The Role of Professional Knowledge in Case-Based Reasoning in Practical Ethics

Abstract

The use of case-based reasoning in teaching professional ethics has come of age. The fields of medicine, engineering, and business all have incorporated ethics case studies into leading textbooks and journal articles, as well as undergraduate and graduate professional ethics courses. The most recent guidelines from the National Institutes of Health recognize case studies and face-to-face discussion as best practices to be included in training programs for the Responsible Conduct of Research. While there is a general consensus that case studies play a central role in the teaching of professional ethics, there is still much to be learned regarding how professionals learn ethics using case-based reasoning. Cases take many forms, and there are a variety of ways to write them and use them in teaching. This paper reports the results of a study designed to investigate one of the issues in teaching case-based ethics: the role of one’s professional knowledge in learning methods of moral reasoning. Using a novel assessment instrument, we compared case studies written and analyzed by three groups of students whom we classified as: (1) Experts in a research domain in bioengineering. (2) Novices in a research domain in bioengineering. (3) The non-research group—students using an engineering domain in which they were interested but had no in-depth knowledge. This study demonstrates that a student’s level of understanding of a professional knowledge domain plays a significant role in learning moral reasoning skills.

Appendix: Coding Instructions and Coding Sheet for Student Paper Analysis

Coding Instructions

In order to achieve the most accurate and consistent classification of respondents’ papers, the same method must be used to code each paper. When reviewing the papers, all coders should follow the instructions below. They will take coders through the assessment form in the order it was meant to be used.

Fill in the classification information at the top of the assessment form according to the attached cover letter.

Analytical Components of Methods of Moral Reasoning

While reading the paper, look for these concepts. Write in the page numbers on the appropriate line next to the concept, noting if the respondent has done one or more of the following: labeled (L), defined (D), or applied (A) the concept. Examples:

• Label: “Jake was concerned the patient had not given full informed consent.”

• Define: “A patient gives informed consent if he or she gives permission for a procedure, being fully and completely aware of all it entails and of all consequences. The consent must be freely given and not coerced.”

• Apply correctly: “After she discussed the procedure with her doctor and had her questions answered, Emily freely agreed to have the operation done.”

The attached glossary provides definitions and examples of all the concepts. Use it as a guide in coding. It should be particularly useful in the following two cases: (1) respondents may apply a concept without explicitly labeling it (as shown in the above example) or (2) if you find that there is a serious error in the respondent’s definition or application of the concept. In the latter case, please make a note in the margin. For example: “L, D, informed consent. Incorrect D: the student discusses informing the patient, but does not discuss the meaning of consent.”

If the paper contains a concept not on the list, then add it to the open spaces on the concept checklist.

Higher Order Criteria (Bottom of the Assessment Form)

The criteria listed here capture more abstract aspects of the ethical analysis. Use of these criteria can be indicated with a simple yes or no, but the coder should also provide a brief justification and page number(s) of when the criterion was used.

• Professional knowledge means that the case is set in the context of well articulated and relevant technical knowledge.

• Identify different perspectives means that the respondent has analyzed the case from different points of view.

• Moving flexibly among various perspectives suggests that the person has a deep knowledge of the different perspectives and can use these different domains as they analyze the case. A paper exhibits this by not only analyzing the case from the viewpoints of various case participants but also by explaining how these viewpoints and analyses relate to one another and to the overall ethical analysis.

• An analogous case can be a separate case cited for comparison. It can also be evident when a student changes the facts of the case, i.e. “What if the subject was your mother?”