Bioethics education for informed citizens across cultures 
Developing teaching materials on bioethics

China report 3=BeijingChapter1Trial1 (BC1T1.rtf); note that confidential information identifying the student names is in a separate file BC1T1co.rtf, to protect their privacy.

Baoqi Su

I. The Middle School Attached to Beijing Normal University (http://www.bjsdfz.com, in Chinese)
Xuanwu District, Beijing

The class trials started on 10 September, 2003
Class’s name: alternative biology, Bioethics
Teachers: the plenary members of the Dept. of Biology
Students: 29 (22 Females and 7 Males) the second year students chose this course voluntarily 
14 weeks, 15: 30-17:00 Wed., 90 minutes for each class
Materials: short versions in English
Language: Chinese

Time schedule of trials: 
Introduction to the textbook project bioethics - Baoqi Su 10 Sept., 03
1. Making choices, diversity and bioethics - Baoqi Su 10 Sept., 03
2. Ethical limits of animal use – Lei Li 17 Dec., 03 (postponed since wedding)
3. Genetic privacy and information – Jinghua Fu 17 Sept., 03
4. Brain death – Li Kuang 24 Sept., 03
National Holidays
5. Organ donation – Yuan Yu 8 Oct., 03
Teacher's meeting with Prof. Darryl Macer 11 Oct., 03
6. Driving personal automobiles – Lei Li 15 Oct., 03
7. Ecotourism – Jianzhi Li 22 Oct., 03 
8. Lifestyle and Fertility – Jing Zhuo 29 Oct., 03
9. Assisted reproductive technology – Jinhua Fu 3 Nov., 03
10. Genetically modified foods – Yongmei Gu 12 Nov., 03
11. Telling the truth about terminal cancer - Li Kuang 19 Nov., 03
12. Euthanasia - Jing Zhuo 26 Nov. 03
13. Testing for cancer gene susceptibility - Yuan Yu 3 Dec.,03 
14. Sustainable Development –Jianzhi Li 10 Dec.,03 

The materials will be distributed to the students in advance. 
Each student is demanded to submit 3 essays (300 words either in Chinese or in English) during the study.

II. Peking Union Medical College
A. 
The class trials will start on 23 Oct., 03
Class’s name: Bioethics
Teacher: Baoqi Su
Students: 54 (Undergraduate)
6 lectures, 15: 00-16: 30 Thurs., 90 minutes / one lecture, 
Materials: mainly short versions in English.
Language: Chinese

B. 
The class trials will start on 4 Nov., 03
Class’s name: Bioethics
Teachers: Baoqi Su
Students: 42 (College)
8 lectures 14: 30- 16: 00 Tues. and Wed., 90 minutes /one lecture, 
Materials: mainly short versions in English
Language: Chinese
(Time schedules to be followed.)

From 4 broad and bright windows trees can be seen growing outside 

Black board

4th floor
hall-way

The cabinets with various biological models at the back of the classroom

8 students could be seated around a table

Water faucets

Diagram of the class arrangement (see photos sent earlier):

Class observation Evaluation Checklist

School Name: The Middle School Attached to Beijing Normal University Class Name/Subject: Alternative biology
Teacher's name: Baoqi Su	                           Observer's name: Jinhua Fu, Li Kuang, Yongmei Gu 
Date and Time of day: 10 September, 2003 15: 30-17: 00  Connected to another class? No / Yes: No 
Student Size (gender: 7 M / 22 F)	                   Language: Chinese 
Length of class: 90 minutes (No break) 	           Material used: Introduction & Chapter 1 

	Evaluation point	Low                  Medium                     High	
Student	Concentration	1      2     3    4     5     6     7     8     9   10√                                                               	
	Subjective oral participation	1      2     3    4     5     6     7     8     9   10√                           	
	Number of different students who spoke in class	
                                  29 students 12 volunteers	
	Involvement in class	1      2     3    4     5     6     7     8     9   10√                              	
	Understanding level	1      2     3    4     5     6     7     8     9√  10                            	
Teacher	Teacher’s control	1      2     3    4     5     6     7     8     9   10√                             	
	Teacher’s correspondence	1      2     3    4     5     6     7     8     9   10√                             	
Material	Interest in material	1      2     3    4     5     6     7     8     9√  10                            	
	Difficulty of text	1      2     3    4     5     6     7     8     9√  10                           	
	Number of content related questions by the students	
                                               5 questions	
	Difficulty of questions in the material	1      2     3    4     5     6√     7     8     9   10                          	

Any special events or extra materials related to the class that were introduced either orally or materially to the students (please attach copies as well):

One case study (in Chinese, ppt slide)
A patient A whose is suffering liver dysfunction because his bibulosity for many years, and needs liver transplantation in urgent. And a young people B whose liver was stabbed when hounding a gangster, and need liver transplantation too. It happens there is a liver available, and its organizing style is compatible with both these two patients. A could afford the transplantation fee, but B could not. 
Question: Should give this liver to who? 

