Health Educator’s Notebook
Focus on Moral Education: A Technique for Health Educators Rosalind H. Flora, PhD
Is moral education a part of the health educator’s responsibility? Most of us believe it is. However, one of the saddest experiences for me was to hear a respected colleague say, “We really can’t be concerned about moral aspects of others’ behavior, and that includes assisting students in their moral development.” As if that wasn’t sufficient, he continued, “Instead, we must teach them how to defend themselves.” Granted, there was a time when professionals believed moral education would usurp the role of the home and church. Although it was never labeled as such, moral education was always taking place in the schools. Along with parents and peers, the school provided an environment filled with interaction and indoctrination that taught the student a certain set of values and morals.
However, moral education is now shifting to center stage and is becoming more explict and direct. Louis Rubin, writing for the Association for Supervision and Curriculum Development, believes, “Two factors mainly account for this somewhat dramatic change: first, societal events suggest that the traditional provisions for developing a moral citizenry are not adequate; and second, scholarly endeavor has given rise to new . . theory regarding ethical education.” 1 With regard to moral development and health education, Crase and Hamrick state that there is a “shifting emphasis from traditional ‘personal’ health topics to more sociallyrelevant topics . . .”2 This shift is focus, in addition to the perceived need as described by A.S.C.D., encourages health educators to implement morals education in all educational settings since we deal with relevant content at the individual, organizational, and macrosystem levels in attempts at behavioral change.
.
51 0
One of the most widely accepted theories of moral development comes from Lawrence Kolberg, who has developed and longitudinally and cross culturally tested sex growth stages of moral reasoning. 3 These stages are based on the individual’s reasoning about a moral question as he moves from being very concrete to becoming more abstract. It is beyond the scope of this column to explain in detail Kolberg’s theory, but if you are not familiar with it, I believe reading Galbraith and Jones and/or the participation in an inservice workshop on moral education is helpful. Galbraith and Jones state, “Moral growth is determined by an individual’s awareness of perspectives beyond the immediate self. Moral growth represents an ability to see the other side and to focus on the issues.”4 As a person grows, the evolution is from being self-concerned and self-centered to othercentered-to social centered, to thinking about various issues as not only an aspect of his own life, but also as an aspect of others’ lives. As he continues to grow, issues are considered an aspect of a universal order with respect to “justice, of the reciprocity and equality of human rights, and of respect for the dignity of human beings as individual persons. ”4 One technique used in moral education to help facilitate this growth is the moral dilemma described by Galbraith and Jones. It is based on principles similar to values clarification: (1) to sensitize students to moral issues; (2) to give them experience in thinking critically about such issues; (3) to provide for them an opportunity to share their perceptions with others; (4) to assist them in learning problem-solving skills, and ( 5 ) to help them raise their level of moral reasoning by being aware and by applying the process in their own lives.
THE JOURNAL OF SCHOOL HEALTH
OCTOBER 1978
The moral dilemma technique can be applied in the health education classroom by first writing a dilemma for any of the health concept areas. Current news is often a resource for ideas. For example: Recently there has been much publicity concerning government price supports for the tobacco industry and government subsidies for research on health-related aspects of smoking. Why does the government appear to be promoting disease and supporting prevention at the same time? With this in mind, consider the following moral dilemma:
ONE VOTE IN THE SENATE Arthur Wagnor is a United States Senator from a southern state whose major agricultural crop is tobacco. During his tenure as a Senator, he has been able to avoid public statements about the harm smoking causes; but now he is faced with a dilemma. A “simple” bill has been proposed, and the Senate must vote on it tomorrow. This bill would transfer the control of tobacco products from the U.S. Treasury Department to the Food and Drug Administration (FDA). Although simple in language, this transfer would mean that all tobacco products would fall under different laws and regulations. Under F.D.A. regulations, oll tobacco products would be taken off the market immediately because of their relationship to various diseases. Senator Wagnor’s staff has studied the impact of this legislation on his home state. In brief, they have projected the following immediate effects: 1. Approximately 450,000 people now working as farmers, or in tobacco processing plants, would be immediately out of work. 2. The estimated loss in State revenue as a
result of decreased sales tax, loss of income tax revenue, et cetera, would be $1.3 billion. 3. An additional $33 million dollars in welfare and public assistance money would be needed to support all unemployed workers and their families. 4. The reaction of Wagnor’s constituents would be so strong that he is guaranteed to lose his re-election campaign this fall. Although the effects on his state would be devastating, and worse yet, he will lose his seat in the Senate, three pieces of legislation he has proposed will probably be defeated in his absence. These bills will produce great gains in welfare reform, education, and international arms restrictions. As he talks with his staff, it becomes apparent that his vote will be the deciding one when a roll call is taken. His name will be in the headlines of tomorrow’s paper. How should Arthur Wagnor vote? To write a similar dilemma, consider the following four essential ingredients: (1) The focus. The dilemma must be realistic, relevant to students’ lives, course content, and contemporary society. The example given here focuses on multiple causation of health problems at the micro, mezzo, and macro levels.6 This helps students analyze behaviors from environmental, social, and psychological perspectives. (2) Cenrral Character. The dilemma must focus around one character or a group of characters - in this case Senator Wagnor. (3) Choice. The character must have two alternatives for action which present a definite conflict, generally an approachavoidance conflict. Neither alternative should represent a culturally-approved “right.” Senator Wagnor may either vote for the bill which will eliminate the incongruent actions of the government with regard to the nation’s health, or he may vote against it, affecting jobs for many economically deprived.
