Ethics education and the zone of parental discretion

A/Prof. Clare Delany1,2

1 The Royal Children’s Hospital, Children’s Bioethics Centre
2 The University of Melbourne, Department of Medical Education

A key pedagogical concept in current discussions about the role of higher education is that it helps students to construct their own knowledge and understanding of disciplinary concepts to promote their ongoing learning in the workplace (Boud & Falkichov, 2007). This pedagogical focus has profound implications for ethics teaching. It emphasises educators’ role to assist students and clinicians to learn how to view their own work and decisions in light of ethical concepts. It requires ethics educators to use accessible language, provide conceptual tools and devise learning tasks which encourage engagement with ethical standards, concepts and approaches to ethical deliberation.  In this paper I use the Zone of Parental Discretion (ZPD) (McDougall et al 2016) as an example of a conceptual ethics tool which encourages debate and discussion about ethical dimensions of clinical practice grounded in real questions raised by clinicians and families.

The ZPD was developed as a consequence of clinical ethics consultations where clinicians requested advice about the most ethically appropriate response in situations where parents disagreed with their recommendations, refused recommended treatment or requested treatment which clinicians regarded as suboptimal.  These clinical ethics discussions acknowledged clinicians’ experience and expertise in recognising ethical issues as the beginning point (Verkerk & Lindemann, 2012). The ZPD was then used as an explanatory concept to assist clinicians to frame, analyse and then decide how to respond to these situations. Clinical ethics consultations are not always proposed as an example of formal ethics education.  In this discussion, I draw from experience conducting ethics consultations where the ZPD was used. I highlight how such discussions enable pedagogical concepts including reflection, ethical deliberation, and ethics literacy, to flourish.


Clare is an Associate Professor in the Department of Medical Education, Melbourne Medical School. In this role, Clare is responsible for coordination of research higher degrees and the masters of clinical education.  Clare is also a clinical ethicist at the Royal Children’s Hospital Children’s Bioethics Centre in Melbourne. This role involves conducting clinical ethics consultations, education and research in paediatric bioethics.

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