interdisciplinary contexts. This ideal can
be accommodated to particular teaching settings, of course, but our
general claim is that instruction in scientific integrity and the
ethics of research is too important to be left solely to either the
researcher or the ethicist. The teaching of ethics thus can go some
way toward eroding entrenched disciplinary divisions.
Published February 1995 v
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