(4) A “Should” Question. End a moral dilemma with what should the character do. Don’t ask “What would the character do” as this calls for a prediction and is not the essence of the exercise. In the same vein, do not ask “What would you do?” Students are often reluctant to share their answer until they are certain they are “right.” To implement the moral dilemma technique, read the dilemma and ask the students to write down what they think the character should do. This forces them to individually commit to a decision rather than waiting to see what everybody else will do. Do a class tally by a show of hands. Divide the class into small groups so they can examine, share, and clarify their decision. Periodically ask “probe questions.” They may be of three types: (1) Issuerelated probes focus on moral issues. Is Senator Wagnor obliged to vote as his constituents want him to vote? Should the U.S. government provide welfare aid via tobacco subsidies? (2) There are roleswitch probes. From the point of view of the tobacco growers, what should Senator Wagnor do? (3) Nearer the end of the small group discussion, ask some universal consequence probes. What do you think will ultimately happen to the tobacco growers if the bill is passed? What changes do you see in morbidity or mortality rates if this bill is passed? To conclude the moral dilemma exercise, each individual should reflect on his position and state again his decision and rationalization. Do not encourage the class to form a consensus or try to reach a conclusion as to what the character should do. The instructor does not possess any “right” answers either. This is to be an open-ended process. It must take place in a free, non-judgmental atmosphere. All answers are right. As the student considers this moral problem, he can experience genuine conflict, apply his level of
moral reasoning, evaluate other levels of moral thought, and confront his own inconsistencies. Health education that provides students with the opportunity to examine and struggle with moral conflicts in a systematic and open process is more valuable than health education that tells students how they ought to behave. Hopefully this process helps students be, as Kirshenbaum describes, “Individuals with clearer purposes, enthusiasm, sharpness of thinking, higher levels of moral reasoning, and the social commitment t c recognize problems, thoughtully analyze them, and take bold and effective action.” 7
REFERENCES Introduction. (In) The School’s Role as Moral Authority. Washington DC, Association for Supervision and Curriculum Development, 1977, p l . 2. Crase D, Hamrick H: Health education: A reexamination of purpose. J Sch Health 1. Rubin LJ:
47:470-474, 1977, p470. 3. Kohlberg L: Collected Papers on Moral Development and Moral Education. Cambridge, The Center for Moral Education, Harvard University, 1973. 4. Galbraith RE, Jones M: Moral Reasoning: A Teaching Handbook for Adapting Kohlberg to the Classroom. Minneapolis Greenhaven Press, 1976, p35. 5 . Flora RR, Lang T, Flora TG: Health Behaviors. Unpublished manuscript, All rights reserved. Published with permission. 6. Simonds SK: Emerging challenges in health education. Int J Health Educ 19(4), October-December 1976. 7. Kirchenbaum H: Values education: 1976 and beyond. (In) The School’s Role as Moral Authority. Washington DC, Association for Supervision and Curriculum Development, 1977, p55.
