Engaging Bioethics: An Approach to Ethics Rooted in Architecture

What happens when a philosopher and an architect co-teach a class? This semester, we aim to find out.

Focusing on a complex, real-world issue in bioethics, we are testing a hunch: Can we break through barriers and find innovative solutions to highly complex moral challenges in bioethics if we combine the analytic methods of philosophy with the creative methods of design?

Eleven Georgetown undergraduates from a variety of disciplines – global health, ethics, political theory and linguistics – are joining us in an experimental class to give it a try. Working in teams, they are tackling an enormously complex and difficult issue in health care – namely, medical error and responsibility.

As another column in this series discussed, avoidable medical error is shockingly common: It is the sixth leading cause of death in the United States, and cause of a million and a half injuries each year. Adding insult to injury, physicians and other healthcare professionals rarely apologize, either from a culture of shame or fears of liability risks. Furthermore, the problem is not primarily about “bad apples,” or incompetent or uncaring health care professionals. The far larger issue is a “systems” problem – a poorly coordinated structure that makes it hard for even the most vigilant and caring of humans to avoid error. Like a poorly designed highway with little signage, a tangle of on- and off-ramps and more cars than it was ever designed for, accidents are systemically guaranteed.

Bioethicists are interested in the policy questions here: How do we decrease error? How do we increase accountability for the errors that do occur? They are also interested in the deep philosophical questions that underpin the policy ones: How do we think of responsibility when the system you’re in makes it hard to be good? When is blame appropriate? When is forgiveness apt?

All of which raises an even deeper question: How do we make progress on radically complex, open-ended problems that intersect with factors as variable as culture, policy and moral theory? Traditional methods that would work for one factor – say, legal liability – will miss issues in another, like culture, and will have a difficult time thinking outside their respective boxes.

The two of us – one a bioethicist, the other an architect interested in the architecture of learning as well as the architecture of space – met last year here on campus in conversations about Georgetown’s new initiative on technology and learning. As a philosopher, one of us leads with analytic distinctions and abstraction (“I see a four-square logic diagram in my head”); as a design expert, one of us leads with experimentation and generativity (“You have permission to not know what you are doing.”) But over a series of really fun, and really long, lunches, we started to realize that, when we moved into topics of extremely high complexity, there was surprising convergence in the ways our minds were working. Napkins were filled with diagrams, logical and generative; pictures revealed theory; and together we bounced between the abstract and the granular.

We have a hunch that we might find a new way of moving forward on problems where traditional approaches have stalled. We are putting our intuition to the test and approaching a complex bioethics issue inside the context of a design studio. Our students are learning visual diagramming skills alongside traditional policy analysis. They are looking at precedents for what they aren’t saying as much as for what they are; they are sketching ideas using art pencils – and software apps. In EthicsLab, a new space in Healy Hall that is designed to facilitate innovation in bioethics, the experimental research and learning project has begun. We’ll be documenting the course, and showcasing the students’ projects. Stay tuned.

Maggie Little is director of the Kennedy Institute of Ethics and associate professor of philosophy. Ann Pendleton-Jullian is visiting distinguished professor at Georgetown University. Engaging Bioethics appears every other Friday.

Originally published in The Hoya on Monday, September 23, 2013