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Subjective and Objective Reasoning (Costello)

This exercise gets students thinking about the biases inherent in decision-making processes. In small groups, students are asked to assume the role of a hospital boards of directors who must choose three people (from a list of fifteen or so) to receive a kidney dialysis. Here's the procedure:

I. Ask students to get into small groups and give each group a copy of Handout #1:

The Situation

You are on the board of directors at PVH. In addition to approving budgets and formulating policies, the board must also decide which patients receive kidney dialyses, as the demand exceeds the hospital's resources. You have been given a "finalists" list--a list of those patients who have been judged to respond equally well to the treatment. The list names ten people. Only three spaces are available.


  1. Independently, choose your three winners. Write a short explanation about how and why you chose as you did.
  2. Meet with your board.
  3. Come to a decision. Ask one person to record the process by which you reached this decision and be prepared to explain it to the class.
II. Field questions about the task; then give each group handout #2:

The Patients

Alexander Whitfield: male, 72 yrs; doctor on the verge of discovering cure for cancer
Juan Rodriquez: male; 28 yrs; policeman; loving husband and father of five children
Mary Ellen Smythye: female; 24 yrs; schoolteacher; single; lives in Chicago
Nick Roshnikov: male; 55 yrs; physicist, expert in atomic power
Evelyn Jones: female; 12 yrs; 8th grader; inner-city resident and gang member
Christie Brown: female; 20 yrs; college student; IQ 165; double major in engineering and law
Kim Hogland: female; 43 yrs; social worker; active in church; state senator
Huey Schickel: male; 9 yrs; farm boy; IQ 170; very musically inclined
Sabrina Murphy: female; 16 yrs; high school student; low grades; cheerleader; has a "reputation" among the guys
Chris Haller: male; 45 yrs; distinguished college professor; well-liked by his students

III. Ask the students to discuss the process they went through in selecting their patients. What criteria did they establish for selection? Did they establish these criteria beforehand? What biases did they uncover as they tried to determine which patients should live and die? Connect their discussion to subjective and objective forms of reasoning and ask them what the most objective form of reasoning would be in this case. (Molly says that sometimes her students do come up with a lottery system, but not often.)

IV. Ask students to reconvene in their groups, and give each a copy of handout #3. Ask the students to reevaluate their patient selection in light of the new information.

Further Information on the Patients

Whitfield has been receiving chemotherapy treatments for lymphatic cancer for the last 14 months. Prognosis is poor.
Rodriquez killed one mafia man and wounded another while trying to save his children--the courts won't let him testify for his own safety.
Smythye is pregnant and has spent the last six weeks in a drug rehab program.
Roshnikov is a Russian spy.
Jones has an IQ of 145--very high for her age.
Brown is lesbian.
Hogland saved a little boy's life ten years ago by donating one of her kidneys for transplant.
Schickel is an adopted child whose parents were murdered.
Murphy is emotionally upset about her parents' recent divorce. She has spent the last two months in counseling at a mental health center.
Haller is an alcoholic and accused child molester.

V. Discuss with students how they reacted to handout #3. Did the new information change their choices of patients? Reconnect to subjective and objective forms of reasoning.