Appendix: Instructors' Guide Bernard M Dickens
The purposes of the International Federation of Gynecology and Obstetrics (FIGO) Introduction to Principles and Practice of Bioethics are to make medical students of obstetrics and gynecology, and interested practitioners, aware of key concepts in bioethics, and to provide them with some case studies to acquire some early experience in their application. Students are expected to review the case studies, supplemented by further real-life cases drawn from their own developing experience, in light of key ethical principles. They should identify principles that they consider relevant to a case study, the level at which they find that principles should be applied, and the priority that should be given to principles in order to make one more relevant to any other to ethical decision making. The case studies are not designed to have “right” answers. We learn as much from errors as from making “right” decisions, and we learn from our own errors as well as from those we perceive our colleagues to make. Students must therefore be given opportunities to make choices that others, including their instructors, consider ethically flawed or indefensible. Instructors must not ini tially direct or unconsciously guide students to make what seem to be acceptable decisions. Some options presented in the case study questions appear to be misguided, but it is for students to reach their own conclusions. Only after students have reached their own conclusions should they be further questioned in order to expose any flaws or concerns that may arise in their ethical reasoning. They must at first be allowed to make errors, in order for instructors to explain the points in their reasoning at which errors have arisen.
They should be required to explain and justify their proposed decisions in terms of the ethical values they find to be at stake, explain why they consider others' different perceptions and prio rity of values to be less preferable than their own, and respond to points that instructors raise to test whether their reasoning and conclusions can bear the weight of ethical examination. Students should not feel bound to change their conclusions on cases simply because they find ‘classmates or instructors’ different conclusions to have an ethical foundation. There may be more than a single ethically acceptable resolution to a question raised in a case study, and in a real-life situation. Students should aim to reach and justify resolutions that they find ethically appropriate, even while recognizing that other resolutions, giving priority to competing principles or a diffe rent level of approach, may also be ethically defensible. Instructors should try to contain consideration of the case studies to the simple fact patterns in which they are framed, and not allow students to develop additional facts that permit resolutions of cases on medical, social, scientific, or other grounds that evade the students having to come to grips with their ethical aspects. In real-life circumstances, there may indeed be strategies that relieve ethical dilemmas, such as increasing supplies of resources or bringing in additional personnel, but in addressing the case studies, the ethical issues should be addressed on their own terms and not be avoided by technical additions of facts. Within the terms of a case study, however, students should be allowed and encouraged to find additional ethical questions and options for resolution that merit attention.