Teaching Ethical Sensitivity

The old belief that values in healthcare are usually "caught, not taught" during the student’s clinical experience has been replaced by the current mission to address medical ethics from day-one and throughout the curriculum. Swick warns of the need to reshape medical education, saying, "Academic medicine faces unprecedented challenges, especially the impact of the changing and more business-oriented health care system on medical education."[1]

The need for improved methods to train allied health students in medical ethics is reflected in the discourse witnessed by online ethics instructors. For example, in a recent case study analysis of a doctor’s decision to use the "first-come, first-served" rule to grant a homeless person a corneal transplant, students argued 20-to-4 against the doctor’s decision. Justification for this unsympathetic position included responses such as:

  • For such a valuable resource, one must first look at the candidate that can give back to society.
  • Fairness has no relevance, factor in who has contributed to mankind and who has been a burden and the answer is clear.
  • Is there relevance due to the social positions? Ideally no, but realistically, yes. It makes no sense to me to transplant a valuable resource when a person’s life expectancy is short.

Despite an introduction to the ethical principles, healthcare students are challenged when asked to apply ethical sensitivity to clinical case studies. According to Kohlberg’s levels of moral development, many students seem to be stuck in the lower stages where their own needs determine the best course of action.[2] Higher levels of moral reasoning emphasize a social contract which respects the value and dignity of all human beings. The one ray of hope is that recent research shows that these higher levels can be obtained through education.[3]

When grounded in sound pedagogy, the online learning environment can actually enhance learning the higher orders of ethical sensitivity. This may be addressed through the design, application, and evaluation of Web-based strategies for teaching in the affective domain. In contrast to the cognitive domain, affective objectives deal with the feelings, attitudes, beliefs, and emotions that influence professional behavior. Teaching techniques for the affective domain must focus on student-centered rather than teacher-centered approaches. The student-centered approach emphasizes active rather than passive learning. Arguments against the student-centered approach claim that academic content is constant; medical ethics is viewed as a modern reflection of the Hippocratic Oath, and as such, it is considered static and sacred. Using this traditional perspective, it is more important for the student to form a passive relationship with the sacred text than an active one based on reflective discussion.

The affective domain recognizes online teaching techniques such as reflective dialogue as tools for active learning.[4] In the student-centered classroom, the student is an active participant in the formation and evaluation of information. The professor’s role is to function as a coach or a counselor, and evaluations become a formative process used to encourage the student to explore new ideas while instilling professional values into their behaviors and lifestyles.

In the student-centered paradigm, learning is not merely the result of individual effort; rather it is a social phenomenon such as described by Dewey. Students learn acceptable behaviors and attitudes from each other, and the emphasis is on learning as a journey rather than a destination. For example, in the affective domain, students are given the freedom to explore the options and consequences of their own decisions. The professor’s role is redefined from a sage who knows all the answers to a guide who clarifies the following:

  • Criteria for success
  • Strategies to motivate students
  • Relationships between process and product
  • Methods of evaluation[5]

Higher education is distinct from lower level schooling in that it professes intrinsic motivation, and not just the cognitive transfer of information.[6] This means that along with teaching fundamental ethical principles and concepts it is also the ethics instructor’s goal to instill ethical sensitivity in his or her students.


  1. Swick, H.M. (2000). Toward a normative definition of medical professionalism. Academic Medicine, 75(6), 612 – 616.
  2. Kohlberg, L. (1981). The philosophy of moral development. NY, NY: Harper & Row.
  3. Bebeau, M.J., Rest, J.R., & Yamoor, C.M. (1983). Measuring dental students’ ethical sensitivity. Journal of Dental Education, 49, 225-235.
  4. Neumann, J.A. & Forsyth D. (2008). Teaching in the affective domain for institutional values. The Journal of Continuing Education in Nursing, 39(6), 248 – 252.
  5. Speck, B.W. (2002). Learning-teaching-assessment paradigms and the on-line classroom. New Directions for teaching and learning, 91, 5 – 18.
  6. Walsh, D.C. (July/August, 1999). The academic calling: Creating spaces for spirit. Change, 18–23


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