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Fifth Period: Life and Death Decision-making

Ethical quandaries at the nexus of science, technology and society are making it into high school curricula.
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Siska Brutsaert's biology students had gotten down the basics of stem cells, the early-stage cells many scientists believe could one day treat a variety of diseases. So in January, she asked them to apply that knowledge to a real-world bioethical dilemma: Was it acceptable to use the cells if they were taken from human embryos? Why or why not?

There was a catch, though: The 18 students in her class at Bard High School Early College, a public school in Manhattan, would defend the rationale of a public figure with whom they might not agree, based on the names they drew. That posed a challenge for Marina Molarsky-Beck, who calls herself a "second- or third-generation atheist" and had to take on the persona of a philosopher influenced by evangelical Christianity.

"My figure was so adamant: Life begins at conception. I certainly don't agree with that, but it made me question my own beliefs," said Molarsky-Beck, 17. "If I don't believe that, what do I believe? It's easy to say that you don't agree with something, but it's harder to figure out what your exact position is."

While bioethics may seem like a heady, esoteric subject for teenagers, it is increasingly being taught in high schools and alluded to in national and state education standards that — if they don't use the word "bioethics" expressly — call for students to become proficient in the relationship between science, technology and society.

At least a half dozen universities and nonprofits offer bioethics training or curricula for secondary school teachers, and the effort got a spike in credibility last fall when the National Institutes of Health released its own bioethics curriculum for kids, publishing a first run of 30,000 copies. Since its September release, the NIH's Office of Science Education has received about 9,000 requests for the free supplement.

The curriculum asks students to weigh the pros and cons of learning whether they carry gene mutations for Alzheimer's disease. It also includes real-world cases of when students should be required to receive vaccines, who should get scarce organs for transplant, what constitutes informed consent for research-trial participants, and the appropriateness of using animals in scientific studies.

The topics — linked to typical high school science lessons on cell biology and genetics — were selected to get students thinking about key concepts in bioethics: fairness, minimizing harms and maximizing benefits, and respect for humans and the natural world.

"It's more relevant to their lives than we may think, and our goal was to provide them with a more rigorous way to confront those issues," said Ezekiel Emanuel, head of the NIH Clinical Center's Department of Bioethics and a special adviser on health policy to President Obama's budget director.

He noted that teens are routinely confronted with whether the use of performance-enhancing drugs in sports amounts to cheating, and were at the center over how to distribute the initially limited supply of swine flu vaccine. Meanwhile, dilemmas such as the Terri Schiavo right-to-die controversy flood news coverage, and bioethics serves as a plot device on TV shows such as Grey's Anatomy and House.

While teachers appreciate the ability of bioethics to make science relevant for students who may not otherwise enjoy it, proponents cite the need for the lessons as civics courses have been eliminated in many schools. With time a concern, bioethics concepts are typically integrated into biology courses as one- to three-day lessons and revisited throughout the year. Occasionally they are the subject of semester-long philosophy courses.

Teenagers, who are often vocal with their opinions but may be struggling to distinguish their values from those of their parents and peers, are a receptive audience. Bioethics requires students not only to identify their opinions, but to justify them with scientific evidence and logical arguments. And they're required to note alternative perspectives, explaining how they'd respond to opponents' objections.

High school is "a perfect time" to introduce bioethics, said Liz Crane, a biology teacher at Brookline High School in Massachusetts who helped write the NIH curriculum. "Teenagers are very drawn to issues of fairness or justice — they're constantly having conversations with their parents about whether a rule in the house is fair, what's equitable or not. The job of a high school is to cultivate curious learners and responsible citizens. At 18, they'll be voting; a college or university is too late to be embarking on these issues."

Science teachers haven't always been so comfortable managing what can become tense classroom debates - one of the reasons the NIH, Georgetown's Kennedy Institute of Ethics, the University of Pennsylvania, University of Utah, Roche Pharmaceuticals, the nonprofit Hastings Center and Northwest Association for Biomedical Research (NWABR), working with the University of Washington — came up with workshops and lesson plans.

