Text: Health Care Ethics USA

Integrating Formative Practices into Ethics Education

Winter 2021
By: Emily K. Trancik, Ph.D.

Traditionally, "ethics education" tends to focus on training participants in ethical principles and applications to case-based scenarios. This type of education is oriented to the intellectual aspects of ethics, and it is critical to ensuring clinicians have the tools they need for moral decision-making. However, incorporating formative elements into ethics programming is also valuable. Doing so connects the textbook learning, which is oriented to the mind, with a reflective holistic approach, which is oriented to the heart, to deepen the way individuals personally connect to ethics, mission, and ministry identity.

The disciplines of ethics and formation have always had significant areas of overlap, especially in understanding the meaning of our identity as a ministry of the Catholic Church, and in promoting human dignity and the common good. Where ethics may focus on principles of Catholic health care ethics, Catholic Social Teaching, clinical ethics best practices, and the Ethical and Religious Directives for Catholic Health Care Services (ERDs), formation emphasizes reflection on identity and connection to self, others, world and God, and on strengthening a sense of calling to vocation, community, and ministry.1 The work of both ethics and formation is strengthened by the other, although they may be siloed in the creation of educational content.

Making ethics training more formative has several benefits. First, formative content encourages participants to think about the underlying reasons why ethics is so important, not just about the content of ethics norms and analyses. Such reflection promotes commitment to ethics both personally and on behalf of the ministry. Second, formation has greatly improved the ability for leaders and clinicians to enter into ethical discourse. For example, leaders who have participated in formation programs tend to be well equipped to consider how decisions affect poor and vulnerable populations, and they are comfortable raising critical ethical questions. They understand how essential ensuring that vulnerable people have access to health care is to the mission, and therefore are able to promote good ethics decision-making. Third, formative approaches to ethics honor the virtue ethics tradition and pursuit of human flourishing. While no overview of the "landscape" of ethics would be complete without education on virtue ethics theory, less attention is given in practice to educating and growing in virtue. Yet, even if someone cognitively understands ethical principles, if they are not motivated to change what they do or have a reason to commit to ethical practice, it matters little what they theoretically know about ethics.

In what follows, I will share key learnings from my experience introducing formative elements into ethics education.

First, in planning education, be intentional about objectives. For a typical ethics education session, an objective might use words like "understand the way in which the principle of double effect applies to the distinction between direct and indirect abortion…" or "develop skills for clinical ethics consultation." Consider the following, contrasting objective: "Commit professionally to the healing ministry and mission of Jesus with special attention to and solidarity with those who are poor and vulnerable." The distinction between these two kinds of objectives is between conceptually understanding with the mind and personally committing with the heart. Ethics education needs to get at both to influence practice, and a formative objective sets the tone for creating and delivering content to meet that goal.

Second, find ways to incorporate art into education. This idea is nothing revolutionary, as engaging with art naturally lends itself to formative experiences. For example, use imagery to assist in an opening reflection related to the theme of the activity. I often invite participants to reflect on the Conclusion of the ERDs before discussing human dignity. That text references the Parable of the Great Banquet, so I share art2 depicting invitations to "the poor, crippled, the lame, the blind" (Luke 14:13) and invite participants to notice something about the imagery, which might help them connect in a deeper, more lasting way. I also incorporate short films to help participants enter into the experience of those who are impacted by the ethics topic being discussed. The encounter through film engages people more holistically; their senses and emotions enrich what is otherwise a solely intellectual experience. Anecdotally, one individual has provided feedback saying that for the first time, they really understood the purpose of the ERDs after connecting with ERD 3 in the context of a short film about food insecurity.3

A third way to be formative in ethics is to create space for reflection on personal experience and institutional identity, in circumstances where time permits. For example, to begin a lecture on ethical theories I asked participants to write a few sentences about a time in their life when they had a true ethical dilemma. Then, we talked about moral theories and processes for ethical decision-making. At the end, I gave them time to revisit their own personal experience and think about how a consequentialist, deontologist or a virtue ethicist might have responded to their circumstance, and how having a process for ethical decision-making may have helped them work through their dilemma. Connecting to their own lives, they could better appreciate the value of applying ethical theories.

As I continue to develop formative ethics education, I am still considering the best way to invite feedback and measure success in such an endeavor. The transformation of hearts that is intended with this kind of education does not lend itself well to quantitative metrics. Anecdotal qualitative evidence and continued engagement with this type of education can indicate that it is enriching the experience of ethics education, and perhaps is cultivating deeper commitments to mission and ethics.

Emily Trancik, Ph.D.
Director of Ethics Integration
Ascension Tennessee


  1. Ascension. "Spiritual and Theological Formation," accessed January 7, 2021, https://ascension.org/our-mission/spiritual-and-theological-formation.
  2. For example, Copping, Herald. "Parable of the Great Supper," accessed January 7, 2021, https://www.doctrinalhomilyoutlines.com/wp-content/uploads/2014/10/harold-copping-parable-of-the-great-supper-400x546-219x300.jpg.
  3. See "Inherit the Earth," https://vimeo.com/350027983.