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See Teacher Support MaterialsSupplementary information on Alzheimer’s disease and MEN II is available online at http://science.education.nih.gov/supplements/bioethics/teacher.From this point forward, the work focuses on thyroid cancer(specifically the kind caused by MEN II), not Alzheimer’s disease.Whenever considering the science behind a genetic test, it’s importantto know the age at disease onset, the predictive value of the test, andwhether there is anything effective that can be done for the condition.MEN II thyroid cancer and the genetic test for it have unique attributes:• disease onset at a very young age (teens to 30s),• nearly 100-percent positive predictor of future thyroid cancer, and• preventive surgery is available.Students should be reminded that most genetic tests are not sodefinitive and do not necessarily offer the opportunity for preventivemedical care. One final important aspect of MEN II is that it can alsolead to cancer of the liver, bones, brain, and adrenal glands, because thecancer may spread from the thyroid gland if it is not caught early.As students proceed through the rest of the module, they will bedeveloping well-justified stances about testing for MEN II specifically.The MEN II and Alzheimer’s genetic tests contrast well in terms of ageat onset of disease, predictive ability of the test, and opportunity forfollowup medical care:• This type of Alzheimer’s arises much later in life (after age 65),whereas MEN II can arise as early as adolescence.• The Alzheimer’s genetic test does not predict with certainty,whereas the MEN II test is fully predictive.• The Alzheimer’s genetic test does not lead to any preventive actions(although there are actions one can take to lessen one’s chance ofgetting it or delay its onset), whereas a positive MEN II test resultcan lead to surgery (thus eliminating the chance of thyroid cancer)and medication.3. Remind students that they need to be satisfied that theyunderstand all relevant information before continuing with theethical question at hand. Give students a few more minutes tobrainstorm new, relevant questions they need answers to beforethey arrive at a full set of relevant facts.12345If students come up with other relevant questions, assign individualstudents to research the answers overnight.Module 4 4-136
Teaching Strategies: Offering ExamplesIf students have trouble coming up with questions to clarify key facts andconcepts, you might want to offer some examples. Students may want toknow more about relevant scientific facts and concepts, social science issues,economics, legal issues, and/or historical ones. Whatever the domain,challenge students to explain why the additional information could berelevant to the main ethical question at hand. In the examples providedbelow, the type of question (that is, the type of information sought) ismarked in parentheses.AssessmentThe questions in Master 4.6function as an embedded,formative assessment. It’s criticalthat all students comprehendrelevant facts before moving onwith ethical considerations. Ifstudents answer these questionsin class at the end of Day 1, you’llbe able to review their answersbefore moving on with Day 2.NoteOn Master 4.6, the first fourquestions are the most concreteones; their answers are located inone spot in the reading. To answerthe fifth question—a synthesis, orcomparison, question—studentsmust reference multiple spots in thereading. The final question requiresinferential thinking; students mustmove beyond the readings.• Is MEN II associated with any other types of cancer besides thyroidcancer? (scientific question)• Do any complications arise as a result of thyroid removal? If so, whatare they? (scientific question)• How does one detect existing thyroid cancer in a patient? Is this aninvasive procedure? (scientific question)• How is thyroid cancer treated? (scientific question)• How old do you need to be to make your own medical decisions?(legal question)• How much would this genetic test cost? Who would pay for it?(economic question)• If Max tests positive, how might this knowledge affect his relationshipwith his family? (social science question)• If Max tests positive and has the surgery, who will be responsiblefor administering the daily medication? Will Max have to take themedication against his will? How might this affect his relationship withhis family? (social science question)4. Give each student a copy of Master 4.5: Genetic Testing—KeyConcepts. Read Master 4.5 aloud with students or assign it as partof the homework.5. Give each student a copy of Master 4.6: Thyroid Cancer, MEN II,and Genetic Testing—Checking for Understanding. Ask studentsto fill in the blanks in class or as homework.Master 4.6 gauges students’ comprehension of key facts about thyroidcancer and the MEN II test. These questions could be used as an “exitticket” from the classroom.4-14 Exploring Bioethics
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NIH CurriculumSupplement SeriesGrad
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Education Development Center, Inc.D
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This material is based on work supp
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About the National Institutes of He
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Introduction
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activity of assessing different rea
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teaching strategies that will help
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2. The ability to distinguish an et
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quence of choosing one path over an
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Table 1. Assessing Student Justific
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Challenges in TeachingBioethics and
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How Exploring Bioethics Can HelpFor
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Prompts to encourage students to re
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Table 2d. Students say they already
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Resources forTeaching BioethicsBeau
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Table 3. Ethical Issues and Curricu
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Each module is divided into three d
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Table 4. Alignment with NSES Life S
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About the Web SiteThe Web site for
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1Module 1Bioethics Concepts and Ski
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• apply important ethical conside
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In Advance1Copies, Equipment, and M
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Teaching Sequence1Day 1: What’s i
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new medication, she is able to stay
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6. Read the list of Round 1 questio
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• With respect to performance enh
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LE/LE/LLE/LPoint out that some of t
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Organizer for Day 1: What’s in a
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Day 2: Four Key Questions1PurposeDa
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4. Emphasize that when bioethicists
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15. Ask students to list as many et
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Organizer for Day 2: Four Key Quest
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Encourage students to share example
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Activity 7:Using Ethical Considerat
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4. Ask a representative from each g
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Organizer for Day 3: Core Ethical C
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References and Resources1Informatio
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What Type of Question? ROUND 1—Et
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What Type of Question? ROUND 3: Eth
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Round 4Q9Should embryonic stem cell
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Oscar Pistorius—The Fastest Man w
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Four Key Questions and Statementof
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Carl’s CaseCarl listened to his t
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1Module 2Balancing Individual and C
