Ethics, Service-Learning, & Social Responsibility

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Grs Lecture Oct 14 2009

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  • .
  • What does it mean to teach and to learn. We need to begin thinking about education differently. To have truly learned is to never be able to see the world in the same way…a perspective transformation (Mezirow), And to never be able to be in the world in the same way.
    Today’s presentation is an invitation to work with me to enable us to develop an increasingly sophisticated view of the world, and then to develop a plan for how to effectively respond to the issues identified.
  • 6 years ago the AAC&U convened a national panel of scholars, educators, policymakers, and business and community leaders to ask fundamental questions about higher education in the US.
    The panel examined the “kind of learning students need to meet emerging challenges in the workplace, in a diverse democracy, and in an interconnected world.”
  • What do you think? Can SR be taught/learned?
    Is it too late by the time you get to university?
  • Example of cancer diagnosis
  • This slide is from a website of a reputable medical school here in the US.
    It highlights what I call conflicting motivations for ISL:
    One could argue that ISL initiatives are becoming less about service and promotion of equity and more about self-interest. Since SL opportunities are usually set in vulnerable communities where there are pronounced disparities in health, the potential for harm is high.
    Vulnerable communities can easily become a means to our ends, ie, fulfilling a course requirement, enhancing a resume, opportunity for adventure and travel.
  • 3 weeks ago I attended a presentation titled, "This is Africa", by a medical residents. The resident presented an 18 minute video of his experience working in a medical clinic in Angola. It was a an emotionally heart wrenching video. The video showed pictures of several very vulnerable patients with horrible conditions, many who later died. Pictures and video footage were taken of patients in an operating theatre, in clinic settings and in hospital beds. The pictures showed very disturbing images of people suffering from severe diseases.
    It was clear that there are great disparities in Angola and endless treatment needs, with a desperate need for doctors. It was also clear that the experience had quite an effect on the resident...afterwards he talked about the incredible clinical experience he gained that he could never have experienced here at home, the satisfaction of “saving lives”, the overwhelming disparity he witnessed, and the overwhelming gratitude he received from his patients.
    There was not one mention of social determinants, neo-colonialism, sustainable solutions, the history and politics of poverty, post-modern imperialism, the pathologies of power, or the white man’s burden (The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good
    by William Easterly .
    I had several questions, as did others in what was a packed room. I could only ask one: I asked the resident if it was difficult to
    receive ethics approval to take pictures of very vulnerable patients in desperate and medically compromised situations. The resident stated that he did not obtain ethical clearance...and quickly moved on to take another question.
    His 18 minute video was not only typical of the stereotypical view that is perpetuated by many such presentations, it is also typical of the "poverty porn" that is perpetuated by well-meaning individuals and organizations that do not understand the fundamental ethic of respect for human dignity.Merriam Webster Dictionary defintion of por·nog·ra·phy(n): the depiction of something in a sensational manner so as to arouse a quick intense emotional reaction.  
  • Many students participate in volunteer abroad programs as part of their service learning...although volunteering and service learning can be 2 very different things.
    Such programs are now part of big business.
  • Earnest Boyer tells us that the problem lies in the disastrous divorce of competence from conscience
    Ernest L. Boyer (1928–1995) was an American educator. Boyer served as Chancellor of the State University of New York from 1970-1977, as United States Commissioner of Education from 1977-1979, and as President of the Carnegie Foundation for the Advancement of Teaching from 1979 to his death in 1995. Boyer was recipient of numerous awards, including over 140 honorary doctorates.
  • Respect for Human Dignity: The cardinal principle of ethics in any type of scholarship is respect for human dignity. This principle aspires to protect the multiple and interdependent interests of the person—from bodily to psychological to cultural integrity.
    The opportunity to serve vulnerable populations is an important factor motivating global health experience participation. The desire to help, combined with other conflicting motivations (enhancing a resume, fulfilling a learning objective, voluntourism, etc.) can pose ethical conflicts and result in negative outcomes.
    An ethic of both scholarship and service must include two essential components: (1) the selection and achievement of morally acceptable ends and (2) the morally acceptable means to those ends.
    The first component is directed at defining acceptable ends in terms of the benefits of international engagement for individuals, communities, and societies, and for the advancement of knowledge and service. The second component is directed at ethically appropriate means of international engagement.
    For example, even in the most promising of international engagement initiatives, a person must not be deceived into participating in any activity through a promise of insincere benefits. Part of the core moral objection would concern the use of another human solely as a means toward even legitimate ends.
