Bringing ethics to life: teaching bioethics at both the high school and college levels in China Baoqi Su Center for Bioethics, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China

After I received my Master’s degree from the University of Tsukuba in Japan in 2002, I started my work at the Center for Bioethics, Chinese Academy of Medical Sciences. After my first meeting with my students, I wished to be a good teacher. But what is a good teacher? What is a good teacher of bioethics? Can ethics be taught? What can be hoped for as the aim of my teaching? Those are questions that I always ask myself.

The primary focus of my teaching is to help the students develop their awareness of moral problems and dilemmas. The advances in the field of biotechnology have brought ethical issues into our lives. Genetic testing can be used to estimate the likelihood that a healthy individual with or without a family history of a certain disease might develop that disease.With the big gap between our ability to diagnose and cure genetic diseases, the effects on a person of being informed that he or she would suffer a genetic disorder can be seriously harmful.

Bioethics education empowers people to face ethical dilemmas Bioethics education empowers people to face ethical dilemmas. It enables students to make sound decisions. However, how do we accomplish this education? When is the best time? Ethics and values play almost no role in high schools or even in colleges in China. As a result, students tend to have a very narrow conception of the way in which ethics intersect with science and technology.

When I studied clinical medicine at the Capital University of Medical Sciences, there was a course named “yixue lunlixue” (medical ethics). It was given during the third year of study before we went to clinical practice. Its focus was to teach would-be physicians and other medical professionals what behaviors is towards patients are appropriate, but not how to face ethical dilemmas in health care and medical practice. The topics covered in the course were usually morality in the physician-patient relationship, morality in preventive medicine, morality in clinical diagnosis and treatment, morality in different clinical specialties, morality in nursing, morality in scientific research, morality in hospital administration, and so on.

The situation of ethics education in China is still inadequate at all levels, even though the times are quite different now. Classes usually are huge in size, sometimes up to hundreds. Teachers have not received adequate training in ethics and teaching. Most of the ethics textbooks are very similar to one another, and are not updated in order to keep pace with international standards. Ethics education is usually very far away from practical problems and real-life situations. All of the above lead to frustration on the teachers' side, and students regard ethics as tedious, dry and meaningless.

The situation of ethics education in China should be changed. I would include the teaching of the value and significance of traditional Chinese ethics, the principles and ideals from Confucianism, Daoism and Buddhism in facing modern bioethical issues. The basic Confucian idea is ren, which means “loving people” The golden rule is: “What you do not wish for yourself do not do to others”. I would also include some classical and modern western theories, such as Marxism. Marxist theory teaches us the pursuit of a just and equal society.

In cooperation with the international project of “bioethics education for informed citizens across cultures” that was initiated by Darryl Macer, a new approach for teaching bioethics has been introduced at both the high school and college levels in China since 2003. The students of all ages can reason about ethical dilemmas. They are capable of critical reflection and ethical reasoning.

High school students are at the right age to consider bioethics issues High school students are at the right age to consider bioethics issues.They want to know of the world around them, to understand political, social and cultural factors that influence the development of science. They recognize the benefits and risks of new technologies. Lectures to high school students do not have to be long. However, it is important to give a broad view of the field. The main purpose is to arouse an interest in the problem area and help students think more about it. In my lectures I would like to start with the familiar, and use what the students know to bring them to topics they want to learn more about.

Discussion is a very important part of such a course and very welcome by the students. Ask students to explain why your choice seems the best one to you. What personal values are involved in making this decision? Are you satisfied with your finial decision? Why or why not? In particular, while teaching, I would feel obliged to raise the students’ awareness of the issues that directly relate to poor or disabled people. What are their rights? How should we respect and promote their rights? It is also important that the students get an introduction to the current debate in China as well as to the general international debate.

The bioethics courses have different curricular goals for students at different levels of education. Lectures were given to the university students too. They are 20-year old or more and have more experience than high school students. The medical and nursing students are generally very interested in ethical aspects of their specialties and future practice. I believe that teachers in medical schools carry a unique task of responsibility and have a privileged chance to promote a humane society.

The undergraduate bioethics lectures that were given were: introduction to bioethics, autonomy, justice, benefits versus risks; ethical limits of animal use; genetic testing and genetic privacy; brain death; organ donation and transplantation; environmental ethics; lifestyle and fertility; assisted reproductive technology; telling the truth about terminal diseases; euthanasia and AIDS testing. These chosen courses focus on the ethical issues that related to their professional practice and their lives.

In the program, teachers’ contribution to the increased student interest is significant. They work in groups to prepare the lectures and discuss frequently how best to teach bioethics. Their dedicated and creative work in the earlier stage of this program is highly appreciated. However, several fundamental issues need to be considered carefully. The curricula of high school and college students are very tight, and the work of teachers is extremely heavy in China. It is still difficult to attract much attention to bioethics as an elective course. The materials in English are difficult for both teachers and students, which leads to the conclusion that we should write a textbook in Chinese as well.

Teachers have a major role in introducing the knowledge of ethics, and the teaching outcome is very much dependent the quality and interest of teachers. This is as true in China as elsewhere. The teachers need to be educated continuously as well. Then a much higher standard of teaching can be achieved. This program will be continued in the following school year in China. A bioethics network is being established in China too. We hope to encourage more teachers from both biology and other fields to join us. By exchanging information and ideas with each other, all of the teachers can be encouraged.

By teaching bioethics to high school and college students, and to medical and nursing students at Peking Union Medical College in particular, I have learnt that the teacher-student relationship can be understood as a model of the physician-patient relationship. Students will perform in analogy to their teachers’ performance.Therefore teachers bear a specific burden and responsibility both for their students and for the students’ later patients.

As a young teacher, I deeply believe that I should behave as a good example. I listen to student’s opinions carefully and support their active involvement. I teach from my heart, and in my heart I know that to study and explore bioethics together with all of my students is a great honor for me. I am deeply grateful indeed to my students after each lecture. Let us together bring ethics to those young people, to life, and to love of life.