  (有一个病人甲因多年酗酒，肝脏功能衰竭，急需移植肝脏。另一青年乙因抓歹徒被歹徒刺伤肝脏，也急需移植肝脏。正好有一肝脏可供移植，而且组织配型与这两位病人正好相容。甲付得起肝移植费用。而乙无力负担移植费用。
问题：应该将这只肝脏移植给谁？)

The allocation of organs
• Chance of success
• Urgency
• Time on the waiting list
• Age
• Social responsibility
• Family role
• Ability to pay

Class Name/Subject: Alternative biology           Date and Time of day:	10 September, 2003 15: 30-17: 00 

Teacher’s name: Baoqi Su                        Observer's name:_Jinhua Fu, Li Kuang, Yongmei Gu_

Class Note1: Flow of Lecture 
Time: 15: 30-17: 00 Wed., 10 Sept., 03
Site: Biological laboratory
Two teachers (Jinhua Fu and Baoqi Su) arrived half an hour in advance and started the preparations including distributing the materials.
(Note: there are ppt files, video and audio recordings for references.)
Class start
Greeting. The teacher welcomes the students to Bioethics lectures and thanks them for having chosen this. 
Introduce the project “Bioethics education for informed citizens across cultures, developing teaching materials on bioethics”. Introduce the overall coordinators. 
China as a member of the international cooperation will conduct the teaching trials as well. The teacher welcomes the students to look through the related websites and join the discussion group.
Explain the 14 topics, which will be discussed at the classes, and hope to give the students a whole expression of this course.
The concrete demands to the students about this course will be left for teacher Jinhua Fu, who will explain in details by next week.
The teacher hopes that each student speaks at least once in each lecture! Since the teacher herself has benefited from it from her former teachers a lot. 
(Slides 1 - 7)
15
The students start to introduce themselves one by one, including the name, where did they come from (they came from 16 different classes of the second grade), hobbies, etc., while need to towards the video and either in Chinese or English.
(Although the time was very tight, but the teacher considered it was very necessary for them to become familiar with each other, and it proved finally that some students’ English are very good, and the majority of them are very open-minded. Almost all of the students like biology very much and expect to learn more at this new course…).
(Please look at the video tape on which there are many lovely faces.)
30
1. Making choices, diversity and bioethics
Students are given 5 minutes to look through the materials, (the majority of them show the materials are too difficult, and many of them are looking up the dictionary or asking for the teacher).
The teacher explains the concept of Bioethics and the 4 basic principles as showed on the slides 9 and 10. Examples are given as “what you do not wish for yourself, do not to do to others”- Confucius; and such as there is no one correct answer to the question whether it is good to tell the truth to the terminal ill patients, etc. 
（Slides 8 - 10 ）
40
Autonomy
Q1. Look around the class and see something each person has done to make them look different to other persons? Students mention such as sex, appearances, hights, hairs, voices, closes, etc. The teacher adds that the thoughts, goals, beliefs, choices of every person, etc.
The students read the sentences of the paragraph 1 and try to translate it one by one, and the teacher summaries the meaning of the paragraph 1. Because the time the teacher summaries the meanings of the paragraph 2 and 3 and focuses on the importance of the issue of individual’s autonomy.
Q2. What are the limits to personal choice? The teacher enlightens them. Being a student is limited by the rules of school, which means one could not be absent to see a movie. And one could not hit the others as he or she likes, etc. The students say personal choices are limited by respecting the others’autonomy, that is doing no harm.
(Slide 11)
55
Justice
The students read the sentences of the paragraph 1 and try to translate them one by one, and the teacher summaries the meaning of the paragraph 1. Then the teacher concludes what is justice. 
Q3. There was a new report of SARS in Singapore yesterday (9 Sept. 03) , what do you think about  some people were quarantined by the government when SARS came in Spring in Beiing? Was their autonomy been violated? The students answer as their autonomy was limited temporarily in order to protect many more people in society (Please see the discussions in details on the separate page, class note 2). 
The teacher summaries the following two paragraphs’ meanings.
Q4. What are the values behind you wanting to study? The teacher explains what is value. Answers of the students include wanting to go to a good university (many students), to earn more money, to lead a good life, to travel the world, to show the filial piety to parents, and to realize the ideals, etc. The teacher focuses on that we should respect the diversity of attitudes of individuals and avoid discrimation in society. 
(Slide 12)
70
Benefits versus risks
With referring the former interpretation of the concept of Bioethics, which is important to learning how to balance different benefits, risks and duties, and giving some examples, such as whether we should support human cloning at present, the teacher together with the students finish learning this part very quickly. 
And then start a case study: 
   A patient A whose is suffering liver dysfunction because his bibulosity for many years, and need liver transplantation in urgent. And a young people B whose liver was stabbed when hounding a gangster, and need liver transplantation too. It happens there is a liver available, and its organizing style is compatible with both of these two patients. A could afford the transplantation fee, but B could not. 
   Question: Should give this liver to who? 
They are asked to discuss within 4 groups firstly and then have one or two member/s to present the group’s opinions to all (Please see the discussions in details on the separate page, class note 2). 
At last the teacher summaries that some related factors should be considered while in clinic, and gives the examples to each factors (Please see the discussions in details on the separate page, class note 2). The allocation of organs: chance of success, urgency, time on the waiting list, age, social responsibility, family role, ability to pay. 
The students are very interested in it and are very active in the discussions, including debates between students for many turns, and they give the persuasive arguments. 
(Slides 13 - 16)
The questionnaires (5 minutes) about today’s lecture (Outcomes please see the separate pages) and distribute the materials for the next week.
Thanks for teacher Jinhua Fu’s hard work of videoing the whole class.
The students wish the teachers happy teacher’s day (10 Step. is the teacher’s day in China.)
See you next week!
(Slide 17)
Notes: none of the students were doing other things in class.

