UNESCO Chair in Bioethics

Moral Games for
Teaching Bioethics
Darryl R.J. Macer, Ph.D.

UNESCO Chair in Bioethics Office
UNESCO Chair in Bioethics,
P.O.Box 6451, Haifa 31063, Israele-mail: acarmi@research.haifa.ac.il
Tel: 972 4 911 3281
Fax 972 4 821 1721

ISBN 965-7077-40-0
All rights reserved © 2008
No part of this publication may be reproduced, stored in a
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in Bioethics, the University of Haifa, Israel.
The views expressed in this document are solely the
responsibility of the author and do not necessarily represent theview of organizations with which they are associated.

COPYRIGHT © UNESCO Chair

The International Center for Health, Law and Ethics
Faculty of Law, University of Haifa

UNESCO Chair in Bioethics

Moral Games for
Teaching Bioethics
Darryl R.J. Macer, Ph.D.
Regional Adviser in Social and Human Sciences for
Asia and the Pacific,
Regional Unit for Social and Human Sciences in
Asia and the Pacific (RUSHSAP),UNESCO Bangkok, Thailand
www.unescobkk.org/rushsap
Comments to Email: d.macer@unesco.org

Israel National Commission for UNESCO

The International Center for Health, Law and Ethics
Faculty of Law, University of Haifa, Israel

Chairholder: Prof. Amnon Carmi

UNESCO Chair in Bioethics

Contents
Preface1

1. Bioethics and choices

2

2. Goals of Bioethics

4

3. Participatory Methods

14

4. List of Games
Game 1: Donuts
Game 2: How do you think?
Game 3: Agree or disagree
Game 4: Moral continuum (line-up)
Game 5: Talk in pairs
Game 6: Consensus Pairs
Game 7: From pairs into groups
Game 8: Small groups
Game 9: Card sortingGame 10: Moral Continuum (using cards)
Game 11: Debates
Game 12: Whispers
Game 13: Who am I?
Game 14: Hot seatGame 15: Concept blocks
Game 16: Bus stops
Game 17: Thought shower
Game 18: Postboxes
Game 19: Brainstorming
Game 20: Drawing a Relationships Web
Game 21: Courage to change
Game 22: Fish tanks
Game 23: Role plays
Game 24: Make dramas
Game 25: Pass the parcel
Game 26: Mathematics Exercises
Game 27: Drawing or producing Art

20
22
25
27
29
31
33
35
37
39
42
44
46
48
51
54
56
58
60
62
64
66
68
71
73
75
78

Game 28: Low hanging fruit
Game 29: Problem tree
Game 30: Problem wall and solution tree
Game 31: Trust gameGame 32: Risk gameGame 33: Mapping stigma
Game 34: Mapping social networks
Game 35: Health JourneyGame 36: Negotiation cards
Game 37: Head or heartGame 38: Future's wheels
Game 39: Devil's advocate
Game 40: Field Visits/Educational VisitsGame 41: Case Study
Game 42: Desired Change Diagram
Game 43: Make a song or advertising jingle

80
82
84
86
88
91
93
95
97
99
101
103
105
107
109
111

Online resources and references

113

References

115

Index by games

117

Index by example topics

119Preface
This book is intended for all who enjoy to teach others how to think.
The objective of learning should be to impart knowledge and skills
that can help assist learners in their personal paths towards finding
their place in the world. Critical thinking is enhanced by asking
questions, and lots of them. This book is simply called Moral Games
for Bioethics, but the games can be used for many subjects and adapted
to make learning enjoyable for all involved.
There are many definitions of bioethics, but ten years ago I called
Bioethics the love of life, reflecting the hope that bioethics should value
life in a process involving emotions and rationality. If we love life we
will enjoy it, and it is hoped that participatory methods, which not
only help people learn more facts, will also be more enjoyable tolearners. Research shows that if we enjoy something we will retain
more of the associated knowledge, and I therefore urge users of thebook to make ethics classes fun.
Feedback is appreciated from users, and students. The book will also
be available on-line for free downloads, and in that spirit I hope that
we can assemble more games for use by teachers and facilitators
around the world.
I wish to thank two colleagues in particular for their intellectual
support, as well as to the many in the international bioethics education
projects that have worked together to develop teaching materials andtest them in many countries in the past years. In recent years inbioethics training work, Dr. Lindsey Conner introduced me to someof the games used in education, and several specific examples of hers
are referenced in this book. I also wish to thank Prof. Amnon Carmi,
for his request to write this book, suggested improvements, andpatience to allow time to put these descriptions down onto paper.
I thank many former students, be they students in classes for years orfor single classes, who have given feedback on different styles ofteaching. There is no age limit for most of these games, as ethics issomething we should learn lifelong. Happy reading and have fun,
while trying to make the world we live in a little better.

1

2

Moral Games for Teaching Bioethics

1. Bioethics and choices
Moral dilemmas face everyone of us. There have been numerous books
written to explain moral theories and how these can be applied todilemmas we face in medicine, daily life and a range of professions.
Given the rapid development of science and technology, for example,
genetic engineering, neuro-engineering, and nanotechnology, and theimplications these raise for individuals and society, people need tohave the opportunity to shape the direction, purposes and goals ofscience and technology.
Bioethics includes ethical issues related to all branches of knowledge,
including the environment, life sciences, and medicine and associatedtechnologies. To ensure public participation and making wise decisions
about their own and their children's future, providing bioethics
education at all levels is necessary. Although the primary audienceof this book is teachers, the debates generated in the classroom arelikely to spill over into the family and community in general. This
book aims to bring moral theory to life by a participatory style featuring
a number of moral games that can be used and adapted to teachethics in a practical manner.
There has been universal agreement for more than a decade thatbioethics education at all levels should be provided to citizens throughthe adoption of the Universal Declaration on the Human Genome andHuman Rights by the UNESCO General Conference in 1997, and by
the United Nations General Assembly in 1998. The international
standards for bioethics education were reinforced in the International
Declaration on Human Genetic Data, adopted in 2003; and the Universal
Declaration on Bioethics and Human Rights, adopted by UNESCO's 33rd
General Conference, in 2005. In essence the apparently new choices
raised by new technology acted as a catalyst to stimulate theconsideration of how people make decisions in general. The work ofeducators in moral values through millennia was applied to the issues
raised by science and technology, and empowering learners to makechoices that make them live a better life.
For some the title of this book "moral games" would imply that thegames here are all moral. There have been discussions of whether
electronic games are moral or too violent. This is not the meaning of

Moral Games for Teaching Bioethics

3"moral" taken here. Rather morality is something that is learned
through clarification of our values and application of these values tocases. The participatory games explored in this book aim to guidemoral decision making.
Critical thinking capacity is essential for empowering persons to copewith changing times. Critical thinking should not only promote thecreation of ideas but also the formation and adoption of humane
moral values while treating patients, or while forming social decisions
with regard to human health and life.
Participation can promote the creation of ideas and individuality,
which we all need in the era of globalization. Learning is
acknowledged as being the result of complex interacting influences
thus teaching must recognize numerous interconnections because of
the impact it has upon peoples' lives.
A teacher's job is to ask questions to make students think forthemselves. There are some general characteristics of good questions.
Good questions should stimulate thought, be short, simple and clear,be definite and unambiguous, encourage persons to express
themselves, be relevant to the content covered and be appropriate to
the learner's ability
This concept of using moral games is also linked to movements suchas student-centred learning, participatory learning and action. Thereis a number of approaches, tools, attitudes and behaviours to enable
and empower people to present, share, analyze and enhance theirknowledge of life and conditions. These games may help them toplan, act, monitor, evaluate, and reflect on moral choices.

4

Moral Games for Teaching Bioethics

2. Goals of Bioethics
Bioethics could be defined as the study of ethical issues and decisionmaking associated with the use of living organisms. I have definedbioethics as love of life (Macer, 1998), and inculcating a balanced
love of life and love of learning is one of the goals of using moral
games to teach bioethics. Bioethics includes both medical ethics andenvironmental ethics, and this book includes examples from both.
Bioethics is learning how to balance different benefits, risks and duties.
Concepts of bioethics can be seen in literature, art, music, culture,philosophy, and religion, throughout history. Every culture hasdeveloped bioethics, and in this book there is a range of teaching
resources that can be used that are written from a cross-cultural
perspective by a variety of authors.
In order to have a sustainable future, we need to promote bioethicalmaturity. We could call the bioethical maturity of a society the ability
to balance the benefits and risks of applications of biological or medical
technology. It is also reflected in the extent to which public views areincorporated into policy-making while respecting the duties of society
to ensure individual's informed choice. Awareness of concerns andrisks should be maintained, and debated, for it may lessen thepossibility of misuse of these technologies. Other important ideals of
bioethics such as autonomy and justice need to be protected andincluded when balancing benefits and risks.
Bioethics is not about thinking that we can always find one correct
solution to ethical problems. The moral games included here teachthat a range of solutions is possible, although in the process it willshow that there are some inappropriate solutions to moral dilemmas,
such as to always believe you are right and others are always wrong.
Ethical principles and issues need to be balanced. Many people
already attempt to do so unconsciously. The balance varies more
between two persons within any one culture than between any two.
A mature society is one that has developed some of the social andbehavioural tools to balance these bioethical principles, and apply
them to new situations raised by technology.
Research has shown that there are a number of goals of bioethics
education including:Moral Games for Teaching Bioethicsa)5

Knowledge
Development of trans-disciplinary content knowledge
Understanding the advanced biological concepts
Being able to integrate the use of scientific knowledge, facts
and ethical principles and argumentation in discussing cases
involving moral dilemmas;
Understanding the breadth of questions that are posed byadvanced science and technology
Understanding cultural diversity and valuesb)

Skills (capacity building in skill acquiring should be multi-faceted
or many sided, and the goals include)
Balancing benefits and risks of Science and Technology
Being able to undertake a risk/benefit analysis
Developing critical thinking and decision making skills andreflective processes
Developing creative thinking skills
Developing foresight ability to evade possible risks of scienceand technology
Developing skills for developing "informed choice"
Developing required skills to detect bias in scientific method,interpretation and presentation of research resultsc)Personal moral development
Understanding better the diversity of views of different persons
Increasing respect for all forms of life
Eliciting a sense of moral obligation and values including honesty
and responsibility
Being able to take different viewpoints to issues including bothbiocentric and ecocentric worldviews rather than only
anthropocentric perspectives.

6

Moral Games for Teaching Bioethics
Increasing respect for different people and cultures, and theirvaluesDeveloping scientific attitudes, reflective processes, and an ability
for holistic appraisal, while not ignoring the value for
reductionist analysis.
Developing knowledge about bias in the interpretation andpresentation of research results, benefits and risks of technology
and bioethical issues, and how to detect bias
Exploring personal morals/values (values clarification)
Conducting values analysis and value based utilization of ourscarce natural resources

Many of these goals apply to ethics education and development ofcritical thinking in general. The games included in this book will help
achieve some of the above goals, and the list is not-exclusive. I welcome
feedback from users of the book to assess how these goals were met
for each user.
Providing different types of teaching methods and models for different
target groups such as lectures, seminars, workshops, drama, narrative,role plays, case presentation and analysis, essay composition, small
group discussion, on-line discussion forums, newsletters, public open
discussion, media commentary and critiques, all have important roles
uses in accomplishing the above goals. Researchers and educatorsneed to work together to research into appropriate teaching methods
for different target groups, to assess the effectiveness and impact (bothpositive and negative) of ethics education. Generating sustainableethics teaching and promotion programmes is a method in itself,
required by education planners.
We do not need to achieve all goals to consider a class to be successful,and different teachers and schools put a different amount of emphasison each goal. It is important at all these levels to evaluate whether
our teaching is having any impact or not. Because investigating
bioethical issues is complex, the educators need to consider whatknowledge needs to be developed in order for students to make senseof moral issues, to be able to critically evaluate them and to possibly
take action based on this knowledge (Conner, 2004). Persons at all

Moral Games for Teaching Bioethics

7

levels do mix ideas in different ways.
The type of class that we are teaching will also affect the outcomes.
For example if we are training medical students to become medical
professionals the goal may be to create medical professionals withcompetence and compassion. Medical education aims to teach not
only high skills in medical practice, but also to foster compassionate
and sympathetic attitudes in future medical professionals. But there
is a difference between these two goals (Nagaoka, 2008). Competence
may be measured more or less objectively. For instance, a doctor'sability to diagnose disease, to prescribe proper medication for thatproblem and so on can be measured by the outcomes. On the other
hand, whether an act is seen as compassionate or not depends on thecontext. Compassion or kindness is an evaluative judgment, madeby the other partner in the interaction, and therefore influenced by
the nature of the interaction as well as the mental states of the otherpartner. One could teach compassionate attitudes by characterbuilding, or through cases. We can see that goals of knowledge, skills
and personal moral development are inter-related, and different
choices of questions, cases, examples and different games can be usedin ethics education.
Evaluation options
Crucial to the development of bioethics education is a method of
evaluation that allows for improvement of materials to better meetthe needs of students in different countries. There are different
methods of evaluation including development of specific evaluation
forms for student and teacher responses to questions, and a range ofways to analyze the content of student discourse, essays and reports.
One important goal of teaching about bioethical issues is to get students
to critically evaluate the issues and most of these moral games can beused to allow opportunities for students to go beyond agreement toconsider carefully the issues, if sufficient time is given.
One of the difficult questions in bioethics education is how to evaluate
the usefulness of the materials provided, beyond mere student orteacher satisfaction. One concept to use is whether students
demonstrate "bioethical maturity" in some way. "Bioethical maturity
assumes a certain level of recognition of weighing up the different

8Moral Games for Teaching Bioethics

arguments that can be used to discuss an issue, the different ethicalframeworks that can be used, and comparisons and balancing of thebenefits and risks of the dilemmas". There are several indicators of"Personal moral development" that can be used (Maekawa and Macer,2005). These include whether students can understand and express
both sides of view. Mature persons should be able to express morethan one side of an argument or a question being mentioned, eventhough they may have their own opinion. The personal point of view(e.g., an "I think" statement) can be developed into reflective discourse
so that it is mixed with other people's points of views being stated,regardless of whether they concur.
Integration of scientific facts is also important in moral reasoning. A
concrete and/or detailed scientific fact is more intellectually
demanding than a broad statement of common sense. We could
expect persons to be able to cite scientific evidence, as well as
quantitative facts and statistics. We would expect students can also
provide reliable sources for their information and be able to detectand acknowledge the bias in information they use. A commonly usedsource of material in many schools is newspaper articles. Teachers
would sometimes take two opposing articles and have the students
discuss.
Environment and biocentric ideas can be promoted. A statement madementioning concerns for the environment or ecological concerns, orfor example the care or treatment of animals may be raised as aconcern. Generally people tend to reason and write from ananthropocentric viewpoint, but as they develop bioethical views they
will be able to view issues from different perspectives.
A utilitarian view is judging an act as being morally acceptable basedon the opinion that the benefits of the action to one group or individual
will outweigh the risks or harm produced affecting a larger
population. It can balance interests of society versus those ofindividuals, and it is not limited to human beings.
A keyword denoting an ethical principle or connotation of one
regardless of whether being directly stated or not would indicate
understanding of how to apply theory into moral decision making.
This could include the term "rights", or specific bioethics principles

Moral Games for Teaching Bioethics

9

and keywords such as benefit and risk assessment, informed consent,
enhancement, public welfare, autonomy, justice, equality of life,
animal welfare, etc.
An idea is a distinct message unit, statement or concept. Ideas cancome from many sources, others or themselves. Analysis of the numberof ideas, key words and concepts can be used to measure the diversityof thinking. Changes in the frequency of keywords and concepts usedby persons over time need to be measured against several variables,
including internal factors connected to the class such as the wordingof the statements discussed, the nature of the materials used, thecomments given by the teacher, and the comments made during thegroups and class. Examination of the progress of moral development
can be aided by detailed discourse analysis of oral discussion or written
reports.
There is a consensus among many Western scholars that the balancing
of four main bioethical principles, which are autonomy, justice,beneficence and non-maleficence, is central to making better decisions(Beauchamp and Childress, 1994). Autonomy means "self-rule", andincludes ideas such as respect for privacy and respect for personal
choice. Justice is to respect the autonomy of others, and to treat
persons equally. Beneficence is to try to do good, and non-maleficenceis to avoid harm. When solving or trying to reach a consensus aboutbioethical problems, these four main principles can be a good guidein balancing which ideas should be mostly weighed. One measure ofbioethics education could then be whether students are able to use
these principles in decision-making. Currently the use of principles
as expressed in the UNESCO Universal Declaration on Bioethics andHuman Rights (2005) is being used to develop a core curriculum toteach bioethics based on inclusion of the consensus view of bioethics
as included in that Declaration.
No matter how we learn, reaching a good moral decision is often
difficult. The best decision may not be the same if made in different
times and situations. One approach that is common in education is
to teach learners to break down ethical dilemmas into manageable
problems, for example, the separation of action, consequence andmotives connected to a moral decision. This separation can be used
to teach different bioethical theories. No matter what bioethical theory

