In this essay Michael Loui explains fieldwork and cooperative learning in professional ethics. The paper describes two courses relating to professional ethics in which students develop skills for working in multidisciplinary teams and deepen their understanding of collective moral responsibility.
In two courses on professional ethics, students collaborate in small groups on a fieldwork assignment. In this assignment, students visit a site and interview several professionals to learn about an actual ethical problem that occurred at that site. The students analyze the problem and write a group paper. Through this assignment, students develop skills for working in multidisciplinary teams, and they deepen their understanding of collective moral responsibility.
The views, opinions, and conclusions of this paper are not necessarily those of the University of Illinois at Urbana-Champaign. A preliminary version of this paper will be presented at the Eighth Annual Meeting of the Association for Practical and Professional Ethics, Crystal City, Va., February 25&27, 1999.
Address for correspondence: Michael C. Loui, Graduate College, 801 S. Wright St., Champaign, IL 61820-6210, e-mail: email@example.com, telephone: (217) 333-6715.
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In college and university classrooms, with increasing frequency, lectures are complemented by collaborative and cooperative learning activities. Courses in philosophy [Thomason, 1990] and specifically in professional ethics [Herkert, 1997] have incorporated collaborative learning methods such as problem-solving in small groups, role-playing, and team projects.
I have used collaborative and cooperative learning methods successfully in two ethics courses at the University of Illinois at Urbana-Champaign: ECE 216, Engineering Ethics, and CHP 295, Professional Ethics. What makes ECE 216 and CHP 295 unusual is the fieldwork assignment, in which students collaborate in small groups to study a real ethical problem. By working in groups and by interviewing a group of professionals who handled the problem, students learn effective teamwork skills, and they improve their understanding of collective moral responsibility, a theme of both courses.
In this paper, I summarize the importance of multidisciplinary collaboration in professional ethics, describe the distinctive aspects of ECE 216 and CHP 295 in detail, and discuss the pedagogical value of the fieldwork assignment in both courses.
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"'Well, that is his loss, not mine,' answered the Rocket. 'I am not going to stop talking to him merely because he pays no attention. I like hearing myself talk. It is one of my greatest pleasures. I often have long conversations all by myself, and I am so clever that sometimes I don't understand a single word of what I am saying.' 'Then you should certainly lecture on Philosophy,' said the Dragon-fly." - Oscar Wilde, The Remarkable Rocket
Collaborative learning is a form of instruction in which students work in small groups on structured assignments. Cooperative learning is a special form of collaborative learning characterized by interdependence between group members, face-to-face interaction, individual accountability for results of the group's efforts, and conscious reflection on the functioning of the group (also called "group processing") [Johnson et al., 1991]. Students in a cooperative group work together to achieve common goals, and they are graded on the success of their group and on their individual contributions. For example, the discussion of a question in small groups is a collaborative exercise. If in addition the instructor may call on anyone in any group to present the group's answer to the entire class, then the exercise becomes cooperative because each student is dependent on the others to prepare a correct answer, and is publicly accountable for the results.
Many professors and students resist adopting collaborative and cooperative learning methods, not only because of lack of familiarity with these methods. Professors worry that they might lose control of a class, and that they would cover less material. Students fear that their grades would be jeopardized by weak performers in their groups, and that they would learn less from peers than from the professor. In a comprehensive guide to cooperative learning, Millis and Cottell  address these concerns and argue that cooperative learning can help students develop academic and interpersonal skills better than traditional teaching.
Cooperative learning offers many benefits over traditional pedagogical approaches [Johnson et al., 1991]:
These benefits accrue for several reasons [Cuseo, 1990; McKeachie, 1994]:
Perhaps the most important benefit of cooperative learning is that students learn how to work in teams with people who have diverse social and cultural values. Students learn how to reconcile conflicting values, and how to integrate different areas of expertise to achieve a common goal. Teamwork skills are increasingly important in almost all careers. Throughout commerce, government, and industry, people work in groups and teams to undertake projects and to reach decisions. Students who have learned teamwork skills in an academic setting are much better prepared for professional careers.