Class Name/Subject: Alternative biology 
Teacher’s name: Baoqi Su_
Observer’s name:	Jinhua Fu, Li Kuang, Yongmei Gu    
Date and Time of day: 10 Sept., 2003 15: 30-17:00
Language: Chinese
Material used: Introduction & Chapter 1
Class Note2: Flow of Dialogue
T—Teacher	S—Student
S (M)—Male student, S (F)—Female student
Ss—Many students

T: This is an international co-operative program including Australia, China, India, Japan, New Zealand, the Philippines, and Taiwan 7 countries. (Slide 5)
Ss: 7 countries?
T: Oh, I was sorry for the mistake. It should be 6 countries and 1 area, and please forgive me.
The students introduce themselves one by one. 
T: Thanks. I am very glad to hear that many of you like the course of biology and expect to learn more at this lecture!

T: Before we look at these principles of bioethics on autonomy and justice in details, I would like to ask:  “What have you done to make yourself look different?”
S (M): Appearances.
S (M): Sexes and voices.
S (M): Behaviours
S (F): clothes…
T: I see some students wearing the school’s uniforms, but there still many respects make each student looks different to others. Also our thoughts, life goals, beliefs and choices are different too. Let us read the paragraph 1. 

T: Individuals have the rights to make their own choices. However, let move to the next question, “What are the limits to personal choice?” “Should there be limits on it?”
Ss: Yes.
T: Who could tell me? The student is limited by the rules of school, which means he or she could not be absent to see a movie, isn’t he or she? And I guess you will agree with me that one could not hit others as he or she likes?
S (F): Personal choices are limited by respecting the others’ autonomy, which is doing no harm.
T: Very good. Now let us move to the next part. Let us read the paragraph 1 together. The last sentence tells us that we should give every member in society equal and fair opportunities in life, which is justice. I believe that we all understand it, right?
Ss: Yes. 
There was a new case of SARS in Singapore yesterday (9 Sept., 03), so here is a question comes to me: “What do you think about some people were quarantined by the government when SARS came in the spring in Beijing?” “Do you know it? What do you think?” “Was their autonomy limited? Were their rights violated? Was it right? Was it justice?”
S (M): Yes. It is to protect other people.
S (F): These people’s rights were temporarily limited, in order to protect more people’ s health.
S (M): There were no better ways than quarantine..
S (F): It is justice to all members in society.
T: What else? You are all right. At that time (or maybe even for now), we did not know clearly about SARS, and we did not clear about the virus. There exited all the questions such as: Where did it come from? How did it transfer to our human beings? What could the treatments be? In fact there was no effective treatment to this new disease, hence the quarantine was the only method to stop its further spread. So although some people’s autonomy was limited for a short period, it was justice in the sense to protect the health of the majority population in society, agree?
Ss: Yes. 