10

Moral Games for Teaching Bioethics

one uses, moral games can be used to allow students to develop theirapplication of theory into practice, comparing different ways ofthinking in the exercises.
Kohlberg's (1969) theory of moral development holds that moral
reasoning, which he thought to be the basis for ethical behavior, hasdevelopmental stages. He claimed that these are universal, however
there is now a consensus that they are not because of different cultural
norms and customs. Kohlberg's six stages were grouped into threelevels: pre-conventional, conventional, and post-conventional. He
claimed it is not possible to regress backwards in stages nor to 'jump'
stages; each stage provides new perspective and is considered "morecomprehensive, differentiated, and integrated than its predecessors."
One criticism of Kohlberg's theory is that it emphasizes justice to the
exclusion of other values. As a consequence of this, it may notadequately address the arguments of people who value other moral
aspects of actions more highly. His theory was the result of empiricalresearch using only male participants (aged 10, 13, and 16 in Chicago
in the 1960s). Carol Gilligan argued that Kohlberg's theory therefore
did not adequately describe the concerns of women. She developed
an alternative theory of moral reasoning that is based on the value ofcare. Among studies of ethics there is a tendency in some studies tofind females have higher regard for ethics theories (Ford andRichardson, 1994). Other psychologists have challenged theassumption that moral action is primarily reached by formal reasoning(Crain, 1985). People often make moral judgments without weighing
concerns such as fairness, law, human rights and abstract ethicalvalues. If this is true, the arguments that Kohlberg and other rationalist
psychologists have analyzed are often no more than post hoc
rationalizations of intuitive decisions. Macer (1998) argued thatbioethics is love of life, but that the decision making process thatcombines both emotion and rationality is based on moral principles.
One of the common goals of school education is that students can
produce a good argument (Toulmin et al. 1984). An argument consistsof integrating the following:
A conclusion or claim - assertions or conclusions about an event or
theoryMoral Games for Teaching Bioethics

11

Facts - data that is used as evidence to support the assertion
Warrants - the statement that explains the link between the data andthe claims
Backing - underlying assumptions which are often not made explicit
Rebuttals - statements that contradict the data, warrant or backingof an argument
To create an argument a person needs to state their claim, then support
it with facts (data) that are arranged logically. For each fact, theyshould give the evidence for the fact (warrant), and for each warrant,
state the quality of its validity (backing). Then for each warrant andits backing, people should think of an opposing point of view
(rebuttal). They then consider further possible warrants and backing
for the rebuttals. At the end then they review, having argued therebuttals, examining whether they need to qualify their original claim.
The mental mapping project, or human behaviourome project1
identified different classes of ideas, and attempted to explain thelinkages between ideas in the construction of moral choices bydifferent persons (Macer, 2002a). The Ideas, Evidence and Argumentin Science Education (IDEAS) project of Osborne et al. in the UK2 ,has as its goal the assistance of teachers in developing their skills toteach about ideas, evidence and argument in science. The materials
they wish to develop include worksheets and video clips to enable
teachers to teach children to develop and evidence scientific argument.
The IDEAS project suggests that the following criteria can be used in
evaluating students' arguments: Is there a claim? Does the argument
have data to support the claim? Does the argument link the data to
the claim? Are there further justifications to support the case? Is there
any anticipation of a counter argument and how it could be opposed?
Ratcliffe and Grace (2003) gave examples of knowledge,
understanding and skills that students studying ethical issues inscience acquire and that can be used to design assessment questions.
They listed several different levels of knowledge:
1. http://www.eubios.info/menmap.htm
2. http://www.kcl.ac.uk/depsta/education/ideas.html

12

Moral Games for Teaching Bioethics

Conceptual knowledge: Learners can demonstrate understanding of:underpinning science concepts and the nature of scientific endeavour;
probability and risk; the scope of the issue - personal, local, national,
global, political and societal context; and environmental sustainability.
Procedural knowledge: Learners can engage successfully in: processesof opinion forming/decision making using a partial and possibly
biased information base; cost-benefit analysis; evidence evaluation
including media reporting; and ethical reasoning.
Attitudes and beliefs: Learners can: clarify personal and societal values
and ideas of responsibility; and recognize how values and beliefs arebrought to bear, alongside other factors, in considering socio-scientificissues.
As with the questions that Kohlberg used for the linkage of student
arguments to moral stages of development, and with the goals of
bioethics education in the Bioethics Education Action Plan discussed
above, there are a number of ways that could be developed into
evaluation tools for assessment of bioethics education.
Evaluation must be done ethically. It is very important to examine
the direction of bioethics education and how this might enable people
to question scientific endeavours and use of technology, and what
impact their moral decisions will have on them as individuals andupon their societies. The skills that are required to do this involve theability to identify existing ideas and beliefs, listen to others, be awareof multiple perspectives, find out relevant information andcommunicate the findings to others. These skills cannot be 'given' to
students through a didactic approach to teaching, where the teacher
imparts the knowledge in a one way stream. Instead, students needto experience situations that will allow them to develop these skills
through interacting with the teacher and with each other. The
methods outlined in this book allow sharing of cases and experiencein a range of cultures as well.
When bioethics is applied to professional behaviour, such as in medical
ethics, methods to evaluate have included the way students conduct
a patient examination. In Buffalo University Bioethics program3
3. http://wings.buffalo.edu/faculty/research/bioethics/eval.html

Moral Games for Teaching Bioethics

13(Singer et al., 1993), they applied the technology of the objective
structured clinical examination (OSCE) (Cohen et al., 1991) using
standardized patients to the evaluation of bioethics. Methods toevaluate the ethical abilities of students, trainees, and practisingprofessions that have been used include multiple-choice and true/
false questions (Howe and Jones, 1984), case write-ups (Siegler et al,
1982; Doyal et al., 1987; Hebert et al., 1990), audio-taped interviews
with standardized patients (Miles et al., 1990), and instruments basedon Kohlberg's cognitive moral development theory (Self et al., 1989).
The reliability and validity of these methods have seldom been
examined. Auvinen et al. (2004) applied the use of Kohlberg's stagesof moral development to assess ethics teaching in nursing students in
Finland, and they found significantly higher ethical maturity whennurses actually had to deal with ethical dilemmas in their practicaltraining in clinics. Pre and post questionnaire surveys about specifictopics relating to the content of the lecture or teaching intervention
can be useful to measure change. A mix of qualitative and quantitative
methodology can help in the monitoring of bioethical maturity.

14

Moral Games for Teaching Bioethics

3. Participatory Methods
This book provides a number of examples of participatory games thatcan be used to teach moral decision making and values. Prior to listing
examples there are some general issues that can be discussed on theconcept of participation. Quite simply, unless students participate inlearning they will not learn nor apply. Generally speaking the greater
the extent of participation and mental involvement the more lessons
we would expect to be retained.
While certain sights can stimulate moral revulsion, such as photos of
victims of war, disaster or abuse, the fact that we take note of them isdue to a mental participation and empathy with those we see, or
imagine. This book is trying to achieve the next level of participation,in which students go beyond simple empathy, to apply reason andlogic as well as feelings to specific cases, which will create a practiceof critical thinking when exposed to real moral questions in their
future.
Facilitators
One of the critical skills for teachers in many of these exercises isbeing able to facilitate group discussions. This skill is needed to increase
the participation of all people in group discussions and to ensurethat a wide range of perspectives and interests are included in thediscussions. Good facilitation skills help to improve the quality ofgroup discussion and problem solving. They can also help build
consensus where necessary, and encourage group ownership of theideas.
The teacher is the chief facilitator, and there are also opportunities inmany games where tutors or leaders of groups are appointed to
manage the smaller groups, or decided by the group themselves. The
facilitator needs to introduce themselves and the purpose and natureof the time given to the group to participants. The facilitator may
normally ask each person in the group to introduce themselves to theothers in the group. This can ensure that everyone is comfortable,
can see and hear each other. The participants in the group should
agree on the aims of the session and how much time is available. The
group agrees on 'ground rules' with participants, including the needMoral Games for Teaching Bioethics

15

to respect opinions and confidentiality. There should be agreement
between the participants on how the discussion will be recorded andwhat will happen to this record at the end of the session. Who isgoing to take notes? Who will check time? Everyone can take theirown notes if they want, and the nominated rapporteur shouldsummarise the main points of the session and follow up that has
been agreed. At the end the facilitator should give thanks to theparticipants for their time and contributions and, if appropriate,agrees a time and place for a further meeting.
An important quality of a facilitator is to develop the appropriate
attitudes and behaviours in themselves and others. These are to be
empowering rather than disempowering, facilitating rather thandominating, participatory rather than excluding, flexible rather thanrigid, for example. Positive traits include being humble, listening toothers, respecting others' viewpoints, and supporting learners. Thereneeds to be a willingness to treat people with equality regardless ofage group, socio-economic status, knowledge, or any other difference.
Giving people time to come up with their own ideas requires patience.
A teacher should not be imposing, nor talk all the time. The teachers
should not impose their own ideas in a prescriptive form of ethics
indoctrination, rather be an interactive facilitator of learning. Whilea time may come in the natural flow of discussions for teachers togive their opinion, it should be resisted when it will inhibit discussion.
Some people are not comfortable participating in classes and evengroups of 8 persons may seem to daunting for them. This may be
more common in cultures where education has a tradition of being
only from teacher (or video) to learner. Having to think for oneself is
not always emphasized in education. At the same time classes can
get out of control if no instruction is provided in response to theoutcomes of these games and activities, and if certain dominating
behaviours are allowed to monopolise the discussion. A balance isrequired.
Above all a facilitator must trust that students can analyze, plan, act,
monitor, evaluate and reflect on issues. In modern society young
people grow up with excessive amounts of information, and havebeen exposed to many moral topics prior to classroom discussions.
Conducting group discussions and games allows all to learn from

16

Moral Games for Teaching Bioethics

people, and to share their own knowledge. Teachers should not judge
people, but can challenge certain ideas to help people see things in a
new way if done in a respectful way.
Class-size
We can often hear complaints from teachers that there are too many
students in a class so there is no way to let the students talk. While
there are different ways to describe the participation of students, in a
lecture for 800 students compared to 32 or 10 students, class-size is
not a barrier to participatory learning. In the case of large classes
there are methods that can be used to improve the participation of
students such as talking in pairs while sitting in the class, or working
in small groups of three or more persons to discuss particular questions
from the text. Many of these games can also be tried outside, not only
inside classrooms. Make efforts to ensure that the games are conductedin places where participants feel comfortable expressing themselves
freely.
While if everything is equal we would prefer less students in a class,a student will probably learn more in a class that has other students
than themselves. Interactive responses between students and teachers
are important in learning, for not only those asking questions but for
all those listening. In the case that you have too few students, ordiversity, then modern free software may allow internet-based videoconferencing between classes and groups on different sides of ourplanet. That can also be attractive for many students.
At the start of each description of a game there is a summary purpose,a suggested guide on class size, and a comment on the actualinteractive unit size for these discussions. A suggested time is added,
as an initial guide. This time does not include the time that may be
used for debriefing or general discussion in the class after the game.
In general most games will take only 2-4 minutes to explain the firsttime, and then become easier as students become familiar with them.
With variations to the games the time taken will vary.
The name of the gameIn the rest of this book there is a series of moral games and exercises

Moral Games for Teaching Bioethics

17

that encourage participation of students, with some examples ofconcrete questions that can be used. Some of the games have been
given names, and other persons may prefer different names. There
are many interactive discussion methods that can be used in classes
with many persons, and I hope that as readers develop more games
they can be shared as resources with all. The point is to explore
methods that make us all think.
The references provide some further background material that canbe openly used and reproduced, but there are many potential
background materials for all of these topics. We would also hopethat students will be able to gather more of the background themselves
if they have access to the materials, whether in hard copy or on-line
over the Internet or in movies. There are books that provide manyother examples of games, whether for classes or for parties.
As part of a participatory method of education it is suggested thatstudents from different cultures produce media resources, including
power point presentations, posters, games, films, puzzles, etc., that
can then be shared between culture and institution. Some people are
gifted in mathematics, others in drawing, others in singing and othersin speaking or mime. Use the gifts that people have to make us all
think. Rather than having outside persons make resources, the student
created resources have also been found to be very useful. It will lead
to learning among those who create the resources, as well as sharing
knowledge between cultures.
Ethical considerations
Teachers have a great moral responsibility. Participants in small groups
discussing sensitive issues, including personal information, also needto exercise responsibility with each other. That is one of the moral
lessons to be learned from these moral games. There are some general
ethical issues that may be helpful for participants to reflect on andunderstand when participating in these exercises with other persons.
These include:
How much information should be shared with students before
enrolling in a class? There could be a difference in the way to approachclasses between the case that students are in compulsory classes to18

Moral Games for Teaching Bioethics

students in voluntary classes who have agreed to sharing moresensitive information in the learning process.
Is there agreement on confidentiality and anonymity if necessary, or
if desired by the participants sharing cases and opinions?
How is the information being recorded and documented?
Is their agreement on who owns the information and who can use
the information?
Do members of the defined community participating in the activity
have a concern or experience with the issue?
Is there a wide understanding of what the activity is about, what it
aims to achieve and the process?
If the focus is on action than it should be more than just an exercise
in gathering problems (vulnerabilities and risks) and 'wish lists'. If it
is activity based then the activity should also explore the assets andstrengths of all participants.
If an action plan affecting others is made than we can ask will theactivity benefit the community touched by the group?
Does the written report reflect multiple voices/perspectives of theclass? Has it, and other outputs, been agreed by all participants?
Have all participants given their permission for their opinions to bepresented to a larger group?
Does the activity methodology allow all people to participate equally?
Does it allow for participants to develop their own conclusions?
Is their agreement on acknowledging different interpretation andissues between people?
Who owns the data from the sessions and can the results be published?
Is adequate reference citation given to the materials and cases used?
Perhaps the most important ethical consideration is that learning
should be fun, and teachers have responsibility for helping
participants to clarify their values, and to answer adequately for eachparticipant the questions that stem from the teaching process. There
are many questions which we do not know the answer to, and an

Moral Games for Teaching Bioethics

19

honest teacher will acknowledge that while preparing students tostart to find their own solutions at the appropriate age.

20

Moral Games for Teaching Bioethics

Game 1: Donuts
Purpose: Values clarification; Listening to others; Ice-breaking
Class size: No limit except physical constraints of space
Time needed: 10 minutes
Interactive unit size: Pairs facing each other

Description
Make two circles of people with pairs facing each other. The pairs
dialogue for 1 minute each on a moral question, and then one of thecircles shifts around two persons so that new pairs are made. The
new pairs repeat the exercise with the identical question. For thethird time ask the other circle to move so that new pairs are formed
again. The people can then go back to their seats.
After repeating three times the persons have each given three answers
to the same question and heard three answers from three different
persons. If there is not space to make circles (donut-shapes), theexercise can be also done with two lines of persons facing each otherto fill available space in a classroom (e.g. at the front of the class, inwalkways between desks, etc.)
Teacher Background
This exercise is deliberately placed as the first moral game because it
can function as an ice-breaker for a new group of people. It is especially
recommended to happen at the beginning of a new course, or newclass, allowing people to get to know each other. For each person toknow others in the class will encourage a constructive social
atmosphere essential to learning, and boost the confidence of students
to speak to others.
The exercise provides an opportunity for each person to clarify their

Moral Games for Teaching Bioethics

21

thinking on the question being asked. At the end of the exercise theteacher can ask students how their views have developed over thecourse of the exercise. They also will have been able to listen to others'
views and describe what others said.
In case there is insufficient room for circular donuts the exercise canbe done by forming two lines of persons facing each other, to makepairs, and to shift one line each cycle. There is therefore almost no
limit to the number of persons who can do this, and the whole exercise
takes only ten minutes of class time. The teacher can then let thestudents sit down and describe their experience and then this can be
related to the theoretical background.
ExamplesAlmost any question can be asked, to express opinions and/or
knowledge. For example:
Q1)

Do animals have rights?

Q2)

Should we experiment on animals?

Q3)

How many children should we have? How many would you
like?

Q4)

Should we allow sex selection for couples wanting to have afamily with a balanced number of males and females?

Q5)

What would you like to do to solve the food shortage in theworld?