    Enhancing your resume, improving clinical skills, opportunities for travel, attracting funding, etc are all ends, and using others (particularly those who are most vulnerable) as a means to achieving those ends is morally unacceptable.
  • Critical Consciousness
    To mitigate this potential for harm, we focus first on building critical consciousness to ensure that ethical considerations have a permanent place in the culture of international engagement and ISL at UBC.  The paradigm of critical consciousness is rooted in the work of Brazilian educator Paulo Freire. Kumagai and Lypson (2009) summarize it nicely as
    …linking the professional training… with human values, an orientation of education and practice towards addressing human needs and interests. […] From a pedagogic perspective, development of true fluency (and not just “competence” [emphasis added]) in these areas requires critical self-reflection and discourse and anchors a reflective self with others in social and societal interactions. By “critical self-reflection, we do not mean a singular focus on the self, but a stepping back to understand one’s own assumptions, biases, and values, and a shifting of one’s gaze from self to others and conditions of injustice in the world. This process, coupled with the resultant action, is at the core of the idea of critical consciousness.
    Aspects of critical consciousness such as cultural competence are often reduced to points on a checklist – to ends in themselves – rather than being seen as one part of this larger fluency. Cultural competence can be defined as “a set of congruent behaviors, attitudes and policies that come together in a system, agency or profession that enables that system, agency or profession to achieve cultural diversity and to work effectively in cross-cultural situations”[1].  Often, the path to cultural competency is presented as a list of steps, but this should be treated only as a general guide.  It is not a mere point on a checklist; it is not in itself an “educational nirvana”[2]. It is a non-linear process; a beginning. Transformative learning cannot happen by imitation because of its structural limits. Learning is a “familiarization from within”.  Framed differently, Dr. David Orr reminds us that the root of our word education is to “educe”, which means to draw forth from, not to cram into[3].
    Critical consciousness is not so much a goal as an ongoing process of trying to diminish the gaps in one’s continuity of awareness, of which things like cultural competence are only a part. Critical consciousness is a lens; it is an identity.
  • Ethics, Service-Learning, & Social Responsibility

    1. 1. Dr. Shafik Dharamsi, PhDDr. Shafik Dharamsi, PhD Assistant Professor, Faculty of MedicineAssistant Professor, Faculty of Medicine && Associate Director, Centre for International HealthAssociate Director, Centre for International Health College of Health DisciplinesCollege of Health Disciplines Ethics, Service-Learning, &Ethics, Service-Learning, & Social ResponsibilitySocial Responsibility
    2. 2. Transformative LearningTransformative Learning Can’t go back to seeing the world in the same way…Can’t go back to seeing the world in the same way… Never being able to be in the world in the same way…Never being able to be in the world in the same way…
    3. 3. Association of American Colleges andAssociation of American Colleges and Universities (AAC&U)Universities (AAC&U) What kind of learning do students need to meet emergingWhat kind of learning do students need to meet emerging challenges in the workplace, in a diverse democracy, and inchallenges in the workplace, in a diverse democracy, and in an interconnected world?an interconnected world? ““Higher education needs to engage in developing responsibleHigher education needs to engage in developing responsible learners whose sense of social responsibility and ethicallearners whose sense of social responsibility and ethical judgment is marked by intellectual honesty, social justice, andjudgment is marked by intellectual honesty, social justice, and a discernment of ethical consequences of various decisionsa discernment of ethical consequences of various decisions and actions “and actions “
    4. 4. Can socialCan social responsibility beresponsibility be taught / learned?taught / learned? What about honestyWhat about honesty and ethics?and ethics? Is it too late to learnIs it too late to learn this by the time youthis by the time you get to university?get to university? If this can be taughtIf this can be taught and learned, thenand learned, then how?how?
    5. 5. UBC's Vision for the 21st CenturyUBC's Vision for the 21st Century ““The University of British Columbia will prepare students toThe University of British Columbia will prepare students to  becomebecome exceptional global citizensexceptional global citizens  promote thepromote the values of a civil and sustainablevalues of a civil and sustainable societysociety  serve the peopleserve the people of British Columbia, Canada, and theof British Columbia, Canada, and the world.world.
    6. 6. Our Mission…Our Mission… As responsible members of society, the graduates of UBCAs responsible members of society, the graduates of UBC will:will:  value diversity,value diversity,  work with and for their communities, andwork with and for their communities, and  be agents for positive change.be agents for positive change. They will acknowledge their obligations as global citizens, andThey will acknowledge their obligations as global citizens, and strive to secure a sustainable and equitable future for all.strive to secure a sustainable and equitable future for all.