Cooperative learning poses an ironic challenge for a course on professional ethics because most professional ethics courses focus on individual responsibility. In collaborative situations, moral responsibility is shared collectively [French, 1984; Ladd, 1982; May, 1987; May, 1991]. Collective moral responsibility does not mean that responsibility is diffused -- or atomized --to the point that no one is accountable. Rather, in a form of collective responsibility called "mutual accountability," group members are individually and jointly accountable to each other for the group's goals, progress, and products [Katzenbach and Smith, 1993]. In both work and academic settings, cooperative groups should be small, to promote individual accountability, and to contravene the natural tendency for an individual to disown the actions of a large group.
In both ECE 216 and CHP 295, we devote several class periods to discussions of responsibility: how professional responsibility differs from ordinary moral responsibility, and what collective responsibility means. The fieldwork assignment, which results in a group paper, reinforces the concept of collective responsibility. Within each group, each student evaluates the performance of each other group member, so that students are individually accountable to each other. The fieldwork assignment is described in Section 5 below.
In ECE 216 and CHP 295, we do not take class time to explain how to work in groups, although we emphasize that students should be civil and courteous to each other. We distribute the following credo, which is adapted from the recommendations of Davis :
"It seems to be one of the unfortunate facts of life that no mathematics book can be published free of errors. Since the present book is undoubtedly no exception, each of the [four] authors would like to apologize in advance for any that still remain and take this opportunity to state publicly that they are the fault of the other three." - Donald L. Kreider et al., An Introduction to Linear Analysis
In real life, solving ethical problems requires collaboration between different kinds of professionals. The combination of different experiences and values can lead to better, more informed decisions. Engineers know that every large project--designing a passenger aircraft, constructing an oil refinery, manufacturing an automobile--requires a team of engineers with different specializations: mechanical engineers, electrical engineers, materials engineers, computer engineers, etc. Broader professional collaborations occur in other settings. In hospitals, patient care teams comprise social workers, physical therapists, nurses, and physicians. In environmental protection agencies, the drafting of regulations requires lawyers, civil engineers, and soil chemists. Physicians and lawyers, traditionally solo practitioners, are now employed in large medical clinics and law firms.
Multidisciplinary ethical deliberation may take two subtly different forms. In the representative form, the group contains a representative of each appropriate profession to ensure that the profession's interests are given attention in the group's decision. In the integrative form, the group ensures that all ethically relevant considerations are recognized in reaching a decision. Whereas a representative group may seek a political compromise among competing interests, an integrative group strives to ensure that the biases of individual professions do not interfere with the quest for good moral solutions. Members of different professions generally perceive and express moral issues differently because of their different training and orientations. In an integrative group, members endeavor to understand the issues from the perspectives of other professions, to overcome their own professions' natural blind spots, and thereby to reach a decision that does justice to all relevant moral considerations.
Ideally, the multiplicity of disciplinary perspectives can enhance the diversity of solutions. In business, a common multidisciplinary team is the "cross-functional" team, which brings together people who normally perform different functions: product design, manufacturing, quality control, marketing, etc. According to Parker , cross-functional teams can reduce the time needed to accomplish goals and can provide innovative solutions to complex problems: Cross-functional teams provide the basis for a creative mix of people with different backgrounds, orientations, cultural values, and styles. While this diversity can be hell to manage, the possibilities for bright new ideas...are great." To maximize this potential for diversity in brainstorming activities, individuals should first generate alternatives alone, not to make up their minds a priory, but rather to avoid possible group pressure for conformity and possible deferral to the most vocal or prestigious person in the group [Sniezek and Henry, 1989].