22

Moral Games for Teaching Bioethics

Game 2: How do you think?
Purpose: Values clarification; Listening to others; Ice-breaking
Class size: No limit except physical constraints of space
Time needed: 20-30 minutes
Interactive unit size: Divides class into different groups based on theiropinion, ideally no more than 15 in a group (smaller are better)
Description
Before the class the teacher should place a set of statements at different
places around the classroom. Place these signs on walls (or trees
outside if you want to take the class outside) in different parts of thespace where you are working. The students will then be asked tocluster next to the statement that best describes their own opinion.
They could be given a written list of all statements so they can chose
and also for later reference to class discussions. This game involves
students standing next to different statements relating to the subject,that best agree with their opinion.
If the group number allows, teachers can ask the students to explain
why they are standing by their different signs in the total group, but
this can also be done inside each small group now formed. When theactivity is complete, encourage the students to discuss what the gamehas shown. For example, where was there most agreement anddisagreement? Why do people have different attitudes?
The groups that are separated could then be given different tasks,
e.g. this could include to work together to list their opinions for why
they chose that statement. There is a separate entry for small group
work, and large groups will tend to have less discussion.
If small breakout rooms are available a statement can be linked toeach room and students would be asked to go to each room. Thenthe students in each group could develop the reasons why they agreewith the statement in a room, and longer time could be spent. The
clusters of students can prepare for further exercises, such as preparing
to debate with other statements. Sometimes you can encourage themto try to persuade others to change their minds. Students who change

Moral Games for Teaching Bioethics

23

their minds can move groups if they wish to.
The exercise can also be done so that students cluster next to thestatement that they most disagree with, instead of using agreement.
Teacher Background
This game allows the students to exercise their choice in which groupthey form based on some moral similarity with others in response to
the statement. The game can provide a lively and non-threatening
way for people to explore their attitudes about key issues. It can help
identify whether people have similar or different attitudes, and why.
This way of looking at personal statements about agreeing or
disagreeing can be particularly useful for exploring attitudes about
moral decisions, gender, cultural traditions and stigma, and sensitive
questions that people may be afraid to express orally in a large group.
They will be able to move to statements close to their own opinion
together with others. The teachers should choose statements about
which people will have different opinions.
Welcome disagreement among the participants and allow enoughtime for everyone to participate fully. Don't move on to a new topic
or statement too quickly because students may benefit by developing
their moral reasoning in depth on one topic then by simply having toagree or disagree with a lot of different statements. It is important
not to let your own attitudes as a teacher influence the activity.
ExamplesThe statements could be descriptions, questions like "Why use it?","Why do this?", "Do you agree with this quotation?", "Do you disagreewith doing this?" For example:
Q1)

Develop 4-6 statements of attitudes and beliefs about HIV/
AIDS, e.g. "You can catch HIV through kissing", "You should
only use a condom with a sex worker." Draw or write threesigns: "I agree", "I disagree" and "I am not sure".

Q2)

Statements about genetics and intelligence, e.g. "Genes
determine your intelligence", "Environment determines yourintelligence", "Intelligence is increasing", "We are what weeat", "Only intelligent people should have children".

24

Moral Games for Teaching Bioethics

Q3)

Who should have the right to the information in your brain?
Put up signs around the room: Lawyers, doctors, family
members, employers, insurance companies, marketing
agencies, government intelligence organizations?

Q4)

What kinds of genetic changes to organisms do you thinkwould be helpful or harmful? Put up 3 signs for: Helpfulchanges; Harmful changes; Changes that only make profit
for companies.

Moral Games for Teaching Bioethics

25

Game 3: Agree or disagree
Purpose: Values clarification; Listening to others
Class size: <100 maximum, ideally <40
Time needed: 20 minutes
Interactive unit size: Divides class by opinion into three different
groups according to the questions asked based on their agreement,
disagreement or uncertainty
Description
This game to ask people whether they agree or disagree with astatement. It is a simple form of values' clarification in which eachlearner is asked to show their opinion, and develop their opinion as aresult of sharing their opinion and listening to others. A particularstatement is made and then the statements, "I Agree", "I Disagree",and "I am not sure" are stuck to places around the room (similar
method to moral game 2). The students are told that if they strongly
agree with the statement, they should stand by the "I Agree" sign; if
they are unsure, they should stand somewhere in the middle near "I
am not sure" sign, and those who disagree should stand near the "I
Disagree" sign. Explain to the students that as you read each statement
they should go to the board which best reflects their views. Select asample of participants to explain why they choose to take a particular
position People may change positions if convinced by other pupils'
explanation, and they can be asked to explain why they changed
position.
Teacher Background
Values clarification is the process of identifying and criticallyexamining one's values, beliefs, attitudes, convictions and opinions
on different issues. Values' clarification aims at allowing students torecognise, acknowledge and tolerate the variety of opinions held byothers. For a larger class you can use 5 signs labeled "strongly agree,
agree, not sure, disagree, strongly disagree". Begin with a lessthreatening or a more general statement so that they get used to themethod. The teacher must avoid expressing their own opinion. The

26

Moral Games for Teaching Bioethics

role of the teacher is to create a climate of tolerance and a sense of
how broad the spectrum of ideas can be. If the discussion becomesheated, the teacher could ask the pupils to pay attention to how deeply
felt values can be.

ExamplesThe examples should be something that we can expect a division of
opinion on, and it can be related to an issue you wish to address
later. For example, do you agree, disagree or are not sure of thestatement:
Q1)

Everyone has equal human rights. The answers may
differentiate those who interpret this as a description of thereality in the world (have), or as an ideal (should have).

Q2)

An embryo is a person.

Q3)

We should all drive cars.

Moral Games for Teaching Bioethics

27

Game 4: Moral continuum (line-up)
Purpose: Values clarification; Listening to others
Class size: <50 maximum, <25 ideallyTime needed: 15-20 minutes
Interactive unit size: As entire class
Description
A statement is made and then students are asked to stand in a Ushape line facing each other to form a continuum based on their view
between two extremes along a moral continuum. The students need
to be able to see each other and form a single line. After some students
give their explanations for why they are standing at that point in theline then students may move to the appropriate point in the moral
continuum so that they are more positive or negative then their
immediate neighbours according to the side.

Yes

No

Teacher Background
The interaction in this shape can start with a general question andthen after students give responses to explain where they are they will
move their positions. Then after some time a modified question canbe given and the students asked to move along the continuum totheir new positions. Then a more personal question, or alternative
can be asked by the teacher to see how students move. The questions
asked by the teacher at the end will be more personal questions to see
how the students respond to a case more related to their own moral
choices.

28

Moral Games for Teaching Bioethics

The line could be in a U shape or straight if a small number. The U
shape allows all students to see each other more easily (and listen toeach other) in the case of a larger number of students, so it is preferred.
Let the students define the issues (the teacher can go into depth after
they sit down again).
ExamplesThis can include a transition from an abstract question through otherquestions to end with a personal question, e.g.
Q1)

a. Do you support the use of reproductive human cloning?
b. Would use reproductive cloning if that was the only way
for you to have a genetically related child after you lost your
8 year old daughter?

Q2)

a. Do you think we should allow patients to choose to end
their own life earlier if they are in pain? b. Do you think that
persons who are depressed can commit suicide? c. If you
had a terminal cancer and were in a lot of pain, would you
take an injection of a medicine to die?

Moral Games for Teaching Bioethics

29

Game 5: Talk in pairs
Purpose: Values clarification; Listening to others; Ice-breaking
Class size: No limit.
Time needed: 5 minutes
Interactive unit size: Pairs sitting next/close to each other.
Description
To break the monotony of a lecture, and increase participation,
students can simply stay seated where they are and be asked to talkto someone sitting next/close to them. It will be also an ice-breaking
exercise if they are asked to choose someone they do not know well.

Teacher Background
This can aid student concentration in addition to having them think
about the content of the lecture. You can ask them to talk to a different
person for a limited time as well, in a similar way to donuts (moral
game 1). The close proximity of students to each other can make thisrather noisy, however it can also bring persons sitting far apart in alarge lecture room close to others to interact with each other. It will
break the ice and allow increased student interaction in the larger
group at question time.

30

Moral Games for Teaching Bioethics

ExamplesThe questions will usually be involving "What do you think about
this?", with each person listening to the other.
Q1)

What do you think students should do to make the world abetter place?

Q2)

Who do you think should be a surrogate mother? Should weallow surrogacy? Would you be a surrogate mother?

Q3)

What do you think about using bleaching creams to makeyour skin whiter?

Q4)

Are criminals whose prefrontal cortex is damaged responsible
for their criminal behavior?

Moral Games for Teaching Bioethics

31

Game 6: Consensus Pairs
Purpose: Listening to others; Consensus building
Class size: No limit except physical constraints of space
Time needed: 10-15 minutes in the group, then reporting back to theclass
Interactive unit size: Pairs
Description
The students form groups of two and work in a pair to provide aconsensus view based on their discussion to the larger group. They
can be given different tasks, but for consensus pairs they must find acommon message.
Teacher Background
Students sit next to other persons in a classroom setting, and may or
may not choose whom to sit next to based on various preferences.
These preferences should be taken into account when deciding
whether the pair work should be done with their neighbour (whomight also be their friend), or whether numbering off of students into
particular groups is required. If the goal of the moral game is to arrive
at a consensus view then it can be easy for two students with similarviews to reach a consensus. However, perhaps greater in-pair learning
can be achieved through teaming up with a person of the opposite
viewpoint. Consensus building with persons of different views is morechallenging, so it may be advisable to have them get used to making
consensus with someone of similar views first, before deliberately
making pairs of persons with opposite viewpoints. At the same time,
it will teach greater skills if they must build a consensus with someone
who has a different view. The pre-selection could be done by grouping
using agree and disagree statements, and then numbering the twogroups and matching the persons together.
ExamplesQ1)

Imagine that you have to give advice to the Minister of Energy32

Moral Games for Teaching Bioethics
on whether the country should build a nuclear power station
to provide energy to a new industrial city, or whether
renewable energy will be sufficient. Provide three sentencesof advice to assist this decision.

Q2)

You must give advice to your friend whose mother has been
diagnosed with terminal cancer. She has said she does notwant to tell her mother she is sick, and has asked the doctor
not to tell her mother. What should you say to your friend,and what information do you need to know regarding this?

Moral Games for Teaching Bioethics

33

Game 7: From pairs into groups
Purpose: Listening to others; Consensus building
Class size: No limit except physical constraints of space
Time needed: 10-15 minutes in the group, then reporting back to theclass
Interactive unit size: Pairs
Description
After a pair of persons has developed their mutual understanding
and possible consensus (or recognition of difference) on an issue, thenthat pair may like to join up with another pair to form a small groupof four. Each pair should report on their own consensus and thenwork together to develop a consensus view from the four persons.
This process can continue to increase size to a larger group, though
the maximum I would suggest is 8 because after that we will see
increasing numbers of silent members appear.

Teacher Background
After the process of consensus building is familiar to the class thenthe students can try building broader consensus inside a larger group.
The sentences that are developed in the larger group may become
refined than they were as a group of only two. The students may
combine ideas into longer sentences, and sometimes there will be more
complex sentences made containing many ideas. The teacher may
have to give guidance if they want to limit the number of ideas in thesentences. This exercise can also improve literacy skills.

34

Moral Games for Teaching Bioethics

ExamplesPlease provide 3 policy options to the government on the following
points:Q1)

Anti-retroviral treatment should be free for everyone.

Q2)

The government should give the land in national parks andgame reserves to landless people.

Q3)

Scientists believe that the human ability to be ethical has
evolved over hundreds of thousand of years. Do you agree
or disagree? What policies should be changed resulting fromthe consensus answer?

Q4)

What should the government action plan be to respond toattempted female infanticide?

Q5)

Make a list of ethical concerns about genetic engineering.

Moral Games for Teaching Bioethics

35

Game 8: Small groups
Purpose: Values clarification; Listening to others
Class size: No limit except physical constraints of space
Time needed: 20-30 minutes
Interactive unit size: Groups of 3-8 persons
Description
Break the class into small groups. Optimal size is 3 persons, but often
more may be chosen, especially if tutors are required.
Teacher BackgroundSome sensitive issues that people may not wish to discuss in the larger
class can be more easily discussed in small groups. A common namefor small groups is "buzz" groups, stemming from the idea that there
will be a lot of discussion like a buzz sound made from bees.
Participants can discuss sensitive ideas with more confidence in thesegroups, building up confidence as they see their ideas being developed.
The ideas generated in the small groups can then feed into the larger
groups, so that in general we see a wider diversity of ideas being
generated.

ExamplesQ1)

There could be a small group discussion about autonomy.
Ask members to look around the group and see somethingthat they and each person has done to make them lookdifferent to other persons? What have you and others done

36

Moral Games for Teaching Bioethics
to look the same? Are there limits to the expression ofautonomy that people have?

Q2)

If your sister tests positive for the BRCA1 (breast cancer 1)gene that increases risk to get breast cancer, would you
recommend to her that she have her breasts or ovaries
removed as a preventative measure? Some women do this if
they are at 90% risk of developing breast cancer. Would you?

Q3)

Do you think golden rice is a "good" GM food? What otherinformation do you need to make a judgment?

Moral Games for Teaching Bioethics

37

Game 9: Card sorting
Purpose: Values clarification; Listening to others
Class size: No limit except physical constraints of space
Time needed: 20 minutes
Interactive unit size: Small groups, 3-6 persons
Description
A series of examples is described on cards and these cards are given
to groups of students to discuss and sort into groups on a desk, andthen explain the rationale to others. Card-sorting works best withsmaller groups of people. Agree on the issue to be explored. You canprovide cards already written with a list of ideas to place into groups
to ensure all the major issues are covered (Examples are given later).
One variation is to ask students to write down or draw on separate
cards all of the different things which relate to the issue, either in
addition to the cards already provided or in place of providing any
cards. Then after the small group time is finished all the class canlook at the different groups' cards, with one person from each groupexplaining the logic of sorting. The different groups can compare theplacements made by each group, and the new ideas written in eachgroup.

38

Moral Games for Teaching Bioethics

Teacher Background
After choosing the topic and cards to include, then ask students tosort the cards into different categories according to their own criteria
about the issue to be explored. When the activity is complete, discuss
what it shows. For example, what idea is in each category and why?
Why did people use these categories? Discuss how to use theinformation. Students could sort cards into different categories, e.g.
from some action that is easy to do to very difficult. Allow students
to naturally come up with their own categories if these have not been
established yet. This tool is a simple way to sort issues when there isa lot of information.
Example statements
Q1)

What helps some orphans and vulnerable children to lead abetter life?

An example of card words and the possible broader categories that they
could be sorted into is below (let the participants decide the categories for
sorting, as there are different ways to sort.:(HEALTH AND NUTRITION): Improve food production, Improve
food distribution, Encourage good hygiene, Vaccination, introduce
home health services and home visits, increase public health nurses.
(SOCIAL INCLUSION): Support special days to raise consciousness,training in child rights, identify most vulnerable households, set up a
children's club, reduce stigma.
(EDUCATION): Create internet sites, provide vocational training,provide practical, Benefits and incentives for vulnerable groups toattend school, Make teachers aware of special needs, allow flexible
school hours.
Q2)

What factors help and what hinder communication between
doctor and patient?

Q3)

Separate the following activities from high to low risk ofhepatitis transmission.

Moral Games for Teaching Bioethics

39

Game 10: Moral Continuum (using cards)
Purpose: Values clarification; Listening to others
Class size: No limit except physical constraints of space
Time needed: 20 minutes
Interactive unit size: Small groups, 3-6 persons
Description
A series of examples is described on cards and these cards are given
to groups of students to discuss and sort into groups or into a
continuum from most acceptable to least acceptable, and then explain
the rationale to others. Students have to discuss and agree what issues
to rank and the scale of the ranking. When the activity is complete,discuss what the ranking shows. For example, compare where items
have been placed, and how they could be ranked in different places
if another scale was used. Are there items that always appear highor low on the scales used for measuring moral acceptability? How
can the information shown by the ranking be used?
Teacher background
Putting things in order of importance and showing the reasons forthe order is a way to apply theoretical knowledge. You can also explore
the concerns and priorities of different people. You can explore which
problems are most serious or most common, and why. Ranking canalso be used to sort out information gained during an assessment. Be
aware that students may feel overwhelmed and allow enough time
for discussion at the end of the activity. Allow a maximum of threeor four criteria. Different objects, instead of paper or cards can beused to represent different items.
Exercise
Exercise on Cloning & Stem Cell Research 4
1.

Sort the following cards into claims and counterclaims.

4. Exercise developed by Lindsey Conner, University of Canterbury, Christchurch, New
Zealand40

Moral Games for Teaching Bioethics
2.

Resort the cards into facts and opinions.

3.

On your own paper, make a list of evidence that you
would need before you could accept the "facts" statements
as justifiable.

4.

Are there any flaws in the arguments given?

5.

How do the bias and interests of each person influence
the position they have taken?

6.

Which opinion would you prefer to take and why?

Teacher notes
1.

Photocopy the Table of comments onto card and cut them
out.

2.

Students try to match the statements (in pairs or small
groups) by physically moving the cards.

3.

Students answer the questions at the top of the worksheeton their own paper.

4.

More research is needed to find out;a. Whether human stem cells can be multiplied for use intransplantationb. Whether the cells, when multiplied, are damaged inany wayc. Whether their multiplication can be controlled to avoid
health risks to recipientsd. What leads cells to develop into specific kinds of tissuee. How cells multiply- this might help us understand andcombat cancer, which happens when cells divide in
an uncontrolled way to form tumours.

Moral Games for Teaching Bioethics
Our inherited and traceable common heritage
which establishes our identity, would bethreatened by the use of anonymous sperm or
eggs.

Research with stem cells will not lead straightto medical benefits such as a new cure for adisease or condition.
-

Independent Bioethics Council

41

In New Zealand, there is no practice anticipatedwhich would threaten identity by producing
inherited traits.
-

Independent Bioethics Council.

Amendment 2, also known as the Missouri
Stem Cell Research and Cures Initiative, if
passed by voters, would protect humanembryonic stem cell research in the state fromlegislative action. According to the proposed
amendment, but not stated in the ballot
question, human embryos used for stem cellresearch would come from fertilization clinics
or by artificial creation of embryos using aprocess known as somatic cell nuclear transfer(SCNT). During SCNT, the nucleus of a nonreproductive body cell is inserted into awoman's egg cell after its own nucleus isremoved. The cells eventually fuse and form
an embryo, without male fertilization having
taken place.

Embryos may be produced simply for the
purposes of cloning for medical benefits.