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adopting vaccination policies that
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In Advance1Copies, Equipment, and M
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Teaching Sequence1Day 1: Exploring
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the key stakeholders, and taken int
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You may wish to highlight the dange
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ClosureAsk students to reflect on t
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Day 2: Community Immunity1PurposeOn
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10. Ask all students in the class t
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• While an unvaccinated person’
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ClosureRecap for students that the
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Tell only the students who were tag
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5. Divide students into pairs, and
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17. Share with students that becaus
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13. Note that the Boston and Dublin
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Teaching StrategiesYou may want to
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Ask each member of the pair to read
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1Centers for Disease Control and Pr
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Get Kids Vaccinated or ElseGet Kids
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Name(s)Station 2—Vaccine RisksDir
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Station 1: Vaccine-Preventable Dise
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MumpsBefore the mumps vaccine was i
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Station 2—Vaccine RisksNote: Like
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Smallpox VaccineThe smallpox vaccin
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Station 4—ExemptionsExemptions vs
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State Exemptions Allowed as of Fall
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Name(s)What are the ethical conside
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Vaccination Status CardsVaccinated
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Opting Out of a Vaccine—Variables
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Measles in DublinIn 2000, an outbre
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What are some of the different pers
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Issues Explored• What is the fair
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Day 3—What Is Your Recommendation
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Teaching SequenceNoteAssign this ho
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Teaching Strategies: Jigsaw Techniq
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Some students might think that the
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11. Explain to students that they w
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Page 173 and 174: Organizer for Day 2: Identifying St
Page 175 and 176: Day 3: What Is Your Recommendation?
Page 177 and 178: Activity 9:Understanding Past and C
Page 179 and 180: ClosureReinforce to students that t
Page 181 and 182: Ask students whether they think the
Page 183 and 184: Liver Function and FailureHepatitis
Page 185 and 186: Name(s)Banting decided that he woul
Page 187 and 188: Name(s)The COC distributed the peni
Page 189 and 190: Name(s)The Admissions and Policy Co
Page 191 and 192: Liver and Liver-Transplant Fact She
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Page 195 and 196: Patient ProfilesAnitaAnita is a 19-
Page 197 and 198: Additional Patient InformationAnita
Page 199 and 200: The United Network for Organ Sharin
Page 201 and 202: Comparing the Past and Current UNOS
Page 204 and 205: 1Module 4Weighing Benefits and Harm
Page 206 and 207: An optional extension activity incl
Page 208 and 209: In Advance1Preparing the Envelopes
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Page 224 and 225: Activity 6:Exploring the Relevant E
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Page 228 and 229: 1Ask students, “What are some rea
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Page 232 and 233: ReflectionDisplay the posters from
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Page 239 and 240: Alzheimer’s Disease and Genetic T
Page 241 and 242: Name(s)Now, on your own, answer the
Page 243 and 244: Name(s)Max’s Family Tree on His M
Page 245 and 246: Genetic Testing—Key Concepts• S
Page 247 and 248: What Impact Would Max’s Newly Dis
Page 249 and 250: Your Tentative ThoughtsName(s)1. Do
Page 251 and 252: Ethical Questions• Who should dec
Page 253 and 254: Extension (Optional)About Retinitis
Page 255 and 256: Issues Explored• Why is it import
Page 257 and 258: Key Science Knowledge*• Nature of
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Students should recognize that rese
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ClosureAsk the class whether they t
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Organizer for Day 1: Research with
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Activity 4: Returning to Your Decis
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5. Discuss the results with the who
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5. Summarize two key points about r
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• The Belmont Report has served a
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Organizer for Day 2:Harms and Benef
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Day 3: Analyzing the Willowbrook Ca
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Deciding on and Recording Main Poin
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Organizer for Day 3: Analyzing the
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Willowbrook StudyCenters for Diseas
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Asthma Simulation OutcomesYou were
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Name(s)Reflection Questions1. Aside
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Letter to ParentsThis is the letter
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What Are the Relevant Ethical Consi
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Name(s)(Fill out with your partner.
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Name(s)(Fill out individually.)Your
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Issues Explored• Should there be
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Key Science Knowledge*• DNA, RNA,
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4. Ask students for their prelimina
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8. Tell students to come to the nex
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Day 2: Deepening Your Thinking—So
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You may wish to note that• Cases
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2. Direct students to turn to their
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Organizer for Day 2: Deepening Your
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Day 3: Making a Recommendation—Se
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Those cases where students do not t
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3. Ask a representative from each g
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Activity 9: Returning to Alba’s C
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1Ear MiceBBC News. 2002. Artificial
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Alba’s CaseSince the early 1990s,
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Dyed FeathersPeople dye bird feathe
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Giant Panda BreedingThe giant panda
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Mad-Cow-Disease CowsMad cow disease
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Purebred DogsHumans have geneticall
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Spider-Silk GoatsSpider silk is str
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VealVeal is meat from calves that i
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Assessing Harms, Benefits, and Pote
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Final Assessment of Alba’s CaseRe
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This curriculum supplementwas devel
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