Medical students will be called upon to make difficult moral decisions throughout their careers, so it is important for them to have some systematic education about moral reasoning. For over two-dozen years, the faculty of the Department of Medical Humanities at the Brody School of Medicine has experimented with various ways to teach the elements of moral reasoning without endorsing a particular philosophical or theological stance. We do discuss the important moral theories of utilitarianism, contractarianism, egalitarianism, and libertarianism in the medical students’ second year course within the context of access to health care, however. In their first year studies, we introduce methods of solving moral problems systematically that do not presuppose any grand theory.

Moral or practical reasoning entails defending judgments in a certain way. The goal in a moral justification is to be clear, to use all relevant information, and to give cogent reasons for one’s views. It also requires that one should not be egoistic, but that one should apply the same reasons to all people, even oneself. This consistency requirement, which is expressed by the Golden Rule, implies that one should be willing to apply similar considerations universally and impartially. Furthermore, one must always assess one's reasons critically in relation to other relevant considerations such as legal, social, and religious traditions or other stable views about how one should act or what kind of person one should be. Although fallible and subject to improvement, these moral and social traditions uphold the preserved wisdom about how to understand and rank values. Moral reasoning also includes a willingness to be sensitive to moral conflicts and problems, to beliefs about what is or is not compassionate, and to the feelings, preferences, and rights of others.

When teaching and doing case consultations, it may be useful to organize discussions on moral issues around the following questions:

1. What is the problem?

2. Are there other or better ways to view it?

3. What data are relevant? Are you using the best information? How good is your data?

4. What are the options?

5. What are the likely consequences of the different options?

6. What rights, duties, values, or legal considerations are important? If there is a conflict what is the weightiest consideration?

7. What are the weaknesses of your view?

8. How would you want to be treated in these circumstances?

For students with heavy science backgrounds, it is helpful to draw similarities between moral and scientific reasoning. Just as scientific judgments are scientific because they are defended in a certain way, moral judgments are moral because they are defended in a certain way. Each method of reasoning requires consistency with logical norms and the best empirical data and theories. Each expresses very high standards, and none can claim with certainty that all of its goals have been reached. Neither method can be certain, for example that all relevant data has been considered and weighed appropriately.

Moral and scientific reasoning methods are also both “self-correcting” since reasoning must be reconsidered in light of new data or better theories. Consider how just framing the problem (questions 1 and 2) can shape the entire outcome of the reasoning process, whether moral or scientific. Suppose that the fairy tale Goldilocks is the “case” under review and we are asked to consider what ought to be done. How we view the central problem shapes our response. Is the story a warning to children who may wander off without permission? Is it a misogynist text that little girls must stay at home and not have adventures? Is it an account of a budding delinquent, who is guilty of breaking and entering? Is it a story about someone with a compulsion to sleep in the beds of men, women, children, or beasts? Each of these views of the “case” directs us to an entirely different set of considerations and to a different cadre of experts to help us solve them. For example, suppose you view the most intriguing problem of our “case” to be about the porridge. The Bear family, you will recall, decided to go for a walk to wait for their hot porridge to cool. If their porridge was equally hot initially, how could the Momma Bear’s porridge in the medium size bowl be colder than the Baby Bear’s porridge in the tiny bowl, by the time Goldilocks sampled them? Perhaps Goldilocks lied. Or maybe the assumption their porridge was equally hot was wrong because the Momma set out leftover porridge from the refrigerator for her portion.

The skill and dispositions to see difficult situations from different points of view transforms how we view issues and this, in turn, determines what constitutes relevant data, values, policies, options, and their consequences. Too often this step is overlooked and people plunge ahead to a “solution” that happens to occur to them without taking the time to be systematic.

People use the elements of moral reasoning every day in deciding such matters as whether someone cheated, lied, kept a promise, was fair, and so on. Our job in teaching moral reasoning is to help make students aware of these features so that they can tease apart difficult problems in a systematic way and find the best solutions available.