In most countries where there are controls on
the use of human embryos there is a ban on
cloning human beings. i.e. producing children
who are genetic copies of other people.

The cruelest deception of all is the deceptionof miracle cures. Scientists are using people
who have diseases and disabilities and giving
them false hopes.

Some people consider that using human embryo
stem cells for research is the equivalent ofkilling a human life because it destroys theembryo.

A mother who wants a cure for her daughter'sType I diabetes- "My feeling is there areembryos out there which have already been
produced with the effort to benefit infertile
couples that are being discarded - they are being
thrown away," she said. "There is good reason
to believe these embryos could provide cures
for a lot of people, including children like mydaughter.

Embryonic stem cells are derived from theinner cell mass of an early embryo, fetuses
from pregnancy terminations. Because they
can divide and develop into each of theapproximate 200 adult cell types in the human
body, embryonic stem cells could provide
regenerative medicine for now incurable
diseases, some scientists believe, and replacedamaged tissue.

The potential to relieve disease is a high moral
calling, We have a moral responsibility to act
in the best of our knowledge and within thelimits of our resources to alleviate humansuffering.

Another view of the moral question says thatgrowing an embryo in a laboratory to generate
a line of stem cells is far different from anembryo in a womb, said the Rev. Bob Towner,
pastor of Christ Episcopal Church.

The human body fights against alien tissue andrejects it. This is the main problem for cell,tissue and organ transplants. Using donor cells
that are genetically the same as those of therecipient is much more effective.

Bone marrow cells have limited ability todevelop into other types of cells or tissues.
They can produce all the different kinds ofblood cells and may be able to replace damaged
tissue. If more research can be done to find out
what determines that a cell is of a certain kind,then it might be unnecessary to use embryonicstem cells.

42

Moral Games for Teaching Bioethics

Game 11: Debates
Purpose: Values clarification; Listening to others
Class size: <50 persons
Time needed: 30 minutes plus
Interactive unit size: Varies from 10-20 active students
Description
The concept of a Socratic debate in philosophy is something that hasdeveloped in many countries over millennia. First set a topic for thedebate, called a "motion" to debate (a motion is statement about asubject which is likely to create discussion). Nominate two chairpersons also and allow them to develop rules, such as only one person
talks at a time with a strict time limit. Ask for ten volunteers. Fivevolunteers will defend the statement. The other five will challenge it
and say that the statement is incorrect. It does not matter whether
they agree or disagree with the statement personally, their role is justto try and defend or challenge the statement. Give the people time toprepare an argument by thinking of all the reasons the statement
maybe correct or incorrect. It may help them to write down a small
speech, or do research and homework to refer to facts that can support
the statement. The role of the chairs is to make sure that only one
person talks at a time and that the debate does not turn into anargument! The role of the remaining class members is to listen to eachof the debaters in turn and consider the merits of each argument.
Each debater presents their argument in a two minute speech. First a
debater who supports the motion, then a debater on the other side
who challenges the motion, and so on.
After all the arguments have been presented, the other participants
may be allowed to comment on what they have heard one by one.
After a given period of time (e.g. thirty minutes) the chair should callthe debate to a close and ask people to vote with their hands on who
won the debate; and secondly on whether they agree or disagreewith the motion (since these two may differ). Discuss what people
learnt from the debate. Who changed their minds?

Moral Games for Teaching Bioethics

43

Teacher BackgroundA debate is a discussion between two individuals or groups of people
who take on opposing views about the same subject. It provides a
non-threatening way to start a discussion about sensitive subjects,
regardless of whether agree or disagree with the motion that they
will debate. It is important to have the students adopt rules of thedebate and structure, so that they move from holding mere arguments
or conversations to a disciplined use of time and argument. Structured
debates between groups of persons on different sides of moral
dilemmas have a long history of use in philosophy. There are many
variations that can be used. The teams should spend some timebrainstorming their arguments before the debate. One variation is tohave larger teams to assemble arguments which only several speakers
will present.
Examples
Adopt a question and then assign 5 speakers to each of the two
opposing views, for example:
Q1)

Genetics determines your intelligence versus Environment
determines your intelligence.

Q2)

Brain death is human death versus Brain death is not humandeath.

Q3)

People living with HIV/AIDS should not be stigmatized: Yesor no.

Q4)

Are criminals whose prefrontal cortex is damaged responsible
for their criminal behavior? Debate the following statements:(i) They should be punished in jail; (ii) They should not go to
jail but should be rehabilitated; (iii) If we have methods tomodify their behaviour by brain surgery and/or drugs weshould do that, even if they do not agree.

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Game 12: Whispers
Purpose: Listening to others
Class size: No limit
Time needed: 10 minutes
Interactive unit size: 10-15 persons in a row or circle
Description
The students can either stay seated in rows across a lecture theatre,or sit in groups with ten to fifteen people. This is a game played inparties and sometimes called Whispers or Muddling messages. The
teacher should print several statements, one on each piece of paper,and give the same statement to the first person in each group. That
person should read in a whisper what it says to the next person, sothat only that person can hear it. They should not show the paper.
The second person will whisper to the third person what they thinkthey heard, and then the third person will whisper that to the fourth
person. At the end of the group the last person should then repeat
aloud to everyone what they heard. If there are multiple groups in alarger class then the last person in each group should read what they
heard, and at the end the teacher will read what the original statement
was.
You can then try again with another person starting. People can also
make their own statement to read.
Teacher Background
This game will show that during communication between two people
there will be miscommunication. When bioethical cases are chosenthat have critical elements we can see how these may change theunderstanding of the information between persons, and this canmirror a process that can happen in a healthcare team over medical
ethics and treatment decisions. It can also show how
misunderstandings can occur in processes of community engagement.

Moral Games for Teaching Bioethics

45

Examples
It is more fun when you involve multiple subjects and moral agentsand events which will tend to get muddled. For example:
Q1)

Jack is a cat who is going senile and wants to receive
euthanasia. His caregiver Bob is taking him to the doctor togive him a lethal injection.

Q2)

Sally wants to have a baby that is genetically the same as her
and the clinic will help her.

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Moral Games for Teaching Bioethics

Game 13: Who am I?
Purpose: Communication; Testing knowledge
Class size: No limit except physical constraints of space
Time needed: 20 minutes
Interactive unit size: Whole class mingling together with each person
talking to others.
Description
Pin the name of a different famous person to each student's back, sothat they cannot see it. Then ask students to walk around the room,
asking each other questions about the identity of their famous person.
The questions can only be answered by "yes" or "no". The gamecontinues until everyone has figured out who they are. The numberof different persons that the students could be expected to know will
depend on their historical knowledge and prior reading. It is not
absolutely necessary to give different names to each student.
Teacher Background
This game could be used as a fun alternative to a written test. The
choice of the famous persons could be made known to persons before
the game and then they could be asked to study about the major
ethical theories, or events, associated with that person. It could also
be played without prior advice to the students to check theirknowledge. The teacher can mingle to observe that the quality of thequestions and answers is high, and that students play the gameproperly. After the game the students can reflect on the results. The
students could also be given different famous persons for a second
time and repeat the exercise.
ExamplesQ1)

Example of remembering famous figures in ethics. Write thefollowing names onto papers to stick onto the back ofstudents, ensuring they do not know who they have on theirback. Always add some extra names to this list or else do notMoral Games for Teaching Bioethics

47

use all the names, so students cannot merely use the processof elimination to deduce the name of the person that they
have on their back.
Names: Aristotle, Avicenna, Tom Beauchamp, Jeremy Bentham,Daniel Callahan, James Childress, Confucius, Dalai Lama, H. Tristam
Engelhardt Jr., Joseph Fletcher, Mahatma Gandhi, Adolf Hitler, David
Hume, Immanuel Kant, Martin Luther King Jr., Hans Kung, Aldo
Leopold, C.S. Lewis, John Stuart Mill, John Rawls, Peter Singer, Plato,
Mo Tzu, etc.

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Moral Games for Teaching Bioethics

Game 14: Hot seat
Purpose: Understanding others
Class size: <40 persons, Ideally <25Time needed: 20 minutes
Interactive unit size: 10-40 persons

Description
Before the game, prepare a limited number of case studies for people
to read. These case studies should be realistic life dilemmas, written
in the first person. Alternatively, ask participants to write down somedilemmas. Ask for a volunteer to sit in the "hot seat". This means tosit down in a chair in front of all the other students. Ask the person
to read out the case study as if they were the person in the case study.
Invite the rest of the students to ask questions addressing the personin the case study as if they are that person's friends.
Where questions require information not provided in the case study,
encourage the volunteer in the hot seat to fill in the details. Repeat
the game with other volunteers and other case studies. After the gamethe students should discuss what they have learned and why it waseasy or difficult to respond to the questions.
Teacher Background
This game helps people understand the situations that may leadsomeone to make certain decisions and face the consequences thatthey do. Sensitive issues can be dealt with. Different roles can be
explored, not only friends. It can be less threatening if two people
take the hot seat together. Don't pressurise people to take the hot seat
if they don't want to. This game is particularly effective for gettingMoral Games for Teaching Bioethics

49

people to put themselves in others shoes and think through the
implications and pressures faced in different situations. The gamecan also help identify what people already do and don't do about the
topic, and explore how people feel about related issues.
ExamplesQ1)

In the following case the hot seat could be the position of themother or the grandmother.

First Family: A baby boy is born. The whole family is very happy andall members of the family distribute sweets to their neighbors on thisoccasion.
Neighboring Family: A baby girl is born and the whole family seems
to be sad. The neighbours come and complain to the mother for giving
birth to a baby girl. This hurts the mother acutely and she takes the
new born away to a distant place to kill the child. As she is snatching
the child, the grandmother of the newborn baby watches this andfollows her child. After walking for a distance she asked her daughter
why she had taken her new born daughter to a distant place. The
mother replies that the agony of giving birth to a girl child has been
pricking her mind and so she has made up her mind to kill the
newborn. The grandmother politely says to the newborn's mother if
she had killed her when she was born as a female child, what would
have been the plight of the family?
At this point you will be asked questions from the class. There arevarious options, for example, a) the grandmother advises her childand the mother apologises for her act; b) the newborn baby, her motherand her grandmother return home and celebrate the birth of the newgirl child; c) the mother kills the child and faces the consequences ofhiding the truth or having the truth revealed; d) the baby returns to
the village but is teased constantly. Use your imagination.
Q2)

You are a nurse in an oncology ward in a privately fundedhospital in Bangladesh. The surgeon has told the medical
staff that patient S has incurable colon cancer with secondary
tumours around their body. The family wants the patient S,
who is 43 years old and a mother of 4 teenage children, tohave surgery which they think will cure the disease, and50

Moral Games for Teaching Bioethics
they do not want the patient to be told the true nature of thedisease. The patient asks you, the nurse, about her condition.
She is very tired of the disease, but does not want to die. She
does not know exactly what the problem with her health is.
She wants to go home. You must answer questions from theclass, who will play many different roles. The roles could
include that of child, patient, parent, medical doctor, hospitaladministrators, ethics committee, your own family about yourwork, and so on.

Moral Games for Teaching Bioethics

51

Game 15: Concept blocks
Purpose: Lateral thinking
Class size: Limited by space
Time needed: 20-30 minutes
Interactive unit size: Break into groups of approx. 25 persons
maximum
Description
Prepare twenty to thirty cubes (e.g. 4cm each side) made ofpolystyrene and stick labels for one concept onto each one. Then give
one block to each person and ask them to place the blocks on top ofeach other into different categories. Ask each person to justify thereason for selection of that category as they place the block into thecategory. The students are told they must try to balance the numberof blocks. If there are already too many blocks in that category then
the teacher should ask them to put the block into another category.
The students should tell the reasons why they would place the block
into the selected category. If they had initially intended to place theblock in another category but they can not because it already has too
many blocks, they should give the reasons that they first had for
placing the block into that category.
Teacher Background
Usually four categories are given. The power of the activity is thatsome of the concepts (ideas) on the blocks can go on several categories
and the discussion and reasoning behind putting them on a particular
one is important. People have to explain their original category andthe new one if they had to achieve a balance. As the stacks of blocks
get higher there is a need to balance. This helps develop lateralthinking.
Sometimes the persons will create an extra category in the middle of
all four, which may or may not be accepted by the teacher. However,to encourage lateral thinking it is often better to restrict the categories
to just the original four - it is a variation. The teacher should reinforce

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Moral Games for Teaching Bioethics

each student, and make them talk with sufficient details of their idea
to others. At the end of the exercise the class can discuss the concepts,
and the teacher can provide more facts and information to them.

ExamplesYou can think of 20-30 concepts that relate to a theme and makeappropriate categories and blocks. Try to ensure that there is at least
one block for each student in the group. If multiple small groups arechosen, then it is not essential that the keywords are the same foreach group.
e.g. Sustainable Development
Q. The different aspects of sustainable development (Ecological;
Social; Cultural; Economic)6 , can be taken and a number of items canbe included. For example block names that have been used include:
Biodiversity
Endangered
SewageSchools
Smog

Ecosystems
Species
Old Batteries
RiversGarbage

Habitats
Mountains
Teachers
Physical Processes
Natural Resources

6. Original categories taken from Morgan Pollard, Sustainable Development, Chapter B6 inMacer, DRJ., ed., A Cross Cultural Introduction to Bioethics (Eubios Ethics Institute, 2006;
eubios.info). Thanks to Lindsey Conner, University of Canterbury, New Zealand for the idea.

Moral Games for Teaching Bioethics
Social welfare
Health & Medical
Politics
Greenpeace
Ethics & Behaviour
Entertainment
Television
Economies of scale
Goods
Employment
Quality of Life
Discount travel

CultureFreedoms
United Nations
Desires
Democracy
Human Resources
PoliceReligion
Legal System
Military Industries
Responsibilities
Family Values
Media
Horse racing
Common resourcesSportsServices
Rights
Product diversity
Car pools
Production efficiency Fair Trade
Consumerism
User pays53

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Moral Games for Teaching Bioethics

Game 16: Bus stops
Purpose: Values clarification; Listening to others
Class size: <100 students
Time needed: 20-30 minutes
Interactive unit size: Class
Description
A series of questions is set up around the class room, and each ofthese places is called a bus stop. The students go to each bus stop
answering the question. They may write their answer at the bus stopon the open list of all students' comments to the question, or justindicate if they agree with the comment of the previous person. They
could also write their comments on a post-it to stick onto the comment
space. Alternatively, they may answer the question on a paper, which
they keep with them.

Teacher BackgroundSome students may be shy to express their comments verbally in frontof all the others, so this method allows them to write their comments,
with or without their name, on questions set up at the bus stops.
Afterwards the class can discuss the comments relating to eachstatement. The students could also be asked to write a report about
the statement and their experience. This game is also suitable in aclass between students who are deaf and those unable to read sign
language, as all can read the comments.

Moral Games for Teaching Bioethics

55

ExamplesThe statements chosen can be any type of statement, or opinion, or
quotation. The statements do not need to be related to each other, or
they can be.
Q1)

For example here is a set of questions on values, to reflect
upon where values come from. Each could be a different bus
stop.
Q. What are values?
Q. What are your personal values?
Q. Why do you value them?
Q. What are the values in your society?
Q. How do you make choices?
Q. Are your choices based on your values?
Q. What values would be useful in society?

Q2)

Q. What are the limits to personal choice?
Q.Who limits your choices?
Q. Are limits to choices good?
Q. Do you limit other's choices?
Q. Should the government limit people's choices?

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Moral Games for Teaching Bioethics

Game 17: Thought shower
Purpose: Values clarification; Listening to others; Lateral thinking
Class size: <100 students
Time needed: 20 minutes
Interactive unit size: One paper for every 6 students
Description
Ask each small group to stand by a large blank piece of paper (e.g.
2m x 1.5m in size), that could be spread out on tables or on the wall.
Provide different coloured marker pens to each group. Ask them towrite down as many ideas as possible about how to improve thechallenging situation that the teacher reads out. Before they start,
stress to students that at this stage, any and all ideas should be written
down without anyone judging them. After 5 minutes, the teacher
should tell them to "Change!" and ask each group to move to anotherpiece of paper, that another group had been working on. Ask themto add to the ideas written by the previous group. After a further 5
minutes, ask the students to "Change!" again. If the class size is smallenough you can repeat the process until all of the groups have added
to all of the pieces of paper, e.g. 5-6 times.
Bring the class back together and stand around each paper in turn as
the class discusses it. Read through what they have written on thepieces of paper and ask students to explain anything that is unclear
to others.

Teacher Background
This exercise can help clarify values after first identifying manydifferent ideas. The ideas can also be used to help prepare students towrite a report in a following class to examine how they can integratethese ideas into a framework.

Moral Games for Teaching Bioethics

57

ExamplesThe questions could be general or specific attempts at problem solving.
Q1)

List all the factors which we should consider before removing
life sustaining treatment from a patient in a coma.

Q2)

Should we provide rewards to students who pick up litteron the school field? Should we punish those who litter? How?

Q3)

There may be many other reasons for Child Labour. Can
you list some of the reasons which you have encountered inyour locality? Think about who can eradicate Child Labour?
List some suggestions to eradicate Child Labour.

Q4)

Can you describe any examples of genetic engineering you
have heard of?