    7. 7. The Development SetThe Development Set by Ross Cogginsby Ross Coggins Excuse me, friends, I must catch my jetExcuse me, friends, I must catch my jet I’m off to join the Development SetI’m off to join the Development Set My bags are packed, and I’ve had all my shotsMy bags are packed, and I’ve had all my shots I have travelers’ checks, and pills for the trotsI have travelers’ checks, and pills for the trots
    8. 8. The Development Set is bright and noble,The Development Set is bright and noble, Our thoughts are deep and our vision globalOur thoughts are deep and our vision global Although we move with the better classes, OurAlthough we move with the better classes, Our thoughts are always with the massesthoughts are always with the masses In Sheraton hotels in scattered nations,In Sheraton hotels in scattered nations, We damn multinational corporationsWe damn multinational corporations
    9. 9. Injustice seems so easy to protest,Injustice seems so easy to protest, In such seething hotbeds of social restIn such seething hotbeds of social rest We discuss malnutrition over steaks,We discuss malnutrition over steaks, And plan hunger talks during coffee breaksAnd plan hunger talks during coffee breaks Whether Asian floods or African drought,Whether Asian floods or African drought, We face each issue with an open mouthWe face each issue with an open mouth
    10. 10. We bring in consultants whose circumlocutionWe bring in consultants whose circumlocution Raises difficulties for every solution-Raises difficulties for every solution- Thus guaranteeing continued good eating ByThus guaranteeing continued good eating By showing the need for another meeting.showing the need for another meeting. The language of the Development SetThe language of the Development Set Stretches the English alphabet;Stretches the English alphabet; We use swell words like 'epigenetic',We use swell words like 'epigenetic', 'Micro', 'Macro'. and 'logarithmetic'.'Micro', 'Macro'. and 'logarithmetic'.
    11. 11. Development Set homes are extremely chic, FullDevelopment Set homes are extremely chic, Full of carvings, curios and draped with batik.of carvings, curios and draped with batik. Eye-level photographs subtly assure that yourEye-level photographs subtly assure that your host is at home with the rich and the poor.host is at home with the rich and the poor. Enough of these verses -- on with the mission!Enough of these verses -- on with the mission! Our task is as broad as the human condition!Our task is as broad as the human condition! Just parry to God the biblical promise is true:Just parry to God the biblical promise is true: The poor ye shall always have with you.The poor ye shall always have with you.
    12. 12. Why do international service?Why do international service? ______medical students and professionals______medical students and professionals describe what motivates them to dodescribe what motivates them to do medical service in developing countries:medical service in developing countries: 1.1. To experience culturesTo experience cultures 2.2. To find yourselfTo find yourself 3.3. To save livesTo save lives 4.4. For adventureFor adventure
    13. 13. ““This is Africa”This is Africa”
    14. 14. Shah S, Wu T. The Medical Student Global Health Experience:Shah S, Wu T. The Medical Student Global Health Experience: Professionalism and Ethical ImplicationsProfessionalism and Ethical Implications Med. Ethics 2008;34;375-378Med. Ethics 2008;34;375-378 After finishing my first year of medical school, I participated in aAfter finishing my first year of medical school, I participated in a mission trip to Mexico. Before flying to Mexico, I was not given anymission trip to Mexico. Before flying to Mexico, I was not given any cultural, medical, or other training, nor could I speak Spanish.cultural, medical, or other training, nor could I speak Spanish. Upon arriving, I was assigned to a clinic where there wereUpon arriving, I was assigned to a clinic where there were hundreds of patients but only one physician. I remember vividlyhundreds of patients but only one physician. I remember vividly seeing a frail 11–year–old boy with polyuria, polydipsia andseeing a frail 11–year–old boy with polyuria, polydipsia and nocturia.nocturia. My lack of medical training limited my differential. With only aMy lack of medical training limited my differential. With only a scattered history and no other tests, I told him to limit caffeinescattered history and no other tests, I told him to limit caffeine intake and see if that helps. Thinking back, he could have had aintake and see if that helps. Thinking back, he could have had a urinary tract infection, any number of renal abnormalities, orurinary tract infection, any number of renal abnormalities, or worse, I sent him out without ruling out diabetic ketoacidosis.worse, I sent him out without ruling out diabetic ketoacidosis. And while I was seeing patients by myself, other first year medicalAnd while I was seeing patients by myself, other first year medical students were performing surgeries in the other clinics and laterstudents were performing surgeries in the other clinics and later bragging about it.bragging about it. (Anonymous student, personal communication, 2 January 2006)(Anonymous student, personal communication, 2 January 2006)