INDEX TO ADVERTISERS
Harcourt Brace/ 468
Riker Laboratories/454
Maico Hearing Instruments/456
Roche/ 463
National Audio Visual Center/467
W. 6. Saunderd473
Pf ipharmecs Div/ Pf izer Inc. /Back Cover
Schering Corporation/516-1BC
Reed & Carnrick/lFC, 2nd Cover, 484-85
Scott Foresman/464
OCTOBER 1978
THE JOURNAL OF SCHOOL HEALTH
511
Focus on Moral Education: A Technique for Health Educators Rosalind H. Flora, PhD
Is moral education a part of the health educator’s responsibility? Most of us believe it is. However, one of the saddest experiences for me was to hear a respected colleague say, “We really can’t be concerned about moral aspects of others’ behavior, and that includes assisting students in their moral development.” As if that wasn’t sufficient, he continued, “Instead, we must teach them how to defend themselves.” Granted, there was a time when professionals believed moral education would usurp the role of the home and church. Although it was never labeled as such, moral education was always taking place in the schools. Along with parents and peers, the school provided an environment filled with interaction and indoctrination that taught the student a certain set of values and morals.
However, moral education is now shifting to center stage and is becoming more explict and direct. Louis Rubin, writing for the Association for Supervision and Curriculum Development, believes, “Two factors mainly account for this somewhat dramatic change: first, societal events suggest that the traditional provisions for developing a moral citizenry are not adequate; and second, scholarly endeavor has given rise to new . . theory regarding ethical education.” 1 With regard to moral development and health education, Crase and Hamrick state that there is a “shifting emphasis from traditional ‘personal’ health topics to more sociallyrelevant topics . . .”2 This shift is focus, in addition to the perceived need as described by A.S.C.D., encourages health educators to implement morals education in all educational settings since we deal with relevant content at the individual, organizational, and macrosystem levels in attempts at behavioral change.
.
51 0
One of the most widely accepted theories of moral development comes from Lawrence Kolberg, who has developed and longitudinally and cross culturally tested sex growth stages of moral reasoning. 3 These stages are based on the individual’s reasoning about a moral question as he moves from being very concrete to becoming more abstract. It is beyond the scope of this column to explain in detail Kolberg’s theory, but if you are not familiar with it, I believe reading Galbraith and Jones and/or the participation in an inservice workshop on moral education is helpful. Galbraith and Jones state, “Moral growth is determined by an individual’s awareness of perspectives beyond the immediate self. Moral growth represents an ability to see the other side and to focus on the issues.”4 As a person grows, the evolution is from being self-concerned and self-centered to othercentered-to social centered, to thinking about various issues as not only an aspect of his own life, but also as an aspect of others’ lives. As he continues to grow, issues are considered an aspect of a universal order with respect to “justice, of the reciprocity and equality of human rights, and of respect for the dignity of human beings as individual persons. ”4 One technique used in moral education to help facilitate this growth is the moral dilemma described by Galbraith and Jones. It is based on principles similar to values clarification: (1) to sensitize students to moral issues; (2) to give them experience in thinking critically about such issues; (3) to provide for them an opportunity to share their perceptions with others; (4) to assist them in learning problem-solving skills, and ( 5 ) to help them raise their level of moral reasoning by being aware and by applying the process in their own lives.
THE JOURNAL OF SCHOOL HEALTH
OCTOBER 1978
The moral dilemma technique can be applied in the health education classroom by first writing a dilemma for any of the health concept areas. Current news is often a resource for ideas. For example: Recently there has been much publicity concerning government price supports for the tobacco industry and government subsidies for research on health-related aspects of smoking. Why does the government appear to be promoting disease and supporting prevention at the same time? With this in mind, consider the following moral dilemma:
ONE VOTE IN THE SENATE Arthur Wagnor is a United States Senator from a southern state whose major agricultural crop is tobacco. During his tenure as a Senator, he has been able to avoid public statements about the harm smoking causes; but now he is faced with a dilemma. A “simple” bill has been proposed, and the Senate must vote on it tomorrow. This bill would transfer the control of tobacco products from the U.S. Treasury Department to the Food and Drug Administration (FDA). Although simple in language, this transfer would mean that all tobacco products would fall under different laws and regulations. Under F.D.A. regulations, oll tobacco products would be taken off the market immediately because of their relationship to various diseases. Senator Wagnor’s staff has studied the impact of this legislation on his home state. In brief, they have projected the following immediate effects: 1. Approximately 450,000 people now working as farmers, or in tobacco processing plants, would be immediately out of work. 2. The estimated loss in State revenue as a
result of decreased sales tax, loss of income tax revenue, et cetera, would be $1.3 billion. 3. An additional $33 million dollars in welfare and public assistance money would be needed to support all unemployed workers and their families. 4. The reaction of Wagnor’s constituents would be so strong that he is guaranteed to lose his re-election campaign this fall. Although the effects on his state would be devastating, and worse yet, he will lose his seat in the Senate, three pieces of legislation he has proposed will probably be defeated in his absence. These bills will produce great gains in welfare reform, education, and international arms restrictions. As he talks with his staff, it becomes apparent that his vote will be the deciding one when a roll call is taken. His name will be in the headlines of tomorrow’s paper. How should Arthur Wagnor vote? To write a similar dilemma, consider the following four essential ingredients: (1) The focus. The dilemma must be realistic, relevant to students’ lives, course content, and contemporary society. The example given here focuses on multiple causation of health problems at the micro, mezzo, and macro levels.6 This helps students analyze behaviors from environmental, social, and psychological perspectives. (2) Cenrral Character. The dilemma must focus around one character or a group of characters - in this case Senator Wagnor. (3) Choice. The character must have two alternatives for action which present a definite conflict, generally an approachavoidance conflict. Neither alternative should represent a culturally-approved “right.” Senator Wagnor may either vote for the bill which will eliminate the incongruent actions of the government with regard to the nation’s health, or he may vote against it, affecting jobs for many economically deprived.