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Moral Games for Teaching Bioethics

Game 18: Postboxes
Purpose: Categorizing different ideas, and relating ideas to each other
Class size: No limit except physical constraints of space
Time needed: 15 minutes
Interactive unit size: Individuals in a class
Description
A series of questions is given to students, and they must place theanswer papers which they post into the appropriate postbox. The
postboxes are placed at different points in the room. It is possible to
make some students responsible for "correct" delivery of a comment
into the appropriate postbox if the postboxes are chosen to represent
categories of ideas. Some students can be made responsible for
opening of the post in one box and reporting of the answers back to
the class.

Teacher BackgroundThe game can help compare different ways of categorizing comments
and sorting of ideas. Discussion can be held at the various stages ofthe process. Modifications can be made. It also has the potential to be
used electronically in distance education, or in classes at different
locations, such as those in different cultures.
ExamplesThe questions could be attempts at problem solving, or could be used
to clarify stages in a moral argument.

Moral Games for Teaching Bioethics
Q1)

59

Consider the following living organisms and whether we canuse them for testing the safety of a new drug to attempt tocure acne. Each of the following is written on a postbox, andyou should write your vote with yes/no and your name:corn plants; cockroaches; mice; apples; chimpanzees; humanadults; prisoners.

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Moral Games for Teaching Bioethics

Game 19: Brainstorming
Purpose: Values clarification; Listening to others; Idea organization
Class size: <50 students
Time needed: 10-15 minutes
Interactive unit size: Class or small groups of the class
Description
A statement or question is written down and everyone needs to makea comment about that. Stating the statement at the beginning gives
students the opportunity to think while the first ones are answering.
You can ask every student by name to mention one issue and repeat
the exercise until the class has run out of ideas.
Next the ideas generated can be discussed. The ideas are owned
collectively by groups of students and there can be attempts made tojustify or explain any answer. After the period of brainstorming, time
for reflection on the ideas or prioritising of the list should be allowed.
The brainstorming can be done as a whole class or in groups.
Teacher Background
Brainstorming is a technique in which every student's response thatapplies to a given topic is acceptable. It is important not to evaluate
ideas but accept and record each idea on the class board or large
piece of paper as it comes. Students need to know that they will not
be criticized for any idea. This can promote respect for other persons
and is a quick method to generate ideas. A time limit can be given per
response to ensure it progresses. This is one way of determining thegeneral knowledge about an issue before starting to discuss the topic.
Brainstorming is effective for sensitive and controversial issues thatneed to be explored, and can encourage students who are hesitant toenter into discussions. It can generate a large number of ideas asquickly as possible

Moral Games for Teaching Bioethics

61

ExamplesThe more general the question is the more likely that you can generate
more ideas. When the class reaches the apparent end, some prompts
can be given to help develop the ideas. Example:
Q1)

Should we keep animals in zoos?

Q2)

Should we sell a kidney to help get money for our child's
education?

Q3)

Do you see anything wrong with using drugs if they enhance
our ability to focus or improve our mood? What do you thinksociety would be like if drug enhancement became the norm?

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Moral Games for Teaching Bioethics

Game 20: Drawing a Relationships Web
Purpose: Clarification of reasoning; Idea organization
Class size: <50
Time needed: 20 minutes
Interactive unit size: Small groups of 5-10 persons
Description
Explain the purpose of the game and ask students to select a type of
person to focus on. Ask the group to draw a picture with the personin the centre of the web. Encourage the students to think of all of thedifferent types of people and organisations that could affect the person,
including those who could provide support to the person and those
who may have negative attitudes or behavior to the person. Ask
students to write/draw them in a circle around the outside of thecentral person. Encourage the students to identify which of the people
and organizations have links to each other. Draw different lines toshow those links. On the lines, write what special relations are shared,
e.g. care, support, financial insurance, education (both given andreceived). When the activity is complete, encourage the students todiscuss what the web shows. For example, how many different typesof people and organisations are associated? What are the relationships
like among the different types of people and organisations? Which
relationships empower people rather than making them dependent?
Teacher Background
The relationship web involves students drawing the web of people
and organisations that interact or affect a person. In the case of avulnerable person the web can help identify what makes a helping
relationship and what makes the situation more difficult. The
discussion can identify the worst problems and also the best type ofhelp and support for those different people. The web can identify thetype of relationships that exist between people involved in care andsupport. It can be used to explore what makes good, supportive andempowering relationships.

Moral Games for Teaching Bioethics

63

Emphasize that relationships are a two-way process. They are about
the person and the different people and organisations both treatingeach other with respect and providing each other with support. An
alternative way to drawing is to do a relationships web using a balland string and pass the string around everyone who is connected.
A variation called a "helping relationships web" is particularly usefulfor identifying the network of support that is - or could be - available
to community members with particular needs.

ExamplesExamples might include "a teenage girl living with HIV/AIDS" or a"grandmother who has been diagnosed with Huntington's disease".
Encourage the students to think about different types of links. For
example, there might be a formal, professional link between a doctor
and a community health worker. But there might also be an informal,
personal link between that community health worker and family
members.
Q1)

Draw all the relationships of people to a teenage girl livingwith HIV/AIDS.

Q2)Draw all the relationships of a grandmother who has been
diagnosed with Huntington's disease.

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Moral Games for Teaching Bioethics

Game 21: Courage to change
Purpose: Experiential tool; Clarification of thought; Relating theory
to practiceClass size: <50
Time needed: 10-15 minutes
Interactive unit size: Groups of 15-20 persons

Easy

Hard

Description
Mark a line on the ground. State that one end means "easy" and theother end means "hard." Ask the students to identify a way in which
individuals or the community need to change in relation to the
problem. Ask for a volunteer to stand on the line that you have drawn,
according to how easy or difficult they think it would be forindividuals or the community to make the change. Ask the volunteer
to explain why they have chosen to stand where they are. Ask them
what support individuals or the community would need to make thechange easier. Ask the students to identify another way in which
individuals or the community need to change, and then have theother student stand on the line. Ask the other students if they agree,
and repeat the process for another 6-8 changes. Record what is easy
and what is hard to change in a way that all students can see.
When the activity is complete, encourage the students to discuss what
Courage to change has shown. For example, what makes changes
easy or hard? What sort of support do individuals or the community
need to make changes easier? How could that support be provided?
Who by?

Moral Games for Teaching Bioethics

65

Teacher Background
This tool involves students standing at different points along a line toshow how easy or hard it is to make changes relating to a behaviour.
Using Courage to change provides a non-threatening way to identify
the changes that people need to make in their lives and community
to solve a problem. It allows people to assess how people feel about
those changes, including which changes are easy or hard and why.
The Courage to change activity is particularly useful for exploring
what individuals need to do to accomplish their wishes.
Talking about changes that need to be made can be difficult. Help
students to feel comfortable by agreeing that all sensitive informationis confidential. Remind students that the activity is about the changes
that people like them can make. It is not necessarily about the changes
that they, personally, can or must make.
Instead of a line, you can use a "secret vote". This involves students
having voting cards and using a scale of 1 - 5 star to show how easyor hard a change is. For example 1 dot (*) would show that it wasvery easy and 5 (*****) that it was very hard. Read out an example ofa change that is needed. Ask the students to vote - by putting dots on
a card and putting it into a box or basket. Count up the votes anddiscuss what the total says about how easy or hard the change is.
ExamplesQ1)

We should reduce the use of private cars to only essential
tasks.

Q2)

We should not print out paper files when we can read themon our computer.

Q3)

We should adjust the temperature of heating or cooling tominimize the need for energy consumption.

Q4)

We should not play any risky sports.

Q5)

Where is the line between trying to look neat and tidy, tolook nice, to look handsome or beautiful, and merely to caterto other person's images of what we should look like?

Q6)

We should give up smoking.

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Moral Games for Teaching Bioethics

Game 22: Fish tanks
Purpose: Values clarification; Listening to others; Powers ofobservation
Class size: No limit except physical constraints of space
Time needed: 10 minutes
Interactive unit size: Threesomes or Foursomes in lines or circles
Description
In the moral game called donuts (number 1) the class makes twocircles of people with pairs facing each other (donuts). In a fish tank
you can add an extra observer in a third circle outside the inside two,
who is only recording and making notes on the conversations between
the other two persons. The pairs dialogue for 1 minute each on amoral question, and then one of the circles shifts around two persons
so that new pairs are made, and they repeat the exercise with theidentical question. The observer needs to follow the person whose
conversation they are concentrating on observing. It is possible tohave two observers per pair, or in other words, one observer for every
person in dialogue, and that observer will follow that person throughthe donut process. After repeating three times the persons have eachgiven three answers to the question and heard three answers fromthree different persons. The observer has seen the changes in one ofthe persons that they have stayed to observe.
Teacher BackgroundThe exercise provides an opportunity for each person to clarify theirthinking on the question being asked, with an objective and silent
observer. At the end of the exercise the teacher can ask both theobservers and active students how the students' views have developed
over the course of the exercise. The speaker may not notice the changes
so well as the observer. They all will have been able to listen to others'
views.
It is also possible to use one observer for every active student (e.g.
two per pair of speakers). In case there is insufficient room for circles

Moral Games for Teaching Bioethics

67

the exercise can be done by forming straight lines of persons facing
each other, to make pairs with observers behind them, and to shift
one line each cycle.
ExamplesSimple questions as for donuts (game 1) can be used as well as
discussion points to share information. For example:
Q1)

We should put all pandas into zoos because their natural
habitat is threatened.

Q2)

Patients should be always told the truth about their disease
and prognosis.

Q3)

Is there any difference between 'good drugs' and 'bad drugs',
and if so, what are they?

Q4)

If scientists can read your thoughts, do you think that they
can also change them?

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Game 23: Role plays
Purpose: Values clarification; Listening to others
Class size: Less than 50 will ensure greater participation
Time needed: 20-30 minutes
Interactive unit size: 4-8 actors and class as the audience
Description
Pupils act out what they would say or do in a given situation. The
acting can last 5 to 10 minutes. Other pupils watch and listen carefully.
First give a description of the role and the situation briefly to theentire group. Ask for volunteers or appoint students to act out therole play. Tell the players that they can add to their roles and use
their own ideas about what the person would say or feel in thesituation. Give the actors a few minutes to prepare and let them act
out the play within 5 to 10 minutes. After the role play, the classshould discuss the performance.
In the case that the students become emotionally involved with theroles it may be advised to de-role them afterwards to avoid themgetting stuck with the names and roles that they assumed in the play.
To de-role the students, you may briefly explain that the roles andnames the acting pupils took in the role play are not part of the pupils'
real life. The acting pupils have not taken on new names or roles.
After the role play, all the class can discuss the performance and thesituation. Ask the volunteers what it was like to act the parts, what
they learned and how they felt. Then, ask the audience what it was
like to watch, what they learned and how they felt. Pupils may raiseand discuss questions such as: Does this happen in our community?
Who or what causes this problem, how can it be solved and who cansolve it? Who had the most power in the situation? What might havebeen the effects of the situation? What could have made the situation
better?
Teacher Background
In role play, pupils use their own experience and creativity to imitate

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a real life situation. When done well, role play increases pupils` self
confidence, gives them the opportunity to understand or feel empathy
for other people's view points or roles, and usually encourages themto come up with practical answers, solutions or guidelines on various
issues. If the students are used to the method then they can create arole play themselves, and they can prepare an outline of a common
situation they would like to role play, and then make it. For the firsttime it may be advised for the teacher to write a situation beforehand- including brief details of the roles and situation for students to act
out, so that the students can develop the ideas themselves.
If the class was subdivided then the subgroups can compare theirexperiences together, e.g. those who played the same role in the
different role plays can discuss with each other their opinions andfeelings as they played out the roles.
Choose enthusiastic and appropriate volunteers to play the roles.
Encourage them to be creative - for example, even making up costumes- in order to bring the situation to life. If students are making a story,
encourage the volunteers to develop a realistic, everyday story, rather
than an extreme one. This will help you to use the role play to discuss
real life situations and issues Role plays are not just about what people
say, but what they do. Pay attention to the body language of both thevolunteers and the audience. It can be useful to "pause" a role play atan interesting point and to have a discussion. You can then re-start
the story afterwards. Alternatively, audiences can suggest different
actions or endings at this point.
Role plays often involve fun which helps people to relax and talk
openly. Find the right balance between fun and retaining the pointof the role play. Role plays can bring up a lot of emotions. People
might be reminded of their own painful experiences or the experiencesof family and friends. Be aware of that and provide plenty of time fordiscussion. It can be useful to have a series of role plays that focus on
the same situation, but are slightly different. For example, in the secondrole play the key characters might be women rather than men, or
have positive rather than negative attitudes, counsellors rather thanclients etc.

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ExamplesQ1)

You are a train conductor and have found that a woman
passenger has not paid the train fare. Upon speaking to her
you suspect that she is mentally handicapped. Should you
impose a penalty fare, ask her name and address, or besatisfied with her payment of the normal train fare. Other
passengers give various opinions. She seems not to beaccompanied by anyone else.

Q2)

You are a school student of 13 years who is pregnant. You
trust your teacher more than your parents and tell yourteacher. He does not know who to contact, because you havepreviously complained that your father beats you at home.
The teacher must also consult with other persons, such as
the school principal and counsellor. Who should go to theclinic for the medical consultation?

Q3)

A number of pharmaceutical companies are developing new
chemicals to improve memory. Would it be a good idea totake a pill to improve your memory and attention? Would adesire to perform well at school outweigh any potential side
effects that you may experience, particularly if those side
effects would not arise until later in life? What ethical issues
can you see arising from the development of such a drug?
Imagine you are a student wanting to do well in an exam,
the doctors, an Alzheimer patient, and family of theexperimental subjects in the clinical trials of these drugs.

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Game 24: Make dramas
Purpose: Values clarification; Listening to others; Self-expression
Class size: 5-20 persons maximum, can subdivide class into small
groups.
Time needed: One to two class periods
Interactive unit size: Small groups of 5 to 20
Description
Divide the class into teams of students who will develop a drama
production. This exercise is best to do with students who have gained
experience with role plays, and allows the students to develop a
drama. For more sophisticated dramas there can be responsible
students for music, costumes, backstage, props, directing, audience
feedback forms. In this way everyone can be given a task.
Teacher Background
Drama is an art form that can be used to reinforce the lessons thatare learnt through oral discussion. It will be useful to choose a theme
to guide the development of the drama. It can also help to mention
the key roles that should feature in the drama.
ExamplesQ1)

There is a written script on brain death and organtransplantation in a resource book chapter that can be used
as an example of a 15-20 minute drama involving over 10
actors. 7

Q2)

Once students are familiar with drama they can be given a
subject to develop a drama on. It will be more participatory
if many are involved, e.g. consider the relationships of people
in a surrogacy case with donated sperm and donated eggs,

7. Alireza Bagheri, Brain death and organ transplant drama, Chapter D6 in Macer, DRJ., ed., A
Cross Cultural Introduction to Bioethics (Eubios Ethics Institute, 2006; eubios.info).

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involving multiple parents, medical professionals, agents,
other children, and the society in general.

Q3)

Many traditional medicines of vegetable and animal origin
are harvested from nature, often from endangered species.
How do you think sustainable use of natural products canbe ensured? If pharmaceutical companies produce new
drugs based on traditional knowledge and/or resources
coming from indigenous peoples, how should these be
rewarded? You could include plants and animals as
characters in the dramas, as well as Western and indigenous
healers.

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Game 25: Pass the parcel
Purpose: Values clarification; Listening to others
Class size: Divide the class into groups of 10-15 persons
Time needed: 20 minutes
Interactive unit size: Groups of 10-15 persons

Description
The facilitator will wrap a small object with many different layers of
paper. On each layer they have written a task or a question. Examplesof tasks are 'recite a quotation from a famous philosopher' or 'tell theyear of publication of a major book'. Examples of questions are: 'Whatis your ethics and why?' or 'What is a positive reason to support the
proposed research proposal?' The facilitator starts the music. The
students pass the parcel around the circle, or throw it to each other.
When the facilitator stops the music, the person who is holding theparcel takes off one layer of paper and carries out the task or answers
the question that is written on the paper. The game continues until
all the layers have been unwrapped. You can make it appealing by
having the object be a gift to the last person to take off the wrapping.
Teacher Background
This game is a variation of a party game, and thus is suited to younger
students especially. The questions and tasks could all relate to thetheme of the discussion, and a series of questions can be developedon a particular topic.

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ExamplesThere can be a whole series of questions on each layer, either related
to a particular theme, or else to test historical knowledge and resultsof lectures study.
Q1) Series:

a. Would you like to know if you had terminal cancer?
b. Would you tell your mother or father if they had
terminal cancer?
c. How would you feel if you found out on the last
day of your life that your family had not been telling
the truth to you about your disease?
d. How would you spend the last week of your life onearth?
e. What would you do?
f. Where would you go?
g. Who would you see?
h. Do you think you can make plans to negotiate yourdying process only if you are fully informed of yourterminal condition?
i. Can you name the benefits of disclosure?
j. Can you name the risks of disclosure?
k. Does attitude towards telling the truth about
terminal illnesses depend on culture?
l. How about in your culture?
m. Is there such a thing as "good dying process" and"peaceful death"? How would you describe it?
n. Is it something that individuals should strive for?
o. How should society deal with this?
p. What is death with dignity?
q. Why is that valued in present society?

