Spring cleaning came a bit late for me this year. I teach various healthcare ethics courses specifically designed for Bachelor’s, Master’s and Doctoral level online health science students; and, before the start of each new semester, I think of ways to prune away the bad (or boring) learning material and graft on the new (and exciting) stuff. Gone are the days when the internet catered only to shy students who preferred lurking in virtual hallways and auditoriums. Today, nearly all students take online courses, and the challenge for me is to teach ethics as well as to motivate ethical behavior in all my students.
I woke up out of a dream this morning, with a profound clarity of thought. It was if I were in an inspirational state of mind, a rare domain for an intellectual (or pseudo-intellectual like me). The pain from my Fourth-of-July-at-the-beach-sunburned-back woke me up several times throughout the night and in that groggy, yet inspirational state of mind I realized that a major ingredient is missing from of my online ethics classes. Well, maybe it isn’t missing as much as it is unacknowledged and untapped. It is the human connection which resides as "the spirit in the machine.”
Martin Buber (1878 - 1965) defined the way we see the world around us using a tree as an example of the "I-It” relationship. We see its color; we watch it move; we identify its type; and, we make predictions about its behavior. Students can usually expect to get good grades for acquiring little more than this kind of knowledge in most classes…except healthcare ethics. That is because it is not enough for a doctor or a nurse or a pharmacist or a health technician to know the difference between right and wrong; they must be motivated to act ethically. Without instilling the ability or desire to do good, lectures and case studies on beneficence and nonmaleficence are nothing more than "sounding brass or clanging cymbals.” For example, informed consent is much more than a mere list of risks, benefits, and alternatives; it is a contract, symbolizing the trust that exists between two people. The informed consent is an expression of the health provider’s "I-Thou” relationship with the patient.
The spirit of the "I-Thou” relationship can be encouraged in the online learning environment, on the discussion boards and in the chat rooms. I recall a student who shared his one-time experience as a hospital interpreter. He confessed that his translation was not a literal one; but, his posting reminded everyone of the significant responsibility we bear caring for another person’s health. The clincher was that this interpreter was translating for his mother, so he knew her as a "Thou” not as an "It.” My dreamlike revelation is to inspire this kind of behavior between health professionals and all their patients.
I’m wide awake now and kind of giggling at this naïve approach; but, it is not such a revelation after all. The value of the patient as a unique individual and not as an "It” is described by the Hippocratic Oath. Health professionals should lead the way, demonstrating the "I-Thou” relationship with each of their patients, and even at home with their own families and neighbors. In this way, health professionals act as role models for the entire community (filling the void created by politicians, celebrities, and athletic superstars who outright reject this duty).
Simple actions of individuals can add up to the behavior of a group; so with every encounter, each of us has the opportunity to start a new movement. It happens now and then on the internet when students discover the spirit of hope, concern and love through their interactions on a machine. If it can happen there, it certainly can happen when we listen to each other’s words, look into each other’s eyes and touch each other’s flesh.
Holub P. Ethics. The Internet Journal of Allied Health Sciences and Practice. 2007 Jul 01;5(3), Article 2.