These days, the NWABR's Jeanne Ting Chowning packs standing-room-only crowds of teachers into her bioethics training sessions at meetings of the National Science Teachers Association and National Association of Biology Teachers. In 2003, she offered one or two sessions with a dozen instructors; she's since doubled the number of sessions, and each attracts 50-70 teachers, she said. And though it's difficult to say exactly how many instructors are now teaching bioethics, Chowning has watched annual downloads of the group's curriculum double in the four years it's been online.

Debbie Beam has taught science for 21 years, but only included bioethics for the past five or six after getting trained through a New York State mentorship program and using high school-specific bioethics lessons developed by the University of Rochester. "I wasn't as comfortable - I didn't feel like I had enough knowledge to teach them about ethics," said Beam, who includes classes on organ allocation in her biology classes at Red Hook High School in upstate New York.

"Some kids would say, 'No one should be able to get a new organ, they abused it,' and the others would say, 'but they're going to die.' [Before I was trained] I might say, 'Well, that's your opinion.' When I talk about why we have medicine and its purpose, they stop and think a little bit."

Of course, moral dilemmas often dovetail with religious ones, posing a challenge both for parochial institutions wary of questioning their own doctrines and nonsectarian schools worried about theology creeping into the classroom. But while schools may opt out of topics that raise questions with strong religious perspectives (Catholic schools sometimes bypass abortion in favor of discussing the ethics of genetically modified foods, said Arthur Caplan, director of Penn's Center for Bioethics), teachers are encouraged to accept religious points of view as valid. Bioethics began with theologians, and religious arguments are part of the public discourse, acknowledged, for example, in state laws allowing religious exemptions for inoculations, Emanuel said.

But noticeably absent from the NIH curriculum (which took three years to develop under a $900,000 federal contract) is discussion of two of the most volatile bioethical dilemmas: abortion and embryonic stem-cell research.

Emanuel insisted their omission wasn't a political decision. "That's simply not true," he said. "Abortion doesn't naturally come out of their biology classes as a topic, and it's one where the arguments on either side are pretty well known. It's not really challenging or illuminating."

In the case of stem-cell research, "The country may be focused on it, but from a bioethical standpoint in terms of the common issues that arise, some of these things are just more - it seems to me - more important," Emanuel said. "Everything we dealt with was an important public-policy debate. These are tough, tough issues. None of the issues that we threw out were easy."

Others who advocate for bioethics in high school argue that kids have a better shot at learning principles of the discipline when the subjects aren't so charged. "There's no real use in starting with real emotional things and short-circuiting the debate," said Dominic Sisti, Penn's High School Bioethics Project manager.

But others dive in. The stem-cell lesson Brutsaert used was based on the NWABR curriculum. And in the semester-long bioethics elective he's offered at Germantown Academy outside Philadelphia for the past two years, Craig Merow has asked his students to consider physician-assisted suicide laws and discuss abortion.

"You can't do bioethics without looking at the most contentious issue in American politics," Merow said.

Still, the potential for resistance to any bioethics discussion - whether the topic is volatile or not — is real, and acknowledged in a sample letter to parents drafted by the NWABR that teachers can send home before launching a class. The letter is intended to diffuse worry that teaching bioethics is just a sneaky way of indoctrinating students. "That's a big concern, obviously," Chowning said.

"Sometimes people have a quick reaction to the word 'values' or 'ethics,' and why are we having these things in schools? Once they realize that teachers are not trying to teach particular values, but students to articulate their positions, their link to ethical theories and to respectfully understand the views of others, that helps."

While it's difficult to quantify the effect of the programs (students are not tested on bioethics on state proficiency exams), the NWABR said in a grant report that 70 to 90 percent of teachers who taught bioethics believed their students' critical thinking skills had improved and that they had become more open-minded as a result.

That was true for Joeylyn Yockey, 19, who took Merow's bioethics class in 2008. "It made me respect people I originally pigeonholed," she said.

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