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Game 26: Mathematics Exercises
Purpose: Creating understanding of reality; Quantitative skills; Benefitrisk analysis
Class size: No limit except physical constraints of space
Time needed: 20 minutes, after preparation as homework
Interactive unit size: Individuals and small groups
Description
Moral dilemmas often include making estimates of benefit and harm
to different agents and in different situations. Mathematical skills canbe used to make calculations that raise moral implications.
Teacher Background
There are some studies suggesting that logical thinking andmathematical ability can help students organize their thinking on
moral dilemmas. Benefit-risk analysis requires some quantitative skills.
This moral game also can teach mathematical concepts.
ExamplesThis is an example of Driving Cars and the Ethics of Costs and Benefits
Cars are an integral part of the fabric of every modern society; so,most students will approach the issue of personal car use with strong
predetermined ideas. The quantitative analysis is a good starting
point to encourage rational and objective analysis and dispassionate
reflection. A project to calculate costs and benefits was proposed.8
In the first session, the issue can be presented and the analysis
explained and demonstrated. Students, either individually or ingroups, should be assigned the task of performing the analysis forhomework. In the second session, students should present the resultsof their analysis to the class and be encouraged to discuss some of the
8. Taken from Rick Weisburd, "Cars and the Ethics of Costs and Benefits", Chapter B7 inMacer, DRJ., ed., A Cross Cultural Introduction to Bioethics (Eubios Ethics Institute, 2006;
eubios.info). That chapter includes further examples and material.

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many questions raised in the chapter.
Some students or their parents may be uncomfortable sharing someof the data needed for the quantitative analysis, for example householdincome and hours worked. If so, then teachers may provide sometypical values for the local community. Other data might be difficult
to obtain; again, teachers might help by providing some reference
values for students to use. It might also be interesting to ask different
students or groups of students to perform the exercise with different
types of vehicles, for example very small cars or sport utility vehicles.
Worksheet I - Start by adding up the costs of car purchase and use;
calculate how much you would have to pay (or your family doespay) for each kilometer you or your family drive. If your family has
its own car, use your family's actual expenses for the calculations; if
not, then do a hypothetical analysis of what it would cost for yourfamily to buy and use a car. Car dealers should be happy to provide
you with cost estimates for a car purchase; they might also be able tohelp with estimates of the other required expenses like maintenance,
insurance, and taxes. Below is a sample calculation for Japan. If you
have access to a computer, the internet, and a spreadsheet program,you can download a sample Microsoft Excel spreadsheet from the
Eubios Ethics Institute at <http://eubios.info/Bet/bet6cal.xls>. A
hard copy example is printed below.
This sample spreadsheet can be modified to fit your local situationand perform the calculations for you. The costs should all be expressedon an annual basis; in your locality, the costs may exclude some of
the items in the spreadsheet and the table below or include others. In
Japan, the average car is used for only 7.3 years. The sample
calculation for Japan, family sedan with an 1.8 L engine and an
automatic transmission. Including all taxes and fees that are paid forthe original purchase only, the price of this new car is 2,132,545 yen.
The sample calculation uses the car catalog specified fuel efficiency
for 10/15 mode driving (a standard urban driving sequence), but
you can easily measure the fuel efficiency of a car yourself by filling
the gas tank, measuring the distance until the next refueling, andthen recording how much gas is needed for the refueling: divide
distance traveled by fuel needed to refill the tank (km/L). The fuelMoral Games for Teaching Bioethics

77

efficiency you measure will probably be less than the value listed in
the car catalog. Worksheet I shows the annual costs for using thiscar.
EXAMPLE - WORKSHEET I
Item
Purchase of 1800 cc
family sedan

Calculation

Annual basis2921292,132,545 Yen/7.3 years

Maintenance andparts, yen

30,000Road tax, yen

35,000Inspection (shaken),
yen

41407

Insurance, yen

80,267 (1)Parking, yen

60000

Total fixed costs, yen

538803Distance driven, km

10,000 (2)Annual fixed cost,yen/km538803 yen/10000 km

54

Fuel efficiency, km/
L

16

Fuel price, yen/L95

Fuel cost, yen/km

95 yen/L x (10000 km/16 km/L) 6

Total cost, yen/km

54 + 6 yen/km

60

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Game 27: Drawing or producing Art
Purpose: Values clarification; Self-expression
Class size: No limit except physical constraints of space
Time needed: 30 minutes
Interactive unit size: Individuals then whole class
Description
Students are asked to draw a picture presenting an ethical dilemma.
The students can also be given the task of drawing a series of pictures,or a cartoon to describe the situation. The art work produced can bedisplayed in the class room or institution to stimulate discussion of
the moral dilemmas.
Teacher Background
Everyone has different talents. For artistic development some students
will thrive at drawing pictures, or a series of pictures, rather thanbeing asked to write a story or to talk about a story.
A variation would be for the students to observe a photograph or
drawing and make a story from that picture. It could be useful toshow such an example before students make their own.
There will be different levels of ability, but it is important like anyother activity that no student is ridiculed for their drawing, or story.
The ability of everyone will improve with experience.
There are many art techniques that can be used besides drawing,
including taking photographs, making a collage from different
photographs or magazine cuttings, sculpture or video production.
ExamplesQ1)

Ask the students to draw their definition of the word "nature".
After the drawing ask the students to explain their picture
and then have others ask questions about it.

Q2)

Ask the students to draw their definition of the word "life".

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Ask other students to ask questions about the art to the artist,and have the artist reply.
Q3)

Draw a picture representing your last visit to a hospital.

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Game 28: Low hanging fruit
Purpose: Values clarification; Listening to others; Setting targets
Class size: Divide larger class into groups of 20 persons maximum
Time needed: 30 minutes
Interactive unit size: Small groups of 10-20 persons
Description
Explain to students the aim of the exercise: a) to identify which
activities and services which will be easier to start and which will beharder and b) to discuss some of the barriers and opportunities tostarting these activities and services. Ask people to draw a tree, which
has both high and low branches. Ask people to write on separate
cards or pieces of papers new activities or services that they thinkshould be introduced to solve the problem. Explain the idea of low
hanging fruit: 'low hanging' fruit is the easiest fruit to pick from thetree and links with the idea that some services and/or activities would
be easier to introduce and carry out than others. Fruit that is hanging
higher on the tree would be harder to pick. Ask students to place theactivities and services on the tree according to whether they thinkthey are 'low' or 'high' hanging fruit.
Ask students to discuss a) things that will get in the way of carrying
these out and b) opportunities that exist to begin these activities orservices. If after discussion they wish to move the fruit lower or higher
up the tree, let them do so. They can also draw another tree forcomparison of an alternative system to see how certain services andactivities may be low hanging under one system but high hanging
under another. Ask one of the students to present a summary of thetree and encourage others to ask questions and make any comments
or suggestions. If the tree has been drawn on something that cannot
be kept, for example the ground, it is useful for someone, when it isfinished, to make a photograph of it (or make a copy of it onto a pieceof paper) for future reference.

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Teacher BackgroundLow Hanging Fruit is a tool that involves drawing a tree and its fruits.
The tree represents the project or programme. The fruits of the tree
represent different activities or services. If the fruits are 'low hanging'
they will be easier to carry out. If they are 'high hanging' they will beharder to carry out. It is useful for summarizing the responses ofsystems to problems under different ethical conditions. It is also usefulfor project and programme planning. It can be used to discuss why
certain activities or services would be easier than others to introduce
or carry out, and to discuss both barriers and opportunities to carryingout or introducing new activities or services. Ensure that people aregiving the opportunities to discuss both barriers and opportunities
before placing their cards on the tree.
ExamplesQ1)

Discuss ways that people can travel to work, and ways toreduce the environmental crisis.

Q2)

Discuss ways to reduce the risks of suffering from diabetes.

Q3)

If and when gene therapy becomes effective and safe, forwhat conditions should we allow it? Should it be used tocure a disease, enhance our immune system, or to make ourbodies stronger? Put the more acceptable options as low fruit
and the least acceptable as high hanging fruit.

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Game 29: Problem tree
Purpose: Linkage analysis; Problem analysis
Class size: <50
Time needed: 30 minutes
Interactive unit size: Small groups
Description
Explain the purpose of the tool and ask students to identify a problem.
This may have arisen from using a previous tool. Make a large drawingof the trunk of a tree and draw or write the problem on the trunk.
Encourage the students to identify all the main causes of the problem
and draw these along large roots of the tree, indicating that they are'root' problems. Select one of the main causes and ask "why do you
think this happens?" This question will help students identify the"secondary" causes. Draw or write the "secondary" causes as smallroots coming off the larger root of the tree. Repeat the process foreach of the other main causes.

Next encourage the students to identify the main effects of the problem.
Ask them to write each effect as large branches of the tree. Select oneof the main effects. Ask the students "why do you think this happens?"
to encourage them to identify the "secondary" effects. Ask them towrite the "secondary" effects as small branches coming off the larger
branch of the tree. Repeat the process for the other main effects. Whencompleted, discuss what the problem tree shows. For example, how
do the causes and effects relate to each other? What are the root
causes of the problem? Students can also turn the Problem tree into asolution/objective tree.

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Teacher Background
This tool involves students using a drawing of the trunk, roots andbranches of a tree to identify a problem, and the causes and effects ofthe problem. Using the problem tree helps to provide a visual way tolook closely at problems and to identify the main causes and effectsof the problem. The tree can also identify the issues that lie behindthe main causes and effects, and inside small groups there can be
active discussion of these. Writing comments onto the tree is an easy
way to visualise the different ideas people have. It can begin to identify
what can be done to address the causes and reduce the effects.
For each cause and effect, the teacher (or group leader) should keep
asking the students "But why does this happen?" until they have runout of ideas. This will help them to identify all of the issues involved,
not just the main ones.
ExamplesQ1)

An example problem is the non-acceptance of homosexuality.
A variety of root problems could be identified and written
on the roots, e.g. family pressure, pressure from community,
lifestyle, culture, tradition, religion, norms, laws, etc. There
could also be a variety of effects in the branches, e.g.
criminality, suicide, prostitution, depression, drug addiction,
advocacy of gay/lesbian rights, etc.

Q2)

Every person of any profession has their personal role in a
family to be a father, mother, spouse, and child, in addition
to their professional roles. Should we respect the healthworker's autonomy to take a break from intensive work tofight a disease like SARS? Do you expect health care workers
to die for protecting the public health? What are some ethicalissues of quarantine?

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Game 30: Problem wall and solution tree
Purpose: Values clarification; Listening to others; Problem solving
Class size: No limit except physical constraints of space
Time needed: 20-30 minutes
Interactive unit size: Groups of 20 in maximum size
Description
Cover a wall with a paper and title one half of it "problem wall" andthe other half "solution tree". Draw a large tree on this side and title
it "solution tree". Problem walls and solution trees can work wellwith large groups of people in public places, or else with small groups
from 5-10 persons. Agree on a topic. Cut up lots of pieces of paper,with at least different colours and/or shapes for problems andsolutions. Put these in separate piles. Ask students to write problems
onto the papers and stick the papers onto the wall (the papers could
be sticky, you could use glue or tape, or the wall could be pre-sprayedwith adhesive spray so that papers will stick on it). The papers willneed to be moved into groups later, so the method of attachment
should not be permanent. Ask students to group similar problems on
the wall.
Next ask people to consider these problem stickers and think ofsolutions to them. Invite people to write solutions on separate piecesof paper and stick these on the solution tree. Group any solutions
that show similar solutions. If this tool is being used in a workshop
setting, the class can agree which solutions would be easy to do andwhich solutions would be difficult to do alone. The teacher or
rapporteur should summarise the main points of the discussion.

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Teacher Background
Using a problem wall and solution tree can help to identify and discussproblems related to a particular topic. The students can group together
similar problems that may have the same solution, then identify anddiscuss possible solutions for the problems. These walls are very easy
to set up and can be left for students to complete anonymously. The
students can be given several days to add to the wall to make themthink more deeply and save class time for interaction. They can also
be left in places where people congregate and have a little time tospare. Clear instructions left by the problem wall and solution tree
will help people to do the exercise themselves.
ExamplesQ1)

For example, 'What do you think of our health services?'.
Put this title at the top of the wall. Have clear instructions
spoken and/or written, and let ideas accumulate.

Q2)

In some countries only married women who already havechildren are allowed to be surrogates. Why do you think that
law was made? Think about how to make policy to regulate
access to surrogate mothers, and other options to treat
infertility?

Q3)

How do you define vulnerability? Who is vulnerable? To
what? What can we do to overcome vulnerability?

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Game 31: Trust game
Purpose: Listening to others; Trust building
Class size: 20 students
Time needed: 20 minutes
Interactive unit size: Circles of 10-20 students.
Description
Ask students to sit round in a circle facing each other. Explain to
students that this is a serious exercise about trust. Ask students tothink of a secret that they have which they would not want anyone
else to know. Ask them to write this down on a small piece of paper,
fold it up and not show it to anyone. Now ask students to pass theirpiece of paper with the secret in it to the person to their left, but not
to look at it. Ask each person around the circle how it feels to havetheir secret in someone else's hand. Now ask each person how inturn how it feels to have someone else's secret in their possession.
You can record some of these responses on a flip chart. Now ask
students to give back the pieces of paper with the secret on them tothe person the secret belongs to. Once this is done, tell students thatthey can all destroy their pieces of paper and relax! No-one has toshare their secret.
Debrief students by asking them: What does this tell us about
confidentiality? What kind of things might people share with us,which should be kept confidential? What rules should we have about
confidentiality in different circumstances?
Teacher Background
This exercise helps people to understand issues of confidentiality. It
also helps people to gain trust in each other. Remind students thattrust is something you do, not something you have. You have to earn
and keep earning trust; and it can be taken away at any time if you
break someone's trust. We all like to think that we are trustworthy.
But people are unlikely to automatically trust you just because you
are a doctor or some other professional. Whoever you are, trust has

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to be built and maintained. The point of this game is not for students
to share their secrets. If some do, that is up to them, but no-one should
feel pressured in any way to do so.

ExamplesThe students can share anything they feel is secret, whether real or
hypothetical. If it is imaginarinary then it could be related to a health
topic, e.g. genetic screening or being carrier of a disease for example.

88Moral Games for Teaching Bioethics

Game 32: Risk game
Purpose: Risk assessment and balancing
Class size: <50
Time needed: 10 minutes
Interactive unit size: Ideally 30 persons but manageable with larger
Description
Explain the purpose of the tool to students. Before the activity, makea list of about 15 true and false ways that something can happen, e.g.
that a gene can be inherited, or HIV can be transmitted. Examples
might include "having sex without a condom" or "sharing a cup witha person living with HIV/AIDS". Draw or write each one on a
separate piece of card. Draw a line on the ground. Explain to thestudents that this is a risk line. One end is "no risk of HIV infection"and the other is "high risk of HIV infection".
Ask for a volunteer. Give them one of the cards and ask them to readit out. Ask them to place the card on the line according to the level ofrisk they think is involved in the behaviour. Ask the volunteer toexplain their decision. Encourage the other students to say if theyagree or not. Explain to students the true level of risk and why it isthat level. If they do not agree, have them place a card with a question
mark (?) next to the doubtful card. Repeat the activity until all of thecards have been placed on the risk line. Return to any cards associatedwith a card with a question mark, or cards that someone says are
now put in the wrong place on the line.
Give students information about the true level of risk involved in the
behaviour and why it is that level. When the activity is complete,encourage the students to discuss what the Risk game has shown.
For example, were there any surprises, such as behaviours thatstudents thought were low risk that are actually high risk? What
were the main areas of disagreement? What affect does false
information have on people's attitudes and behaviours about issues?
What does the line show about the level of risk in people's real lives?
What action could be taken to reduce people's level of risk?

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Teacher Background
This example involves students standing in different places along aline to show the levels of risk involved in behaviours relating to theissue. It can be used for various risk events, such as environmental or
health risks. Using the risk game helps to explore issues about
behaviour and risk, and understand people's knowledge and attitudes
about levels of risk. It can help identify areas of risky behaviour thatmight be priorities for future action. The risk game is particularly
useful for raising awareness about how to prevent adverse eventsfrom happening, especially among the general community. It canalso be used to focus on levels of risk faced by specific groups, such as
those in certain environments, occupations or with hereditarydiseases.
Students may be anxious about risk behaviour they have had in thepast. Allow time for discussion and questions, and support those who
realize they have put themselves in risk in the past. The game canprovide important opportunities to share accurate information about
risk. If a student puts a card in the wrong place the teacher should
firstly encourage them to talk about their decision. But, you should
also give them the correct information, in a supportiveway.
Examples on a line no risk to highest risk
Q1)

The cards relating to risk to be infected with HIV/AIDS could
include: sharing cutlery, kissing, sweat, saliva, being faithful
to your sexual partner, blood transfusion, sex without acondom, mother to child transmission, tears, sharing ahandkerchief, using the same clothes, for example.

Q2)

The risk of a heart attack, could include cards such as: eating

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too much sugar, eating too much salt, constipation, genetic
disease, fast driving, air pollution, noise, family history,
viruses, for example.