In ECE 216 and CHP 295, we teach students about the dangers of premature consensus, through memorable stories such as the "Abilene Paradox" [Harvey, 1988] and cases such as the Challenger disaster. Whether because of group tyranny through peer pressure ("Groupthink") [Janis, 1982], or because of individual anxiety about possible ostracism [Harvey, 1988], people in groups sometimes agree to undertake actions that upon private reflection, they would individually judge to be unwise. We encourage students to adequately consider dissenting views. In general, students should generate and evaluate multiple alternative solutions, and their pros and cons, prior to the identification of a preferred solution, for the following reason: people tend to overestimate the quality of their choices in difficult situations, and by generating reasons against their preferred alternatives, they reduce the chance of rationalization [Koriat et al., 1980].
"Formal education can rarely improve the character of a scoundrel." - Derek Bok, Beyond the Ivory Tower
ECE 216, Engineering Ethics, is an elective for juniors and seniors, with no formal prerequisite other than expository writing at the freshman level. ECE 216 carries three semester-hours of credit. Since 1993, ECE 216 has been offered every spring. The number of sections has increased to three or four in recent years, with sections taught by different professors. Since 1996, one section of ECE 216 has been offered to students in the Campus Honors Program. The maximum enrollment in each regular section is 25 students--the maximum in the honors section is 15--because ECE 216 is designated as a writing-intensive course. Each student writes six mini-papers, each two to three pages long, and an eight-page term paper. Each mini-paper analyzes an article or a case. An article analysis summarizes the main ideas, identifies the author's implicit assumptions and perspectives, and assesses the strengths and weaknesses of the arguments critically. A case analysis explores the conceptual and ethical issues in the case, determines the responsibilities of the actors, and proposes possible solutions. Each mini-paper may be revised and submitted for a higher grade by the due date of the next mini-paper, and the term paper must be revised. In the honors section, the fieldwork assignment substitutes for two mini-papers.
The syllabus of ECE 216 emphasizes issues in engineering ethics at the level of individuals and organizations, rather than social policy: professionalism, responsibility, honesty, confidentiality, conflict of interest, safety, relationships between engineers and managers, loyalty, whistle-blowing, codes of ethics, licensing, and choosing a vocation. Case studies include the Challenger disaster and the BART (Bay Area Rapid Transit) case.
CHP 295, Professional Ethics, is a new interdisciplinary seminar for students in the Campus Honors Program. I developed CHP 295 with James Wallace, a professor of philosophy who specializes in ethics, in the summer of 1996. Since then, we have offered the course only once, in the fall semester of 1997. The course also carries three semester-hours of credit.
Like other interdisciplinary courses in professional ethics (for example, a course at Cedar Crest College [Meade and Weaver, 1995]), CHP 295 presents ethical problems of different professions such as law, medicine, and science, with guest speakers from various disciplines on campus. CHP 295 considers relationships with clients, including deception, informed consent, and confidentiality; relationships with other professionals and employers, including loyalty and whistle-blowing; and relationships with the public, including licensing, compensatory justice, and access to services. We emphasize the collaborative solution of ethical problems using multiple disciplinary perspectives, particularly in the fieldwork assignment.?
Both ECE 216 and CHP 295 use a variety of case materials. Short cases, such as the cases assembled by Harris et al. , are used in class. Typically, the students are divided randomly into small ad hoc groups, each with three or four students. Each group discusses the same case for about twenty minutes, and then the entire class discusses the case, identifying and solving the moral problems in the case. For some cases, the class engages in role playing: students volunteer for speaking parts, and each student who does not have a speaking part serves as a coach for a student with a speaking part. Each speaker caucuses with two or three coaches to prepare for the run of the role-playing session. Thus, the role-playing activity is a collaborative exercise.
Short cases are assigned as mini-paper topics. Each student analyzes the factual, conceptual, and moral issues in the case and proposes possible solutions.
Whereas a short case involves only one or two ethical issues, the fieldwork assignment gives students experience with a long case that involves multiple ethical issues. Through this assignment, students learn to identify ethical issues in complicated real situations. In CHP 295, before undertaking the group fieldwork assignment, the students have one group paper assignment, to analyze a fictional case with multiple ethical issues (see Appendix #1).
For more suggestions on cases and their uses in teaching ethics, see the article by Davis .
