Case-Based Ethics Instruction: The Influence of Contextual and Individual Factors in Case Content on Ethical Decision-Making

Abstract

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sensemaking processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed.

Appendices

Appendix 1: Example of One Manipulated Case

Underlined information was manipulated based on the condition. Specific manipulations are designated in bold

Big Pharma Case—Autonomy Supportive Social Context and Prevention goal

Jason is in his second year and Robin is just finishing her first year of postdoctoral training in a cell biology lab where they share a good working relationship. They have generous fellowships thanks mostly to their mentor’s enterprising associations with the pharmaceutical industry. Dr. Davis, their mentor, does contract work that requires review and approval by industry scientists before work can be submitted for publication.

His university has offered to negotiate with the drug companies for better publication terms. Davis has so far refused on the grounds that he does not want to compromise his competitive edge which has won him a solid reputation along with continued funding for a team of first rate graduate students and post-docs. In fact, Dr. Davis prided himself on cultivating an atmosphere in his lab for students requiring little guidance and direction. He valued those students willing to take initiative and made it very clear to all incoming lab members that he will never take time to remind them of any deadlines, punish, or threaten them in any way. He often said, “It’s your future…why should I care about it?” Autonomy-supportive social context

Despite the Davis lab reputation, Robin was very impressed with Dr. Davis’ work and considered herself lucky to secure a spot in his lab. She most feared disappointing him and worked hard to prevent failure. Prevention goal

The two post docs are using different animal models to test the efficacy of a gene product. It is hoped that this gene product will interfere with cancer cell-signaling and slow or arrest meta-static activity. Jason’s results are extremely encouraging, but Robin’s are not. She confides to her friend that she is disappointed with her failing project and a year’s loss in productivity. Moreover, she was extremely annoyed by Davis’ lack of guidance and assistance with this project. She didn’t appreciate Davis’ method of conducting his lab and didn’t totally agree with his philosophy of allowing students complete autonomy. She is also frustrated because Davis has hinted that she must be doing something wrong. After all, Robin is working with the same protein as Jason, and it is reasonable to expect that her results would at least show a similar trend. Autonomy-supportive social context

Jason replies candidly about what he learned in his first year—that the industry’s emphasis is on getting results. He points out that if the Davis group does not produce, the project will be turned over to another team that will, and the fellowships will follow the money. Also, since Davis depended on his students to do the work without his interference, if the project should fail, he will likely blame them. Prevention goal

What Jason said made sense, but Robin was uncomfortable with the implication she thought was being conveyed. She made a noncommittal remark and changed the subject; however, the new information preyed on her mind. Was she being naively idealistic about science?

Following this talk, Robin resolves to work harder on the gene product. She begins to put more hours into her work thinking that her initial results must have been faulty. She is determined to show Davis that she is not a failure and can make a worthy contribution to his lab. Prevention goal

Despite her newfound goal, Robin continues to feel uncomfortable with the climate of the lab and her interactions with Jason. She contemplates discussing the issue with Davis but fears he will react just like Jason. Ultimately, she decides that the best course of action is to not change her results and to leave the laboratory altogether. When she discusses her resignation with Davis he is surprised and asks for an explanation. She circumvents the real issue, simply telling him that she doesn’t feel like she fits in very well and would like to take her career in a different direction. Robin, admittedly, is conflicted over her decision to withhold information from Davis but thinks that she might create a bigger issue if she shares the entire truth.

Six months later, Robin finds herself in an entry-level position at a small bio-medical company. She is satisfied with her current work and is relieved that she no longer faces the pressures of her previous lab. She is even more relieved that she left her post-doc position when she receives word from a former lab mate that Davis’s laboratory has lost its funding after being investigated by the Office of Research Integrity on data fabrication charges.

Appendix 2: Tight Schedule Low-Fidelity Task

You are a member of a dedicated team of graduate students working on a project that is funded by the National Institute of Mental Health (NIMH), which is a federal government agency. The project is designed to track the effectiveness of state-run mental health care programs for the poor. The study requires extensive interviews with a large number of people on a yearly basis and the team is running behind schedule.

You and the other students believe that the schedule was unrealistic, and that it would have been almost impossible to stick to the schedule, even in a best-case scenario. There is just too much to do in a short amount of time. The project director, Dr. O’Connell, is highly focused on results and completing the project on time, and he insists on accelerating the pace of interviewing in order to meet the deadline. You are beginning to feel overwhelmed.

On top of this project, you decided to take an extra class this semester. You wanted to take this extra class, because you want to graduate a year early. Your plan is to take an extra class this semester, an extra class next semester, and three classes next summer. You wanted to leave school early because you recently got engaged, and you want to get married and start your new life. Your fiancée recently moved out of town, and you have been spending a lot of your weekend time visiting him/her.

You talked to your advisor about your fast-tracked plan for your coursework, and he discouraged the idea of graduating early. He emphasized that it would be very difficult and time-consuming, but you were convinced that because you wanted it so much, you would be able to do it.

An important progress report to the NIMH is due in 1 month. You and the other staff members still do not know how you are going to complete the rest of the interviews. If this progress report does not work out, it will hurt the opportunity to get more funding in the future. This has put even more pressure on all of the staff and Dr. O’Connell. If you lose funding for this project, all of your hard work will have been for nothing. Dr. O’Connell is putting even more pressure on the graduate students to catch up to the already impossible schedule. You have scheduled your time this semester so tightly that you have very little flexibility in how and when you fulfill your responsibilities to this and other projects. You are not sure how you are going to get the extra interviews done in time.