Outbreak

from the November 2016 digital issue of Madison

The scenario:

No one saw this coming. When it hit the East Coast, it hit hard, creating anxiety and panic, and intellectual, logistical and ethical challenges.

Symptoms of headache, light sensitivity and uncontrollable fever point to an outbreak of meningitis B, a disease that resists medical treatment and can lead to disability or death.

Early reports indicate five regional outbreaks, which will require vaccinations to prevent the rapid spread of this highly contagious disease.

Emergency response needs to be lightning-quick and precisely targeted.

Unfortunately, the vaccine supply is limited with only enough quantity to treat two of the outbreaks, which include:

• military bases in Virginia and New Jersey
• inner-city youth in Baltimore, Maryland
• two doctors who traveled to an international conference in Kentucky
• environmental activists who returned to Atlanta from a research trip to Appalachia
• high-school students in New England

As a member of a Centers for Disease Control and Prevention team, you are summoned to Washington, D.C., to lead the effort to prevent an epidemic and minimize human suffering. Your task: decide who gets the vaccine in this complex, nuanced scenario, made even more plausible in an age of global concerns over diseases such as Ebola and Zika.

That was the scenario faced by 4,400 freshman JMU students during a late summer orientation exercise designed to teach them ethical reasoning skills. Contagion was developed by the Madison Collaborative as the centerpiece of It's Complicated, the innovative program introducing students to JMU's ethical reasoning framework.

As one of more than 150 volunteer facilitators, I was trained on how to familiarize students with JMU's Eight Key Questions, which can be used to evaluate the ethical dimensions of a problem, and begin to develop a structured thought process.

I met a group of 25 students who had watched a video outlining the scenario in advance of our 75-minute session in the EnGeo Building.

After prefacing the exercise with an overview of why ethical reasoning skills are important and why respectful discourse is essential in our society, we watched the Contagion video together and began a guided discussion to determine which of the Eight Key Questions were most relevant to the Contagion circumstances.

A wallet-sized card with Eight Key Questions provokes thoughtful discussions on the need for ethical decision-making in complex situations.

Discussion started slowly but gained in volume when disagreements arose. Forceful rebuttals and counter-arguments increased as the exercise progressed to the decision-making phase: Who gets the vaccine? Who gets left out? Why?

Another facilitator, Diane Foucar-Szocki, experienced a similar dynamic. Foucar-Szocki works in JMU's Department of Learning, Technology and Leadership Education, and was in her fourth year of facilitating.

"Once students get over their initial hesitation," she said, "they bring their minds and experiences to the case and begin to wrestle with its complexities. In this year's all-female group, internet shaming connected the case to their daily experiences. They had quite a discussion about what response their decisions might solicit on the internet."

"The ethical reasoning questions of responsibility, fairness, empathy and character took on new depth and dimension when considered through the very real and public nature of today's internet discourse," she added. "They lost track of time and forgot this was an orientation experience. They were engaged and learning together.

I could see in their eyes and in the animation of their conversation that this was becoming more than just exercise; they were moving fully into their higher education. What a wonderful way to spend an hour with our future leaders!"

Several students in my group questioned the scenario itself, citing a lack of certain information and clarity that made the decision more difficult.

"Just like real life," I said, "where you will find yourself forced to make a decision without having all the facts. But now you have a process that helps you make the best decision you can, based on what you do know."

Fletcher Linder, a professor of anthropology, and director and professor of interdisciplinary liberal studies, encountered a similar teachable moment with his group of students.

"I was perhaps most impressed with the questions students asked regarding the Contagion scenario," Linder said. " For example, students wanted to know the incubation period of the pathogen, the chances of people dying from it, the ease with which it spreads, the multiple means through which it spreads, how much it costs to generate vaccines, the adequacy of manufacturing capacity to generate enough vaccines to cover estimated needs, the ability of cities to quarantine citizens, etc.

"Students asked these and other questions in order to engage in informed deliberations about appropriate courses of action, and I came away from the discussion with a positive impression of our incoming students' desire for knowledge-based civic action."

I would echo the words of my colleagues as to how rewarding it was to witness a new generation of JMU students energetically engaging in a complex, thought-provoking mind game with no easy answers, and no clear "right" solution.