In both ECE 216 and CHP 295, each student completes an individual term project on a topic related to the course. Students choose their own topics, typically the ethics of a social problem: the privacy of electronic mail, pollution credits, genetic engineering, manufacturing with overseas labor, and so on. Each student gives an oral presentation of the term project, which results in a term paper that substitutes for a final examination. For the term paper, each class is divided into groups of three students, and within each group, students exchange papers to obtain comments from two peers. To focus the student's comments on another student's paper, we provide a checklist on content, organization, and style. Within each group, students have different topics, to avoid conscious or unconscious plagiarism. Hamilton-Wieler  argues that this kind of collaboration, called "peer editing," helps students develop self confidence as writers, and fosters a community of writers in the classroom.
"One way of making education more holistic is to get outside the classroom and off the campus...the change in environment changes everything. The class becomes a social unit; students become more fully rounded human beings--not just people who either know the answer or don't know it. Inside the classroom, it's one kind of student that dominates; outside, it's another. Qualities besides critical thinking can come to light: generosity, steadfastness, determination, practical competence, humor, ingenuity, imagination. Tying course content to the world outside offers a real-world site for asking theoretical questions; it answers students' need to feel that their education is good for something other than a grade point average." - Jane Tompkins, A Life in School: What the Teacher Learned
The fieldwork assignment in ECE 216 and CHP 295 has two primary purposes:
Each group of students visits a pre-selected site in the community to learn about an ethical problem that professionals at that site have encountered. Each group writes a paper that presents the problem as a case and provides a case analysis. Unlike the interview assignment designed by Whitbeck , in which each student writes an imagined scenario and asks professionals what they would do that scenario, students in ECE 216 and CHP 295 work in groups on cases that actually occurred. They learn to handle realistic situations with multiple facets and subtle nuances in complex sociopolitical contexts. Unlike the service-learning assignment of Fitzgerald , in which students volunteer at community service agencies to learn about social responsibility, students in ECE 216 and CHP 295 interview practicing professionals learn about professional responsibility.
In preparation for the fieldwork assignment, the instructor locates a primary contact at each site. In different semesters, the sites have included a medical clinic, a hospital, a law firm, a manufacturer, a software publisher, and a consulting engineering firm. The ethical problems chosen by the contacts can vary in depth and difficulty. We have learned that it is important to discuss the problem choices with the contacts in advance, to ensure that the problems are appropriate.
Students rank the sites from most preferred to least preferred. We generally assign students to one of their top two site choices, while balancing personalities and strengths among the groups to be fair to everyone. Research on cooperative learning strongly recommends heterogeneous groups, to provide a diversity of ideas and viewpoints [Johnson et al., 1991; Millis and Cottell, 1998]. Each group has three or four students, and each site is visited by one group.
Each group has about four weeks for the assignment. First, one student in a group calls the contact person, asks about the general outline of the problem, and arranges a date and time for the first round of on-site interviews with the contact and other professionals at that site. During the interviews, the students ascertain the facts of the ethical problem, identify the assigned duties and moral responsibilities of the participants, and inquire about cultural, organizational, and legal constraints on possible solutions. The students ask specific open-ended questions.
After the first round of interviews, the students in the group brainstorm to decide how to present the case narrative, to analyze the case, and to formulate alternative solutions. In this phase of the assignment, students witness the power of groups in providing multiple perspectives on a problem and generating multiple ideas. At this stage, the students prepare an outline of the paper. Next, the students return to the site to talk to the contact person and others again to check on the accuracy of the case narrative and to evaluate the feasibility of their proposed alternative solutions.
Because students are busy, they frequently have difficulty in scheduling meetings outside the class time. If necessary, they may schedule interviews during a class period, and they are excused from class for the day. In future offerings of these courses, we plan to use World Wide Web conferencing tools, to enable groups to meet asychronously.