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Game 33: Mapping stigma
Purpose: Increase observation powers; Understanding discrimination
Class size: <50
Time needed: 60 minutes
Interactive unit size: Field work can be done in pairs or threesomes
Description
This is a field work exercise that can be conducted on a campus or in
the broader community. The class can be divided into pairs, or groupsof three, with individuals of mixed gender and physicalcharacteristics. First discuss in class what stigma is. We can say thatstigma is an attribute that singles out an individual or a specific groupof individuals as different. They are regarded in a negative andjudgmental way because they possess that attribute. It can lead todiscrimination, and the exercise can also map discrimination. Discuss
what type of stigma will be examined, e.g. stigma related to gender,
body size, skin colour, being HIV positive.
In pairs or threes, students walk through the campus, community or
location looking for places where stigma is evident or discrimination
occurs. Students can also map stigma by looking at a map that they
drew of the location and discussing in small groups where it occurs.
Students can then walk around the venue in pairs or threes, witheach observing the reaction of others to them or the member who
may be the focus of unusual attention. They could compare the waythat others interact with each member of the team in the same
situation to observe human behavior to them. Once back in the classthe teams can write up and present their results to the class.
Comparisons can be made to the results from other teams.
Teacher Background
Mapping Stigma is a discussion that explores stigma faced by people
in the community. Mapping Stigma is useful to identify different
contexts in which stigma occurs, and to explore the reasons for stigma
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effects of stigma on different people. The results could be applied
beyond a descriptive study to identify strategies for reducing stigma.
The teacher can debrief students by asking students about the reasonsfor stigma in different places, the effects of it and strategies for reducing
it. The students should be emotionally prepared for the exercise, notingthat discrimination and stigma are important social concerns.

ExamplesQ1)

Would you like to know your genes?

Q2)

Can you get a genetic test in your country? If yes, for what
diseases? Do any of these have social stigma attached?

Q3)

Think about what characters are determined by genetics andwhich are determined by the environment. How do people
differentiate about these?

Q4)

What is it like to sit in a wheelchair and watch the way people
look at you?

Q5)

Find the institutes in your area doing genetic engineering. In
which areas are they researching and why?

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Game 34: Mapping social networks
Purpose: Mapping society; Understanding human relationships
Class size: <50
Time needed: 30 minutes
Interactive unit size: Small group work, 3-5 persons.
Description
Individuals and small groups can make social network maps. Different
groups can make social network maps for different people. First theyneed to agree on which person to map, and then on any limits to therelationships to map. For example, the relationships of the person
drawn at the centre of the map may be limited to human beings, or
include ecosystems and the environment, or just sentient animals.
The group should then draw other people (or items) with whom they
have important relationships on the map. Use lines and arrows to
indicate relationships. Use different coloured lines, or lines made fromdifferent objects, to show different kinds of relationships, e.g., 'helping'
relationships, friendships, business relationships, ecologicalrelationships, and so on. Use distance between people and the central
object or person on the map to show the importance of the relationship- the closer to the person, the more important. Discuss what is shownon the map, and let the whole class compare the different maps madein each small group.
Teacher Background
Social network maps are diagrams that show relationships that areimportant to an object or normally a person (or family or peer group).
Social network maps are useful to explore relationships within acommunity, and to understand what is important about these different
relationships. For example, do these relationships provide practicalhelp, emotional support, or information? The maps can help
understand how people communicate within a community, and how
information is shared (or not shared). They help explore how different
people (or groups) are involved in decision-making. The groups can
explore the benefits and risks of different relationships. The maps

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can help students understand divisions and isolation within acommunity. For example, are there some people who have very few
relationships

ExamplesQ1.

If you visit a doctor do you make treatment decisions on yourown or in discussion with other family members, and thedoctor? Who else affects your treatment decisions?

Q2.

Should there be a consensus regarding truth telling by
medical professionals to patients? Should there be universal
standards (applicable to all countries) for truth telling? Whoshould decide these standards? Who could administer it?
What social networks are involved?

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Game 35: Health Journey
Purpose: Time analysis
Class size: <50
Time needed: 30 minutes
Interactive unit size: 1-2 persons
Description
Health Journeys are best if first drawn by individuals or in pairs.
Explain to students the purpose of the tool. Ask the students to think
about the different health issues experienced by a person who is sick,or to think about their own health issues. Ask the students to choosea specific period of time. Examples might include "a person's healthjourney in the last month" or "my health journey since being tested
positive for the genetic or infectious disease." Encourage the students
to draw the health journey of the person. As the journey progresses
the line goes up when things getter better and the line goes downwhen things get worse. Indicate on the line what made things betteror worse at each point. Discuss the health issues that the person may
experience during the chosen period of time. These include physical,
mental and social health issues, and can be linked to discussions ofquality of life (QOL). Show the health issues on the health journeyline.
Encourage the students to identify gaps in available treatment andsupport. Ask students to present their health journeys, explaining
what has helped the person, what has not, and how the health journey
could be made easier. The class can summarise the major problems
that people face, and these could be fed into a problem tree or anotherexercise.

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Teacher Background
This tool involves drawing the story of a person's health over a periodof time. It involves identifying and indicating the person's health "ups"and "downs", identifying the treatment and support that they need,
where it was lacking, and discussing where they might get it. Usinga health journey helps to provide a non-threatening way to discuss
sensitive issues about physical and mental health, and how to measure
QOL. The process can help identify knowledge and beliefs about thedisease. It can help identify common health problems faced by people
living with a disease, or likely problems that may arise in future
pandemics. It can help identify the treatment and support needs ofcommunity members, what treatment and support is available topeople living with a risk or actual disease. It can identify barriers toaccessing treatment and support and how these barriers might beovercome.
If people don't want to draw their own health journeys, ask them tomake one up by thinking of the health journey of different people
they are familiar with or have heard about. Encourage students tothink about informal treatment and support e.g. traditional medicine
or psycho-social support from friends as well as 'modern' medicine.
Students could draw health journeys for different people - for example,
a young man, a young woman, a child -this helps to explore thedifferences in health and treatment issues faced by different people
Examples
Q1)

Make a map of the stages in the progress of a disease. The
map might include comments like: Person ---' Clinic ' referral
to Hospital ' counseling, talking to friends, tests, loss of job,financial problems, death, recovery…The relations to otherpersons can be added in how they affect the health journeyof the person, or as influences on the line.

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Game 36: Negotiation cards
Purpose: Values clarification; Clarification of reasoning
Class size: <50 maximum
Time needed: 20 minutes
Interactive unit size: Ideally in small groups of 10-15 persons
Description
Make 20 large playing cards. Make a list of 10 "typical" community
members. Make two playing cards for each "typical" person, using
pictures and symbols to show what they are like (e.g. their gender,
age, disease status, profession, social status, home). Divide the cards
into two packs of 10 cards, so that each pack contains a full set of"typical" people. Mix the cards up, so that they are in a different
order in the two packs. Put the two packs side by side and turn them
face down, so that you cannot see the drawings. Turn over the top
card of each pack and show the students the "typical" community
members. Ask the students to imagine a situation involving those
two people. Encourage them to think about which community
member would have the most power and why. Ask the students to
identify the skills and strategies that the person with less power would
need to protect themselves in the situation, e.g. a medical consultation,
making a contract, becoming friends, sexual relationships, etc. Thenask them to do the same for the person with more power.
When that discussion is complete for that case, put those cards on
the bottom of the packs. Then turn over two new cards and repeat
the activity. Keep repeating the activity until all of the cards havebeen discussed. When the activity is complete, encourage the students
to discuss what the negotiation card game has shown. For example,
what types of people tend to have more power in which type ofsituations? Why is that? What type of skills and strategies are themost important for people with less power? What could be done toimprove those skills and strategies?

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Teacher Background
This tool involves using cards (with drawings of "typical" people) to
identify the different types of skills and strategies that are needed
during different encounters or situations. Using the Negotiation card
game helps to explore power within situations and associated withdifferent professions. Identify the type of skills and strategies thatpeople need in each situation and what the people already have, sothat they can consider what skills and strategies need to be improved
and how that could be done. If a situation is unimaginable between
the two people shown on the cards, put one of them at the bottom of
its pack and turn a new one over to replace it. This activity is a good
opportunity to discuss situations that people often deny or ignore,
for example, sex between adults and children or between people ofthe same sex. If this happens, encourage students to focus on thereality of such situations, rather than judge the people involved.
ExamplesQ1)

The cards could include a mix of many different ages, gender,
and professions. Think about the specific situations that are
relevant to the topic of the lecture or course.

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Game 37: Head or heart
Purpose: Values clarification; Clarification of reasoning
Class size: 50-100 maximum
Time needed: 10 minutes
Interactive unit size: Ideally 30 persons but manageable with larger
Description
Give a concrete case and describe four different options as answers.
Ask everyone to choose one and stand in groups according to thedecision. Then select several volunteers from each group to explain
why they chose the position. Next you can ask whether people usedtheir head or the heart in making the decision, by placing their left
hand on their head if they used their head (a rational reason), andtheir right hand on their heart if they used their heart (an emotional
reason). Some people will have used both.
Then you can ask them to walk into the appropriate place on a triangle
drawn on the floor with three apices according to whether they usedrational, emotional or intuitive decision making. This can lead to a
discussion of the way that we make decisions. Different cases can be
discussed. Often people use a mix of modes of decision making.
Teacher Background
This game can help people to relate the decisions that they make inresponse to a moral dilemma to different ethical theories. We all use
a mixture of modes of decision making, yet some ethical theories only
emphasize rationality over emotions or relations between people.
ExamplesQ1.

Should genetic testing be performed when no treatment isavailable? Consider the possible options: a. All genetic tests
are useful information and should be told. b. Genetic test
results should not be told to patients but only used forresearch. c. Genetic test results should be shared to healthinsurance companies. d. Genetic test results should only be

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told to patients if they can do something to prevent thedisease.

Q2.

Should genetic testing be used for children? Why? Consider
the possible options: a. Genetic tests should be done on 5
year old children but not told to them. b. 10 year old children
can do genetic tests and told of any results. c. 11 year oldchildren can be tested and informed of therapeutically useful
results. d. genetic tests should only be done on 18 year olds
when they are adults and can be told the full results. Followup: At what stage in life would you undergo genetic testing?
Imagine if therapy or diet and lifestyle change in childhood
can affect the health outcomes?

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Game 38: Future's wheels
Purpose: Planning for the future
Class size: No limit except physical constraints of space
Time needed: 20 minutes
Interactive unit size: Small groups
Description
Explain that this activity will be to draw a set of circles, or wheels, ona piece of paper, radiating out from a central event. After considering
the central event think of a consequence of the situation, and thenwrite this consequence into a new circle. Then think of a consequenceof that new situation, and repeat the exercise to form a set of radiating
circles, or wheels, to see how the future rolls out from a central event.
This can help consider the causes and consequences of problems andsituations that are often unclear. When done in a small group thegroup can work for building a consensus about all the possible, or
probably, consequences. It can also be useful for planning essays orcompositions on causes and effects of problems or situations.
The central problem under discussion should have identifiable causes,
which consequently roll out into effects. Students should brainstorm
in either groups or as a class afterwards on the root causes and steadily
identify more causes that lead into the central problem. In the same
way they should map out the effects that emanate from the central
problem. Pupils should draw arrows to show the relationships. Afterthe exercise is completed more time may be spent to discuss the future's
wheels with the whole class, and to summarise the activity by asking
students questions on the lessons they have learnt.
Teacher Background
Future's wheels can be used to consider the consequences of risky
behaviour. They also indicate the sense of the problem identified as arisky behaviour. Basically the problem wheel rolls into futureconsequences which roll into other negative and undesirable
situations. Similarly, the wheels of the causes of the problem being

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discussed seem to roll into the problem. This is a graphical presentationof the causes and the results of certain behaviours that can help
students visualising the future.
The advantages of future wheel's are it allows for participation of allwhether at group or class discussion level. The session moves quickly
and usually keeps the attention of learners. The future's wheels
diagram has a strong visual impact and can enhance understandingof concepts, as it provides a clear picture of the complex nature of
problems. Future's wheels require that the students should have someknowledge of the subject area before it can be used.
ExamplesDevelop future's wheels on the following topics:
Q1)

Drug and alcohol abuse by a 15 year old boy.

Q2)

Damage caused by a cyclone to a low lying deforested coastalarea.

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Game 39: Devil's advocate
Purpose: Values clarification; Listening to others; Strengthening moral
conviction
Class size: No limit except physical constraints of space
Time needed: 10 minutes
Interactive unit size: Pairs

Description
Devil's advocate is a form of role play in which one person tries as
hard as possible to convince a friend to give in to temptation. The
other person has to respond to all the devil's temptations by giving
the reasons why he or she does not want to give in to the temptation.
Students should identify temptations which they face in their lives(e.g. smoking, over-eating, sex, drinking, stealing, cutting down trees
carelessly). In pairs one student pretends to be a bad friend (thedevil) who is trying to make the other give in to the temptation. The
students should reverse roles after some time. The teacher shouldsummarise the activity by highlighting the reasons against giving into the temptation.
Teacher Background
Devil's advocacy is useful to promote critical thinking and problem
solving skills in pupils as they need to be aware of the arguments forboth sides of an issue since they exchange roles half way through the
advocacy. This helps students prepare for handling peer pressure
and temptation towards risky behavior. There is a danger that some
pupils might be convinced by the arguments in favour of the risky
behaviour if the technique is not well handled…

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ExamplesQ1)

In pairs, perform devil's advocate on the following examples:
Early marriage, Drug and substance abuse, premarital sex,
driving cars without seat belts. Discuss what are the strengths
and limitations of this method?

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Game 40: Field Visits/Educational Visits
Purpose: Observation powers
Class size: No limit except physical constraints of space
Time needed: Varies
Interactive unit size: Small groups of up to 10

Description
Field trips are lessons conducted outside the classroom with the aimof giving pupils first hand information and experiences on subject
matter under discussions. The trip is part of ongoing study andteachers' should prepare in advance activities for pupils to do at thesite. Students are given the chance to relate classroom work to theireveryday life. For example, a teacher may take his or her class to a
nearby pond to observe the life cycle of mosquitoes in science; or takestudents to a hospital when considering health education; or to a
nearby main road to observe road users in environmental behaviour
studies. Educational trips are outings made in order to consolidate
what is learnt in the classroom. The planning process can involve theclass in general discussion of how you would effectively plan andorganise a field/educational trip. In small groups discuss potential
aims and objectives well in advance, to prepare the field trip as partof a study unit. This should be after the teacher has made a preliminary
trip to determine the suitability of the place and resource persons (ifappropriate). Ensure that students have pens/pencils and paper fornotes, and ideally a prepared evaluation form and guide. Discuss inclass any precautionary measures to the students and agree upon atime schedule and activities to be done by students before the trip.
Ask class leaders to help you control the class.

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Teacher Background
The teacher may not need to do much at the site except monitor thesafety of the students, rather it is the responsibility of a resource person
to explain the ideas and processes to the pupils. These trips could
include visits to industrial sites, hospitals and other institutions. The
advantages of field trips and educational visits are that students gain
knowledge, skills, and attitudes by observing (using all their senses),and students can relate classroom ideas to the real world. It provides
students with an opportunity to carry out practical work in relation
to what they have learnt. Providing people with a variety of learning
styles helps them learn to more effectively. There are several
disadvantages, firstly that it can take considerable time at both thesite and in transport. It can require a lot of arrangements andorganization, and sometimes requires parental consent before younger
children can be taken out. There may also be economic costs, andincreased risk of unforeseen events.
ExamplesThere are many examples of field trips, and an assessment needs tobe made of objectives, alternatives and time beforehand. Experts canalso be invited into the classroom instead of taking all students on afield trip. In the past trips to the cinema were also popular, but inmany countries DVDs and Internet provide alternatives for students
to use video resources in their own time. Many of the moral games
can also be played at field sites, which may provide new stimulation
to assist learning outcomes.