T: Let us go to the next part then. “Different people have different goals and can have different values.” Does anyone have an idea about values? Who could tell me?
Ss: ?
T: I believe that actually you all know what are values in mind, but maybe it is difficult to express in language. Would you like to tell me what support you to study hard here? 
S (F): To master the knowledge.
S (M): To be able to go to study at a famous university.
S (M): To earn more money and become rich.
S (F): To lead a good life.
S (M): To realize the ideal.
S (F): To be skillful at the biotechnology to help myself to a good figure in the future. 
S (M): To have more choices in the life.
S (F): To show the filial piety to parents, and be able to traval the world in the future.
S (F): To contribute myself to the people and society.
T: Thanks for all your ideas. I guess what you have mentioned such as knowledge, wealth, good life, beliefs, ideals and having a lot of opportunities in the future are all values behind you wanting to study well. These are things you value as students, don’t you?
Ss: Yes.
T: Every one has his/her personal values as a member of society like you. In one hand, we may share some common values like honesty, kindness, generosity, morality, about life, about belief or ideal; in the other hand, different people may have different views, so it is very important to respect the diversity of attitudes of individuals and avoid discrimination in society, isn’t it?
Ss: Yes.

T: Now let us turn to the second page. As we have mentioned earlier in the beginning of the lecture, one important issue of bioethics is to balance different benefits, risks and duties. Let us look through this part quickly and start the case study. 
T: The question is if you were the doctor, should you give this liver to whom? What are your considerations? I would like you to discuss it within the 4 groups first and then have one or two members to present your group’s opinions to all, ok?
Ss: Yes.
S (M): Could half of the liver save the patient’s life?
T: Yes, I think so. It is possible. 
T: Because of the limited of time, shall we start now?
S (Group 1, F): Teacher, is it same to transplant half of the liver to the whole liver to the patient?
T: It should be some differences, such as the function, the ratio of the success, etc. but from the view of medicine, it should be possible that half of the liver works well too.
S (Group 1, F): Then I agree to give both patients half of the liver to save both of their lives.
T: How about patient B could not afford the transplantation fee?
S (Group 1, F): Try to collect the money from the society for B is a hero, and at contemporary society there are not many heroes appear.
S (Group 1, F2): I will give this liver to patient A who could pay the operation fee, because I do not think it is practical to get money from the society.
T: Thanks, and I understood your opinion. The hospital needs to survive in the society too, of course it needs the benefits and only that it could serve more patients.

T: What else? Ok, let us move to the next group.
S (Group 2, M): It is better if we could save 2 patients’ lives at the same time, but if it was not possible with considering many factors, I would prefer to give this liver to A, because he could pay the fee, and what’s wrong with drinking for happiness?
T: Good. I am glad to see that our students are very compassionate on both of the patients. To consider its feasibility is also necessary. He said it was noting wrong with drinking for happiness. Agree?
Ss: Yes. No….
S (Group 2, M2): What could we do if after receiving a liver, patient A returns back to drinking? 
T: A very good question. The Medical Association of America regulates if the patient who is an alcoholist who needs liver transplantation, the hospital could only put him/her to the waiting list after he /she stops drinking at least for one year. 
S: (Group 2, M3): But he may die during that period?
T: Well, maybe he should stop drinking much earlier. Any other?
S (Group 2, M3): I am wondering that the situation of B is urgent with continuous blooding, so I think I should give this liver to B first, and maybe A could still wait for a period. 
T: Very good point, yes the urgency is another factor that the doctor should consider in clinic. How about the group 3’s opinions?

S (Group3, M): Giving it to B in moral, but the doctor may give it to A in practice. We are living in a practical society.
S (Group3, F): If I were the doctor I would prefer to give this liver to patient B than A. There are more valuable things in life except money. Human beings are emotional and compassionate animals. The doctor should not hesitate to do the operation on B, who was seriously injured while fighting with gangster. I also wonder the behaviour of A although he has money. 
S (Group 3, M): I very appreciate her kindness, but it is true that the hospital could not neglect the economic benefits. There are many cases that the patients flee away without paying fees after they are saved in the emergency of hospitals. I believe A contributes more than B who has no job.
S (Group 3, F): B is young and has acted bravely. There have many ways to collect money for him, no need to add burdens to hospital.
T: Thanks for the discussions. We knew some farmer patients of SARS were cured in hospitals although they could not pay. (Several students raising hands want to speak.) Thanks, but could we listen to the group 4’s opinions first?

S (Group 4, F): Only the big and famous hospital could conduct the organ transplantations at present, so If the hospital saved B’s life without being paid, it could increase its good reputation by the media, and then many patients will come, which will finally increase the economic benefits of the hospital.
T: Yes, there was a report that an abandoned female fetus receiving an amputation of an extra leg at X hospital successfully, which brought a good influence to society. Don’t you know it?
Ss: Yes, her name is Qing Qing.
T: What else? 
S (Group 1, F): The doctor needs to consider the ages of the two patients too. A will be not worth a transplantation if he is already 70 or 80-year old.