After the interviews, the students in a group produce a single paper six pages long, double-spaced, divided into a case narrative and a case analysis of approximately equal length. Although the case narrative should be faithful to the spirit of the actual incident, the narrative may embellish the details of the case. For example, the narrative may include snippets of conversations that might have occurred. Further, the names of the participants are changed to protect their privacy. The case narrative for one group in CHP 295 appears in Appendix #2.
Students find that writing a paper in groups is challenging. Not only must they reach a consensus on the content of the paper, but they must also produce a single document. If different students draft and rewrite different parts of the paper, the result can be incoherent. Alternatively, all students in the group could write every sentence together, but this method takes much more time. As Ede and Lunsford  emphasize, however, the benefits of coauthorship outweigh the disadvantages.
After the instructor reads the paper and returns it to the group, the students have one additional week to revise the paper and to submit the revised version for the grade on the assignment.
When the revised papers are submitted, each student submits a confidential evaluation of each of the other students in the same group. The peer evaluation includes an overall rating on a five-point scale (Excellent, Good, Satisfactory, Fair, and Poor), and comments on the following criteria:
Before evaluating others in a group, each student evaluates his or her own performance. Although the self-evaluation is not used in determining the grade on the assignment, the self-evaluation helps the student assign a rating to another student by comparing their performances.
There are several ways to incorporate peer evaluations into the student's grade on a paper. In ECE 216 and CHP 295, we use the following simple rule: each student whose average rating is Satisfactory or better receives the full grade for the group paper, which is usually very high; each student whose average peer rating is below Satisfactory receives a commensurately lower grade. Another way to incorporate peer evaluations is to make the student's grade for the paper a weighted combination of the group grade and the average peer rating, with the lowest peer rating dropped.
The peer evaluations emphasize the mutual accountability concept discussed in Section 2: each student is accountable to every other student in the group. Peer evaluations are fair, because they reward students who contribute to the group's goals and penalize the few goldbrickers.
In addition to submitting peer evaluations, each student completes a simple individual evaluation of the assignment:
Lewis et al.  offer detailed advice on assessment of multidisciplinary teams.
The students' evaluations of the fieldwork assignment have been overwhelmingly positive. Representative excerpts are given in Appendix #3. In the final evaluations of each course, many students say that the fieldwork assignment was the highlight of the course, and that they wish there could have been more fieldwork assignments.
In two professional ethics courses, a fieldwork assignment enables students to connect their academic learning with professional practice in a meaningful way. Through this assignment, students become more confident about their ability to handle difficult ethical problems that may arise in their careers as professionals. Furthermore, because the assignment is conducted in groups, students develop teamwork skills and gain a deeper understanding of collective moral responsibility.
ECE 216 was developed with the support of a grant from the campus Program for the Study of Cultural Values and Ethics, recently renamed the Illinois Program for Research in the Humanities. CHP 295 was developed with the support of a campus course development award. For CHP 295, James Wallace collaborated with me on the design and offering of the course, and Ann Reisner provided conceptual assistance. Kathleen Collins, Steven Johnson, Eugene Morehead, Scott Morrison, Lott Thomas, and David Withoff served as contacts for fieldwork assignments in ECE 216 and CHP 295. Richard Burkhardt and Bruce Michelson encouraged me to teach in the Campus Honors Program, and Carol Bernson handled the logistics. Janet Sniezek recommended articles on the psychology of group decision making, and Gail Hawisher sent me copies of papers on collaborative writing. Steven Johnson suggested numerous improvements to a previous draft of this paper, particularly the important distinction between the representative and integrative forms of multidisciplinary ethical deliberation.
Students in CHP 295 were assigned to groups, with three students in each group. Each group wrote a three-page analysis of this fictional case.
At Dewey, Cheatham & Howe (DCH), the fourth largest law firm in Chicago, managing partner Robin D'Cradle wants to increase the productivity of the secretarial staff. Robin believes that many secretaries spend too little of their time typing legal documents and too much time sending frivolous e-mail messages. Robin hires Dana Torrez, an information systems consultant, to enhance the firm's computer systems to monitor the keystroke rates of the secretaries and to record their e-mail messages for later review by supervisors.