(4) A “Should” Question. End a moral dilemma with what should the character do. Don’t ask “What would the character do” as this calls for a prediction and is not the essence of the exercise. In the same vein, do not ask “What would you do?” Students are often reluctant to share their answer until they are certain they are “right.” To implement the moral dilemma technique, read the dilemma and ask the students to write down what they think the character should do. This forces them to individually commit to a decision rather than waiting to see what everybody else will do. Do a class tally by a show of hands. Divide the class into small groups so they can examine, share, and clarify their decision. Periodically ask “probe questions.” They may be of three types: (1) Issuerelated probes focus on moral issues. Is Senator Wagnor obliged to vote as his constituents want him to vote? Should the U.S. government provide welfare aid via tobacco subsidies? (2) There are roleswitch probes. From the point of view of the tobacco growers, what should Senator Wagnor do? (3) Nearer the end of the small group discussion, ask some universal consequence probes. What do you think will ultimately happen to the tobacco growers if the bill is passed? What changes do you see in morbidity or mortality rates if this bill is passed? To conclude the moral dilemma exercise, each individual should reflect on his position and state again his decision and rationalization. Do not encourage the class to form a consensus or try to reach a conclusion as to what the character should do. The instructor does not possess any “right” answers either. This is to be an open-ended process. It must take place in a free, non-judgmental atmosphere. All answers are right. As the student considers this moral problem, he can experience genuine conflict, apply his level of
moral reasoning, evaluate other levels of moral thought, and confront his own inconsistencies. Health education that provides students with the opportunity to examine and struggle with moral conflicts in a systematic and open process is more valuable than health education that tells students how they ought to behave. Hopefully this process helps students be, as Kirshenbaum describes, “Individuals with clearer purposes, enthusiasm, sharpness of thinking, higher levels of moral reasoning, and the social commitment t c recognize problems, thoughtully analyze them, and take bold and effective action.” 7
REFERENCES Introduction. (In) The School’s Role as Moral Authority. Washington DC, Association for Supervision and Curriculum Development, 1977, p l . 2. Crase D, Hamrick H: Health education: A reexamination of purpose. J Sch Health 1. Rubin LJ:
47:470-474, 1977, p470. 3. Kohlberg L: Collected Papers on Moral Development and Moral Education. Cambridge, The Center for Moral Education, Harvard University, 1973. 4. Galbraith RE, Jones M: Moral Reasoning: A Teaching Handbook for Adapting Kohlberg to the Classroom. Minneapolis Greenhaven Press, 1976, p35. 5 . Flora RR, Lang T, Flora TG: Health Behaviors. Unpublished manuscript, All rights reserved. Published with permission. 6. Simonds SK: Emerging challenges in health education. Int J Health Educ 19(4), October-December 1976. 7. Kirchenbaum H: Values education: 1976 and beyond. (In) The School’s Role as Moral Authority. Washington DC, Association for Supervision and Curriculum Development, 1977, p55.
INDEX TO ADVERTISERS
Harcourt Brace/ 468
Riker Laboratories/454
Maico Hearing Instruments/456
Roche/ 463
National Audio Visual Center/467
W. 6. Saunderd473
Pf ipharmecs Div/ Pf izer Inc. /Back Cover
Schering Corporation/516-1BC
Reed & Carnrick/lFC, 2nd Cover, 484-85
Scott Foresman/464
OCTOBER 1978
THE JOURNAL OF SCHOOL HEALTH
511