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Game 41: Case Study
Purpose: Values clarification; Listening to others; Applying theory topractice
Class size: <50 students preferredTime needed: 20-30 minutes
Interactive unit size: Small groups
Description
Case studies work best with small groups of students. Case studies
may also be of organisations as well as people. Before the activity,
prepare a case study from real life. You can do this in several ways:
One way is to summarise oral life histories or write an account of areal life situation you are aware of. Explain why you are giving acase study to students. Ask a student to read out the case study.
Alternatively, if there are several case studies, divide students into
groups and ask each group to read through a different case study.
When this is done, encourage the students to discuss the case studies.
For example, what do the students feel about the situation in the casestudy? What are the main issues in the case study? What helped thesituation? What caused problems? How does this relate to their own
situation? Would students have acted the same way in this situation?
What options are available to deal with the situation? What othersupport would have improved the situation?
Teacher BackgroundA case study is a true story about a real situation or person. Sometimes,
the actual person featured in the case study tells the story themselves.
Using a case study helps to start discussion by explaining how
something affects the lives of real people, communities ororganizations. The students can reflect on what lessons can be learnt
from other peoples experiences. It can also provide an opportunity
for people to reflect and talk about their own situations. Always gain
permission to use the case study from the person or organisation that
it is about. They must be informed about how the case study will be
used and agree to this. Sometimes, the person in the case study tells

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the story herself or himself. If a person tells their own story, it isimportant that they understand the possible consequences beforehand.
For example, students may say things, or ask questions, which theperson finds difficult or upsetting. Students may find it useful andhelpful to share their own personal experiences that are similar to
those illustrated by the case study. However, do not pressure people
to discuss personal issues if they do not want to, and it is safest if casestudies are not involving the personal experience of the class members.
Explain the advantages and disadvantages of using case study as ateaching method. Advantages of using a case study are that the casestudy technique serves as an effective substitute for reality. The learner
analyses and solves real - life challenges without suffering or going
through the consequences of failure. Working in groups enables eachpupil to participate actively and think through what they might do if
the problem or challenging situation occurred to them. Using casestudies are useful in developing critical thinking, problem solving anddecision making skills. The main limitations of case study are it cantake time and effort to develop the case study. There are often no
definite solutions to problems presented in case studies, which means
the facilitator ought to be skilled in handling case studies.
ExamplesQ1)

Develop a case study on a topic in a subject of your choice.99. http://www.unescobkk.org/fileadmin/user_upload/shs/Resources/ICcase.pdf

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Game 42: Desired Change Diagram
Purpose: Values clarification; Listening to others; Priority setting
Class size: <50 persons
Time needed: 10 minutes
Interactive unit size: Small groups of 3-8 persons
Description
Divide the class into small groups. It is sometimes useful to makesure that different views are well-represented, as people are likely tohave different ideas about what changes they would like. Agree on
the time-period to be discussed, for example, by the end of the school
year. Ask students to draw pictures showing important changes thatthey would like to see at the end of the time period. Discuss what isshown in the pictures. Looking at what people desire to change,
agree what the objectives of a project should be. A few weeks later
discuss the pictures again after a period of time to see which of thesechanges have happened, and evaluate them. Some people may
measure future landmarks in terms of events related to them, seasons,festivals, rather than months or years. You can also use the matrix tostart a discussion about what strategies will bring about the desiredchange. Students will usually identify some desired changes that are
not related to project activities. This helps show how relevant project
activities and objectives are to different people's priorities.
Teacher Background
A Desired Change Diagram is a picture that shows the changes thatpeople would like to see in the future. A Desired Change Matrix isuseful to identify different people's hopes for change in the future.
Students can see that different people have different ideas andexpectations of community action or project activities. The students
can keep the matrices and use them as a base- line about the situation
at the moment to evaluate the changes. This can be used in the future
to see if that change has been achieved or not. You can use them to
explore how well the objectives of a project or community initiative
match the priorities of different people.

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To focus on changes related to project activities, discuss project
objectives with students before starting, so that more time is spend in
the introduction.
ExamplesQ1)

Do you think GM food will be an appropriate method for
eradicating hunger and malnutrition from the world? Howelse can we eradicate hunger and malnutrition in an everincreasing global population? What can you do about this?
Make an action plan matrix.

Q2)

What is your ethical concern about air pollution? List out
advantages and disadvantages of oil in daily life? Please
collect data on how many houses, institutions, and industries
have set up solar water heaters. List ways and means you
can conserve the energy. Make an action plan matrix.

Q3)

Please consider how to conserve natural resources? Think ofways to conserve water, conserve energy, protect the soil,
and promote sustainable agriculture, and make an action
plan matrix.

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Game 43: Make a song or advertising jingle
Purpose: Promoting creativity; Listening to music
Class size: <50 persons
Time needed: 60 minutes or moreInteractive unit size: Small groups of 2-4 persons

Description
Where possible ask pupils to compose songs on specific issues, though
they can choose the topic. It can help to identify songs from the local
settings e.g. traditional songs, songs by bands or choirs. Listen to thesongs together with the pupils. Ask questions such as: What is thenature of the song? Is it well known? Who are the target audience?
What are the messages? Are they culturally appropriate? - Are themessages contributing to the understanding of the subject matter athand? - What impact would the message(s) in the song have on the
youth? Then ask students to make their own song (or poem).
Teacher Background
There are many music synthesizing software used to compose music
available nowadays. It does need creativity to come up with a songor a jingle, but in many modern schools all students will have made amusical composition as part of their education. All students listen tosome music and it can reach them in different ways to lectures orvideos. Songs and jingles provide teachers with ready-made messages
which can be discussed with pupils to determine the nature of themessages and their appropriateness. Using songs and jingles has beenfound to be a powerful means of reaching out to some students. Songsand jingles provide knowledge, skills and attitudes to pupils in an
enjoyable manner, if they like the type of music. The messages can befurther discussed with their peers after class; thus allowing for more
student participation.

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Examples
Q1)
Q2)

Listen to any popular song and attempt to answer the above
questions on it.
Pick an ethical issue in society and write a song to describe
the fate of a person facing the ethical dilemma.

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Online resources and references
There are many examples of bioethics materials that can help students(and teachers) prepare for the games. There are also somecommercially available books on games to play in class to encourage
student participation in learning.
The International Bioethics Education Network was initiated in 2004,
and the creation of networks linking research into policy is acornerstone of efforts in all levels, from local to regional. List serves
network persons, and some function in English for educators andstudents, and persons from a wide range of countries have tried theseresources, and contributed to this project over the past years.
Internet site - http://www.unescobkk.org/index.php?id=2508
Internet site - http://eubios.info/betext.htm
Education listserve - http://groups.yahoo.com/group/
Bioethicseducation/
Student
listserve
http://groups.yahoo.com/group/
Bioethics_for_students/
A growing compilation of open access teaching materials and different
languages following the 2006 resources from the UNESCO Bangkok
Bioethics Education project in, Macer, DRJ., ed. A Cross-Cultural
Introduction to Bioethics (Eubios Ethics Institute), is available on http://www.unescobkk.org/index.php?id=multilingual_material
or http://eubios.info/ccib.htm.
For further information, including:News in Bioethics and Biotechnology
http://eubios.info/NBB.htm
UNESCO Ethics home page
http://www.unesco.org/ethics
UNESCO Bangkok SHS home page, and UNESCO Asia-Pacific Schoolof Ethics
http://www.unescobkk.org/index.php?id=1313
Teaching Guides, References, and Internet links are in:
http://eubios.info/BetCD/BetbkTR.doc

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Global Ethics Observatory www.unesco.org/shs/ethics/geobs
Some Internet sites offer their own exclusive bioethics resources, butthese are not always openly available, e.g. BioEthics Education Project(BEEP), Graduate School of Education, University of Bristol, UK.
http://www.beep.ac.uk/content/index.php
Jesuit Distance Education Network, Center for Online Bioethics
Education
http://www.ajcunet.edu/distanceeducation.aspx?bid=543
The Philosophers' Magazine (TPM) Games to play on the Internetwith interactive software www.philosophersnet.com/games/
International HIV/AIDS Alliance, 100 ways to energise groups,
Games to use in workshops, meetings and the community
http://www.aidsalliance.org/graphics/secretariat/publications/ene0502_Energiser_guide_eng.pdf
Informed Consent: Case Studies http://medlaw.haifa.ac.il/index/
main/4/informed.pdf
Teaching Ethics in Psychiatry: Case vignettes
http://medlaw.haifa.ac.il/index/main/4/psy.pdf
Reproductive Health: Case Studies with Ethical Commentary
http://medlaw.haifa.ac.il/index/main/4/ReproductiveHealth.pdf
Psychiatric Ethics and Rights of Persons with Disabilities in Institutions
and the Community
http://medlaw.haifa.ac.il/index/main/4/psychethicsperlin.pdf
Classroom Communication - Use of Emotional Intelligence and NonVerbal Communication in Ethics Education at Medical Schools
http://medlaw.haifa.ac.il/keidar1.pdf

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References
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Beauchamp, T.L. and Childress, J.F. 1994. Principles of Biomedical
Ethics. Fourth Edition. New York: Oxford University Press.
Cohen R, Singer PA, Rothman AI, and Robb A. (1991) Assessing
competency to address ethical issues in medicine. Academic Medicine
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Conner, L. 2004. Assessing learning about social and ethical issues ina biology class. School Science Review, Vol. 86, No.315, 45-51.
Crain, W.C. 1985. Theories of Development. New York: Prentice-Hall.
Doyal L, Hurwitz B, and Yudkin J.S. 1987. Teaching medical ethics
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Gilligan, Carol. 1993. In A Different Voice: Psychological Theory and
Women's Development. Cambridge, MA.: Harvard University Press..
Hebert P, Meslin EM, Dunn EV, Byrne N, and Reid SR. 1990.
Evaluating ethical sensitivity in medical students: using vignettes as
an instrument. Journal of Medical Ethics Vol. 16, pp. 141-145.
Kohlberg, L. 1969. Stage and sequence: the cognitive-developmental
approach to socialization. Chicago: Rand-McNally.
Macer, Darryl R.J. 1998. Bioethics is Love of Life: An Alternative Textbook.
Christchurch, N.Z.: Eubios Ethics Institute.
Macer, DRJ. 2002a. The next challenge is to map the human mind,
Nature Vol. 420, pp. 121.
Macer, D.R.J., chief editor, 2002b. UNESCO, IUBS, Eubios Living
Bioethics Dictionary. Christchurch, N.Z.: Eubios Ethics Institute. Online since 2002: http://www.eubios.info/biodict.htm
Macer, D.R.J., ed., 2006. A Cross-Cultural Introduction to Bioethics
Christchurch, N.Z.: Eubios Ethics Institute.
Macer, DRJ. 2008. International Approaches to Evaluation of
Bioethics Education. In Macer, DRJ, ed., Asia-Pacific Perspectives on

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Bioethics Education. Bangkok: UNESCO.
Maekawa, F. and Macer, DRJ. 2005 How Japanese students reason
about agricultural biotechnology. Science and Engineering Ethics, Vol.
10, No. 4, pp. 705-716.
Miles SH, Bannick-Mohrland S, and Lurie N. 1990. Advancetreatment planning discussions with nursing home residents: pilot
experience with simulated interviews. Journal of Clinical Ethics Vol. 2,
pp. 108-112.
Nagaoka, S. 2008. Teaching Compassion. In Macer, DRJ, ed., AsiaPacific Perspectives on Bioethics Education. Bangkok: UNESCO.
Ratcliffe, M. and Grace, M. 2003. Science for Citizenship: Teaching SocioScientific Issues. Maidenhead: Open University Press.
Self, D., Wolkinsky, F.D. and Baldwin, D.C. 1989. The effect of teaching
medical ethics on medical students' moral reasoning, Academic
Medicine Vol. 64, pp. 755-9.
Siegler M, Rezler A.G. And Connell K.J. 1982. Using Simulated Case
Studies To Evaluate A Clinical Ethics Course for Junior Students.
Journal of Medical Education Vol. 57, pp. 380-385.
Singer PA, Cohen R, Robb A, and Rothman AI. 1993. The ethics
objective structured clinical examination (OSCE). Journal of Generaland Internal Medicine. Vol. 8, pp. 23-8.
Toulmin, S., Rieke, R. and Janik, A. 1984. An Introduction to Reasoning.
Second edition. New York: Macmillan.
UNESCO. 1997. Universal Declaration on the Protection of the Human
Genome and Human Rights.
UNESCO. 2005. Universal Declaration on Bioethics and Human Rights.

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Index by games
Game 1: Donuts

20

Game 2: How do you think?

22Game 3: Agree or disagree

25Game 4: Moral continuum (line-up)

27

Game 5: Talk in pairs

29Game 6: Consensus Pairs

31

Game 7: From pairs into groups

33

Game 8: Small groups

35

Game 9: Card sorting37

Game 10: Moral Continuum (using cards)

39

Game 11: Debates

42

Game 12: Whispers

44

Game 13: Who am I?

46

Game 14: Hot seat48

Game 15: Concept blocks

51

Game 16: Bus stops

54

Game 17: Thought shower

56

Game 18: Postboxes

58

Game 19: Brainstorming

60

Game 20: Drawing a Relationships Web

62

Game 21: Courage to change

64Game 22: Fish tanks

66

Game 23: Role plays

68

Game 24: Make dramas

71Game 25: Pass the parcel

73

Game 26: Mathematics Exercises

75

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Moral Games for Teaching Bioethics

Game 27: Drawing or producing Art

78

Game 28: Low hanging fruit

80

Game 29: Problem tree82

Game 30: Problem wall and solution tree

84

Game 31: Trust game86

Game 32: Risk game

88

Game 33: Mapping stigma

91

Game 34: Mapping social networks

93

Game 35: Health Journey95

Game 36: Negotiation cards

97

Game 37: Head or heart99

Game 38: Future's wheels

101

Game 39: Devil's advocate

103

Game 40: Field Visits/Educational Visits105

Game 41: Case Study

107

Game 42: Desired Change Diagram

109

Game 43: Make a song or advertising jingle

111

Moral Games for Teaching Bioethics

119

Index by example topics
This index includes question numbers (the first numeral indicates themoral game, followed by the Question number). Many questions
can be used well in different games to those they are listed.
Abortion: 23Q2

70

Agriculture: 42Q3

110

AIDS see HIV
Air pollution: 42Q2

110

Alzheimer's disease: 23Q3

70

Animal experiments: 1Q2; 18Q1

21; 59

Animal rights: 1Q1; 12Q1

21; 45Autonomy: 8Q1; 34Q1

35-36; 94

Beauty: 21Q5

65

Birth control: 1Q3

21

Brain death: 11Q2; 24Q1
Cancer gene tests: 8Q2
Car use: 3Q3; 21Q1; 26Q1
Child Labour: 17Q3
Cloning: 10Q1, 12Q2;
reproductive human cloning: 4Q1
Consent: 23Q2; 37Q2
Conservation of resources: 21Q2; 24Q3; 42Q3
Cosmetics: 5Q3

43; 71
36
26; 65; 76-77
57
39-40; 45
2870; 100
65; 72; 110
30

Cost-Benefit analysis: 26Q1

76-77

Criminal responsibility: 5Q4; 11Q4

30; 43Diabetes: 28Q2
Diet: 32Q2
Disability: 33Q4

81
89-90
92

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Moral Games for Teaching Bioethics

Disaster: 38Q2
Discrimination: 33Q2; 33Q3
Doctor-patient communication: 9Q2; 27Q3; 29Q2;
34Q1; 36Q1
Drug safety testing: 18Q1
Drug use: 22Q3; 38Q1; 39Q1

102
92; 9238; 79; 83
94; 9859
67; 102; 104

Embryo status: 3Q2

26

Endangered animals: 22Q1

67

Energy choices: 6Q1; 21Q3; 42Q2

31-32; 65; 110

Enhancement: 19Q3; 21Q5; 23Q3; 28Q3

61; 65; 70; 81

Environmental crisis: 28Q1; 38Q2

81; 102

Ethicists: 13Q1

46-47

Euthanasia: 4Q2; 12Q1; 25Q1
Evolution of behaviour: 7Q3

28; 45; 74
34

Female infanticide: 7Q4 ; 14 Q1

34; 49

Food shortage: 1Q5; 42Q1

21; 110

Gender: 36Q1
Genetics and Intelligence: 2Q2; 11Q1
Genetic testing: 8Q2; 20Q2; 31Q1; 33Q1;
33Q2; 37Q1

98
23; 4336; 63; 86; 92
92; 99-100

Gene therapy: 28Q3

81

GMOs: 42Q1

110

Health costs: 7Q1; 27Q3; 30Q1

34; 79; 85

Health journey: 35Q1

96

Hepatitis transmission: 9Q3

38

HIV/AIDS, 20Q1;
discrimination: 11Q3;
transmission: 2Q1; 32Q1;
treatment, 7Q1

63
43
23; 8934

Moral Games for Teaching Bioethics

121

Homosexuality: 29Q1

83

Human rights: 3Q1

26

Huntington's disease: 20Q2

63

Infertility: 30Q2

85Intellectual property rights: 2Q3; 24Q3
Intelligence: 2Q2
Life: 27Q2

24; 72
23
78-79

Life sustaining treatment: 17Q1

57

Littering:17Q2

57

Memory: 23Q3

70

Mentally handicap: 23Q1

70

Nature: 27Q1

78

Nature conservation: 7Q2

34

Nature versus nurture:11Q1; 33Q3

43; 92

Nuclear power: 6Q1

31-32

Obesity: 28Q2

81

Organ trade: 19Q2

61

Organ transplants: 24Q1

71

Orphans: 9Q1

38

Poverty: 7Q2

34

Privacy: 2Q3; 31Q1
Psychological modification: 11Q4; 22Q4
Punishment: 23Q1
Risk: 21Q4; 32Q1; 32Q2; 39Q1

23; 31-32
43; 6770
65; 89; 89-90; 104

Quarantine: 29Q2

83

SARS: 29Q2

83

Sex selection: 1Q4

21

Smoking: 21Q6

65

122

Moral Games for Teaching Bioethics

Sports: 21Q4

65

Stem Cell Research: 10Q1

39

Stigma: 11Q3; 33Q4
Surrogacy: 5Q2; 24Q2; 30Q2

43; 9230; 71-72; 85

Sustainable Development: 15Q1

52

Traditional medicines: 24Q3

72

Transport (also see Cars): 28Q1

81

Truth telling: 6Q2; 14Q2; 22Q2; 25Q1;
34Q2; 37Q1
Unplanned pregnancy: 23Q2; 39Q1

32; 49-50; 67; 74
94; 99-100
70; 104

Values: 16Q1

55

Whitening creams: 5Q3

30

World improvement: 5Q1

30

Zoos: 19Q1; 22Q1

61; 67