    15. 15. The Business of Volunteer Abroad ProgramsThe Business of Volunteer Abroad Programs Mongolia 2 Week Trips1 Month2 Months3 MonthsExtra Month Teaching Teaching English to 18 and under n/a $ 2,245 $ 2,995 $ 3,795 $ 995 Care Orphanage Work $ 1,795 $ 2,245 $ 2,995 $ 3,795 $ 995 Culture & Community Mongolia Nomad Project $ 3,045 $ 3,795 $ 4,695 $ 5,595 $ 1,545 Sports School Sports $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Medicine & Healthcare Medicine $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Nursing & Midwifery $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Medical Electives $ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Journalism Print n/a $ 2,445 $ 3,195 $ 3,995 $ 995 Broadcast n/a $ 2,445 $ 3,195 $ 3,995 $ 995 Business n/a $ 2,445 $ 3,195 $ 3,995 $ 995 Law & Human Rights Law & Human Rights in Mongolia n/a $ 2,445 $ 3,195 $ 3,995 $ 995 Veterinary Medicine & Animal Care$ 1,995 $ 2,445 $ 3,195 $ 3,995 $ 995 Language Courses 14 Hour Language Course Add-On $ 345 60 Hour Language Course Add-On $ 1,345 2 Week Summer Special $ 2,195
    16. 16. ““After two months, I had observed many unforgettableAfter two months, I had observed many unforgettable surgeries, like the removal of a giant breast tumor, thesurgeries, like the removal of a giant breast tumor, the removal of an intestinal tumor, and even a few plasticremoval of an intestinal tumor, and even a few plastic surgeries. Most importantly, I had met many caring andsurgeries. Most importantly, I had met many caring and intelligent people and learned a lot about medicine,intelligent people and learned a lot about medicine, Argentina, the world and myself”Argentina, the world and myself” Medicine & Healthcare Intern in ArgentinaMedicine & Healthcare Intern in Argentina
    17. 17. Competence & ConscienceCompetence & Conscience The crisis of our time relates to the disastrousThe crisis of our time relates to the disastrous divorce of competence from conscience.divorce of competence from conscience. Once professionals begin to practice, they stopOnce professionals begin to practice, they stop thinking beyond the technical aspects of theirthinking beyond the technical aspects of their work.work. Professionals must be able to make judgmentsProfessionals must be able to make judgments that are not only technically correct but alsothat are not only technically correct but also ethically and socially considerateethically and socially considerate .. Ernest BoyerErnest Boyer
    18. 18. We’ve come to helpWe’ve come to help Adapted from Dickson, M 1993Adapted from Dickson, M 1993 Unfortunately, Professionals often see themselves and theirUnfortunately, Professionals often see themselves and their services as the solution to people’s problems and theservices as the solution to people’s problems and the means for achieving progress.means for achieving progress. This thinking has even influenced their public who come toThis thinking has even influenced their public who come to believe that their own development is really thebelieve that their own development is really the responsibility of professionals.responsibility of professionals. Training in the professions contributes to this dependencyTraining in the professions contributes to this dependency by preparing future practitioners to fix the problem overby preparing future practitioners to fix the problem over affecting change in global systemic inequities.affecting change in global systemic inequities.
    19. 19. Our professional solutions often ignore the complexity ofOur professional solutions often ignore the complexity of the human condition and importance of self-the human condition and importance of self- determination and empowerment.determination and empowerment. Professional training tends to nurture a certain arrogance inProfessional training tends to nurture a certain arrogance in which knowledge and skills are seen as the prerogativewhich knowledge and skills are seen as the prerogative of professionals, giving us a certain superiority.of professionals, giving us a certain superiority. Poor people are perceived as uninformed and backward,Poor people are perceived as uninformed and backward, having only themselves to blame for both their povertyhaving only themselves to blame for both their poverty and their poor health.and their poor health. Inevitably, most services tend to ignore vulnerable, poorInevitably, most services tend to ignore vulnerable, poor populations.”populations.”
    20. 20. The service approach sets up the typical paradox between solving problems and preventing problems. Despite prominence being given to preventing problems, national expenditures continue to go toward more facilities, equipment, and technology, rather than to social change.” Most resources are expended on the elite who are able to pay and who demand ever more sophisticated services.” “Professionals rarely see poor people and do not know their realities or their needs… Worse, professionals do not know that they do not know!”