T: Thanks all for your considerations. I believe there are many factors to be considered in clinic. Such as the chance of success, for example, 10 organs to give to 10 patients, if the ratio of success is 90%, then how many persons could be saved?
Ss: 9.
T: But the ratio of success is only 10%, then how many?
Ss: Only 1.
T: And the factors like urgency, time on the waiting list, age. Could age be a factor?
Ss: Yes.
T: Maybe sometimes. For example, we may not consider transplanting a heart to a 90-year old patient since it will be even dangerous for him to undertake a big operation. But we need to note that there are no much difference between a 50-year old and a 20-year old person, right?
Ss: Yes.
T: The factors such as social responsibility, family role, and ability to pay need to be considered too. By studying this case, I hope the students could have a further understanding of the importance of balancing benefits, risks and duties in daily life. We will continue the discussion in the following lectures too.
T: The class was over. Thanks for your attentions.
Ss: Happy Teacher’s day!
T: Let us thank teacher’s Fu’s hard work of videoing the class. See you next week!
(Note: Above is only the main flow of the dialogue at the class.)

Questionnaire  after introductory class

Name:____________          
Sex: ______________          Age:____________           Date:_____________
Q1. What is bioethics?
Did not understand                         Well understood     Do not know
1     2     3     4    5    6    7    8     9      10           11
Q2. Do you think it is important in your daily life?
Unimportant                               Very important      Do not know
1     2     3     4    5    6    7    8     9      10           11
Q3. How about the materials in English?
Very difficult                                    Very easy      Do not know
1     2     3     4    5    6    7    8     9      10           11
Q4. How about the length of the class?
Too long                                         Too short      Do not know
1     2     3     4    5    6    7    8     9      10           11
Q5. How do you like today’s lecture?
Not interesting                              Very interesting      Do not know
1     2     3     4    5    6    7    8     9      10            11

(Note: above please see the separate pages, diagrams)

Q6. Please give any of your opinions about this lecture if have (either in Chinese or English).
“I think at the class, we spent much time on the translating the passages. I hope that we can do more discussions.” 
The lecture was very good. Please to teach in Chinese, if we could have some time to read the chapters first.
The materials are somehow superficial, which could be improved with more information.
The difficulties could be reduced if the materials distributed in advance since the obstacles of the language could be swept off before the classes. 
“Well done! But I am sorry for my poor English. I have some difficulties in English.”
Is it possible to get some materials in Chinese too?
It is better to distribute some Chinese translations together with the English materials.
Answering the questions when sit down. (Note: agree or disagree? Baoqi)
Hope that we are not asked to translate English materials.
It is too short of the discussion time!
It is better it is more lively and practical.

(Notes: the sentences are original in English with the mark of “”. The limit of the time near the end of the class could be a factor why not too many students gave their opinions.)

Students: 22 Female 7 Male (and received the total of 29 answer sheets)

(More than half of the students (15) well understood the concept, but still have some (6) do not understand clearly.)

(The majority of the students think ethical issues are very important in their daily life.)

(The majority of the students think the materials in English are very difficult.)
(Notes: today is the first lecture of Bioethics, and the materials have not been distributed in advance. About the difficulty of the materials will be checked with the following lectures too. Baoqi)

(The majority of the students agree that the length of the class is suitable.)

(The majority of the students show today’s lecture is very interesting.)

Teacher’s notes

1.	It is better to distribute the materials in advance so the students could sweep off the language difficulties before the class. It is very important for the teachers to pay attention to it continuously. 

2.	Chapter 1, page 1 of short version, give very member to give every member?

3.	Case study is very welcomed by the students, and many of the students show that the time for discussion is too short. I think the case study is practical within 90 minutes. 

4.	A similar questionnaire will be conducted once more in the middle of the lecture. 

5.	I personally think that it is very difficult to finish Class Note 1 and 2 after each lecture, especially for us need to translate the content into English of 90 minutes’ lecture. The main flows of the lectures, plus the opinions of the teacher and observer on the chapters will be a good way to improve the chapters and the teachings. 

Observer’s notes

The English of this Chapter is a little bit difficult to understand. Some questions are difficult to understand too. 

Appendix
Photos: 
1	the classroom
2	the models
3	ppt show
4	pictures while they were looking through the materials
5	and  6 show new buildings of the school
7	Happy teacher’s day