Dana is grateful for the contract, a satisfying recognition for the excellent reputation of Dana's small but growing consulting business, Urbana Information Consultants (UIC). If all goes well, Dana can look forward to a long relationship with DCH. Dana has some nagging doubts about the wisdom of using keystroke rates to measure productivity, and is concerned that the e-mail messages might include embarrassing personal correspondence. Nevertheless, Dana accepts Robin's argument that managers have a duty to monitor productivity, and that because DCH owns the computing equipment, all e-mail messages belong to DCH.
Reasoning that it would be impractical to record every keystroke and to store every message, Dana decides that a statistical approach should suffice. Dana asks J.C. Jackson, a distinguished professor of statistics at the University of Illinois, for advice. After studying the situation, J.C. recommends a complicated adaptive randomized sampling method to collect the data, and a sophisticated resampling strategy to infer the keystroke rates.
At UIC, Dana's associate Kelly Kim is a recent computer engineering graduate from Illinois. Kelly doesn't understand J.C.'s algorithms completely, but is confident about implementing them correctly. Anyway, thinks Kelly, J.C. is fully responsible for the results of the statistical calculations.
Kelly wants to implement a state-of-the-art distributed client-server system, to learn about this new technology. Kelly is convinced that from a technical point of view, the best network server for the system is the amazingly fast IPM AS/460, augmented with several gigabytes of disk storage. Kelly is thoroughly familiar with the capabilities of the IPM AS/460 because Kelly's domestic partner is the product manager for the IPM AS/460 at Illinois Programmable Machines. In fact, because Robin seems willing to invest a lot of money in the project, Kelly surmises that DCH could afford two network servers, for much higher reliability.
Among the small group of people at DCH assigned by Robin to work with Dana's firm is Leslie Long, the chief accountant. Robin has trusted Leslie for many years. Leslie's motto is, "Good decisions require good data." Nearing retirement, and with many responsibilities at DCH, Leslie has been unable to keep up with modern auditing techniques. Leslie is uncomfortable with the statistical audit proposed by J.C.: Leslie suspects that because secretaries' workloads vary dramatically from one day to the next, a sampling approach may not produce sufficiently reliable data. Leslie may offer only a qualified opinion on the system.
Also in the DCH delegation is Merle Matsunaga, a paralegal assistant. Merle insists that only the secretarial staff be monitored electronically. In Merle's judgment, the professional staff, including the paralegals, handle particularly sensitive information from clients. Thus, their e-mail messages should not be stored centrally, where the messages could be read by any secretary's supervisor.
Because no one in the DCH delegation is on the secretarial staff, Dana decides to find out more about the secretaries' workloads by talking with a friend, Noel Nielsen. Noel works part time as a secretary at DCH, while studying for a bachelor's degree in occupational health. None of the secretarial staff had been informed about the electronic monitoring project previously, but Noel eagerly tells Dana about the stressful work environment at DCH. Although the salaries are high and the computing equipment is excellent, there is tremendous pressure on the secretaries to type legal documents rapidly and accurately. Some of the staff complain that their hands feel numb in the middle of the night.
What are the factual, conceptual, and ethical issues in this case? How should Robin, Dana, J.C., Kelly, Leslie, Merle, and Noel work together to solve the ethical problems?
Case narrative by Rebecca Brooks, Jeff DeSando, and Leah Horvath, students in CHP 295, Fall 1997.
A 35-year old student from India, Mr. Castanza, arrived at Ethical State University Hospital after complaining of severe head pain. The attending neurologist Dr. Jerry administered a CAT scan, which indicated that the patient suffered from bleeding on the brain. This is a life-threatening condition, and, shortly after the diagnosis, Mr. Castanza became unconscious and was declared brain dead. Since brain death is considered legal death in the state of Illinois, the attending physician Dr. Newman intended to remove Mr. Castanza from the ventilator unless the patient's wife granted permission for organ donation. The ventilator was not keeping Mr. Castanza alive, it was merely sustaining the tissues in the case of organ donation...