    21. 21. “Meanwhile the greater population remains voiceless and welcomes almost any service, whether it is appropriate or not.
    22. 22. To think, act, speak and live ethically; toTo think, act, speak and live ethically; to view learning, teaching, working andview learning, teaching, working and research through an ethical lens and toresearch through an ethical lens and to put ethics into the practice of being aput ethics into the practice of being a student, staff or faculty member at UBCstudent, staff or faculty member at UBC and abroad.and abroad.
    23. 23. Respect for Human Dignity:Respect for Human Dignity: A Moral ImperativeA Moral Imperative A fundamental ethic of service-learning:A fundamental ethic of service-learning: 1.1. The selection and achievement of morally acceptable ends;The selection and achievement of morally acceptable ends; andand 2.2. morally acceptable means to those ends.morally acceptable means to those ends. It is unacceptable to treat persons solely as means, (mere objectsIt is unacceptable to treat persons solely as means, (mere objects or things), because doing so fails to respect their intrinsicor things), because doing so fails to respect their intrinsic human dignity and thus impoverishes all of humanity.human dignity and thus impoverishes all of humanity. The welfare and integrity of the individual must remain paramountThe welfare and integrity of the individual must remain paramount in all human relationshipsin all human relationships
    24. 24. Critical ConsciousnessCritical Consciousness  Ensuring that ethical considerations have a permanentEnsuring that ethical considerations have a permanent place in our work through critical self-reflectionplace in our work through critical self-reflection  Not a singular focus on the self, but a stepping back toNot a singular focus on the self, but a stepping back to understand one’s own assumptions, biases, and values,understand one’s own assumptions, biases, and values, and a shifting of one’s gaze from self to others andand a shifting of one’s gaze from self to others and conditions of injustice in the world. This process, coupledconditions of injustice in the world. This process, coupled with the resultant action, is at the core of the idea ofwith the resultant action, is at the core of the idea of critical consciousnesscritical consciousness..
    25. 25. ““We see these situations which appear soWe see these situations which appear so appalling to us - where there is no justice,appalling to us - where there is no justice, little hope, and overwhelming hardship - andlittle hope, and overwhelming hardship - and we want to do whatever we can to assistwe want to do whatever we can to assist people…people… We want to offer our skills, our knowledge,We want to offer our skills, our knowledge, our solutions. Sometimes it is welcomed,our solutions. Sometimes it is welcomed, seldom is it refused, but we never know ifseldom is it refused, but we never know if what we are offering is best. Is our workwhat we are offering is best. Is our work disempowering? Is our message culturallydisempowering? Is our message culturally inappropriate so that it will not be heard orinappropriate so that it will not be heard or will even cause social harm? Is it a drop inwill even cause social harm? Is it a drop in the bucket when a fire hose is needed?the bucket when a fire hose is needed? Does it even create dependence?”Does it even create dependence?”
    26. 26. ““In some cases, we are not reflective and ourIn some cases, we are not reflective and our actions are inappropriate because we haven'tactions are inappropriate because we haven't thought them through. In many cases, we havethought them through. In many cases, we have the best of intentions, but incompletethe best of intentions, but incomplete knowledge and understanding…knowledge and understanding… So to those who have questioned the value ofSo to those who have questioned the value of international volunteers, I would ask theinternational volunteers, I would ask the following:following: What do you want from us? What should we, asWhat do you want from us? What should we, as concerned individuals with a variety of skillsconcerned individuals with a variety of skills and interests, be doing? Should we stay out?and interests, be doing? Should we stay out? Get active politically in our own countries?Get active politically in our own countries? Support economic reform? Simply support theSupport economic reform? Simply support the concept of empowerment? Or something else?”concept of empowerment? Or something else?”
    27. 27. ““I pose these questions because I feel thatI pose these questions because I feel that the huge number of well-meaningthe huge number of well-meaning outsiders represent a tremendouslyoutsiders represent a tremendously valuable force for positive change, andvaluable force for positive change, and that it would be a shame to waste thethat it would be a shame to waste the potential contribution of this group.potential contribution of this group. What is more, I feel that to tell this groupWhat is more, I feel that to tell this group that their contributions to date have beenthat their contributions to date have been useless (or even that they have doneuseless (or even that they have done more harm than good) without offeringmore harm than good) without offering some alternative mode of engagement,some alternative mode of engagement, would be to overlook an importantwould be to overlook an important potential ally in the struggle for change.”potential ally in the struggle for change.”

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