Mrs. Castanza, though legally next of kin, was bound by the Indian culture's belief that her husband's parents were the closest relatives. Therefore, she requested that her husband be kept on the ventilator until his parents could arrive from India within the next 24 to 48 hours. The Castanza family had a strong Hindu faith which included a belief that the body must be cremated within 24 hours of death to ensure that the person's soul will not remain in limbo. Mrs. Castanza wished to allow her husband's parents a chance to see their son before his cremation ceremony.
Mrs. Castanza was considerably distressed and needed a familial support system. She was only 18 years old and had just learned the day before that her fertility treatments had been successful, and she was finally pregnant with their first child. She was deeply distraught and spent much of her time weeping beside her husband's bed, saying that he had promised to take care of her always.
Despite the young wife's heartrending pleas, the hospital was bound by an unwritten policy concerning keeping brain dead patients on life support. Generally, the hospital does not promote sustaining physical life after brain death has been declared, although there have been a few cases were exceptions were made. One such case involved a pregnant woman who was kept on ventilator support until her fetus was mature enough to survive outside the womb. Other cases where exceptions have been made involved patients who might have served as organ donors.
The nursing staff with Dr. Jerry and Susan, the social worker, felt that the wife's request was reasonable. Since there were not any patients waiting for the bed, they did not see any reason why Mr. Castanza could not be left on the ventilator. Those who supported the woman's request felt that health care involves more than treating the body, it also involves ensuring the mental health of the patient and the patient's family. These individuals viewed medicine as a holistic healing process that must recognize the emotional, social, and religious needs of the patient and family. The nursing staff was concerned about the wife's well being since she lacked a support network and had confronted so much intense and varying emotional shock in such a short time. The nurse manager Elaine, Dr. Jerry and Susan tried to develop a plan that would allow the family some extra time, but also not prevent other patients from receiving maximum care. Out of respect for international friendship, religion, and the fact that the family was coming, Mr. Castanza was to be left on the ventilator for 24 hours without any additional active treatment.
Despite his original agreement, the attending physician did not want to keep the patient on the ventilator and was not legally bound to do so. The head of critical care, Dr. Kramer, felt that it would set a dangerous precedent to allow the patient to remain on the ventilator and also that it would be very expensive to continue to treat the brain dead patient. The hospital expenses would be billed to the family, but there was a substantial risk that the hospital would have to cover the cost.
Dr. Kramer further believed it was unethical to perform medical procedures on a corpse. Treating a brain dead patient is inappropriate and essentially a physical assault on the corpse. Though the original agreement dictated that Mr. Castanza would be removed from the ventilator if additional care was required, Dr. Newman ignored this provision, believing that the ventilator itself qualified as additional care. It was not possible to leave Mr. Castanza on ventilator support for 24 hours without active treatment because, after 12 to 16 hours, extensive care and medicine would be required to keep the body from deteriorating. Since the nurses had already stated that active care would not be provided within the 24 hour time frame, Dr. Newman's argument was invalid. In addition, Dr. Newman felt that keeping Mr. Castanza on the ventilator would not be beneficial for Mrs. Castanza's emotional health, as it would only perpetuate the family's denial of Mr. Castanza's death. Dr. Newman was so strongly opposed to treating Mr. Castanza that he yelled (within hearing range of the wife) "What in the hell do you want me to do, treat a dead man...?"
The case came to the attention of the head of the bioethics department...when two Indian resident doctors brought forth their concerns about possible racial and religious discrimination. The critical care doctors believed no discrimination was involved since they were not preventing the patient from being cremated within 24 hours, they were merely preventing the parents from seen their son's body. The ethics committee met several times in an attempt to resolve this moral dilemma, but was unable to reach a conclusion.
[The paper continues with 3 pages of analysis.]
Michael C. Loui
Department of Electrical and Computer Engineering,
Coordinated Science Laboratory, and Graduate College
University of Illinois at Urbana-Champaign
January 16, 1999
Presented at the OEC International Conference on Ethics in Engineering
and Computer Science, March 1999