“The God Squad” Lesson Plan

playing god? in the classroom is an educational resource designed to accompany the playing god? podcast, for use by instructors to introduce bioethics concepts and facilitate discussions of ethics among high school and above students. The playing god? in the classroom resources are free and available for non-commercial uses. For other uses and more information, please contact [email protected].

This Lesson Plan accompanies Episode 10, Season 1 of playing god?

Click here to access this Lesson Plan in a printable pdf format

Summary

In the 1960s, a committee of seven Seattle residents met regularly to decide which patients with chronic kidney disease were “worthy” of getting access to a new but scarce technology, life-saving dialysis. Whoever wasn’t selected by the committee would likely die within months. An exposé of this so-called “God Squad” helped spark the formation of a new field: bioethics. In this bonus Episode to theplaying god? Podcast, students will hear how this early committee made life-and-death decisions, and why its approach is unlikely to be used again. 

This Lesson Plan uses a historical case study to facilitate a discussion on allocating scarce life-saving resources in healthcare. Students will critically examine how decisions were made in the 1960s and contrast this story from the past with contemporary allocation decisions featured in other Episodes.

Vocabulary

The following are key terms used in the Episode and their definitions. The terms are marked in bold when they appear elsewhere in the Lesson Plan.

Key Terms

The following are key terms used in the episode and their definitions. The terms are marked in bold when they appear elsewhere in the Lesson Plan.

Allocate 

To distribute according to a plan based on clear rules and principles. 

  • Today, kidneys are allocated based on a scoring system that considers how sick someone is and how long they have been waiting for a transplant. 

Health Equity 

A state in which everyone has a fair opportunity to attain their highest level of health.  

Laypeople 

People who do not belong to a particular profession or who are not expert or versed in some field.

Scarce 

Insufficient in number to meet demand. 

  • In the 1960s, kidney dialysis machines were scarce. In the Episode, the Seattle hospital had nine dialysis machines and over 450 patients who needed them.  

Utilitarianism 

An ethical theory that argues that decisions should be made with the aim of providing the maximum benefit for the maximum number of people, while minimizing harms.

Discussion Guide

The following Assessment Questions can be used by instructors to evaluate student comprehension of the Seattle residents’ story and the bioethics concepts featured in the Podcast Episode. The Discussion Questions can prompt students to make claims and provide evidence and their reasoning. Student comprehension and views can be assessed before and after listening to the Episode and/or participating in the group activity.

Assessment Questions
  • What were the challenges of treating kidney disease in 1962? 
  • Describe the process that the Seattle clinic used to allocate access to treatment on the dialysis machines. 
  • What does it mean to consider “social worth” in this decision? What non-medical, social factors were important to the committee, based on what you heard in the Episode? 
  • What is the difference between a utilitarian approach and an equity-based approach to scarce resource allocation? 
Discussion Questions
  • Some members of the “God Squad” committee were laypeople, who helped make the final decision about which patients would be treated with dialysis. Why do you think the hospital chose laypeople for the committee? Do you agree with that choice? Why or why not? 

The following questions are drawn from the Discussion Guide from Episode 3: Need a New Liver? Drinkers to the Back of the Line.  

  • Was there a time in your life where there weren’t enough resources to go around? How was it decided who would get the resource and who wouldn’t? Or, how was it decided who would get the resource first, and who would have to wait?
    • Possible examples: the last slice of pizza; concert tickets; a ride in someone’s car 
  • In the 1960s, dialysis machines were a scarce resource. What other scarce resources can you think of that we, as a society, have to allocate fairly, deciding who gets the resource and who doesn’t, or who has to wait?
    • Possible examples: PPE (personal protective equipment, like gloves, and safety glasses), ventilators, hospital beds, vaccines during the COVID-19 pandemic 
  • What factors should be considered when evaluating someone’s place in line for a scarce life-saving resource like a dialysis machine, or a kidney transplant? Which factors are not okay to consider? 
    • Possible examples: severity of disease/urgency, a “good match” (likelihood the treatment will succeed), the availability of alternative treatments, and effectiveness of those treatments, side effects and quality of life, genetics, age, health insurance status, social support/relationships, income, employment (such as a healthcare worker), intelligence, time on the waitlist, and others. 

Sample Activities

The activities allow students to actively engage with the bioethics questions at the center of the Episode. Students will develop critical thinking skills and reason-based judgment by citing evidence from the Podcast and other sources. In bioethics, there often isn’t a single “right” answer to a particular question; ideally, students will express and evaluate diverse viewpoints about complex, real-world problems. 

Large Group Activity: Compare to Another Episode

This Lesson Plan is best used in tandem with another Lesson Plan from Season 1 of playing god? 

Episode 3: Need A New Liver? Drinkers to the Back of the Line
This Lesson Plan discusses the allocation of scarce healthcare resources. Students will identify and apply ethics concepts used in making those difficult decisions. Using the Discussion Questions in that Lesson Plan and this one, students can compare and contrast allocation decision making in the Seattle dialysis case from the 1960s versus now. 

 

Episode 4: Why Can’t I Buy a Kidney?
Episode 5: A Womb of One’s Own
Episode 8: Miracle Drugs, Million Dollar Price Tags
Episode 9: The Future of Babymaking
These Episodes also introduce issues of allocation. Each deals with a different kind of scarce resource, and the ethics concerns and decision making processes are different for each. Pairing this Lesson Plan with one of these can show students how different resources and different circumstances call for different ethics considerations when deciding who should have access to a limited resource or expensive technology. 

 

Episode 1: I Would’ve Let You Die, Too
Episode 2: The Girl Who Died Twice
These Episodes show students how medical decisions are made for individual patients in ethically challenging situations. In these Lesson Plans, students learn the values that inform these decisions and the stakeholders who have a say. Contrast those decision making processes with the one featured in this Episode.

Individual Activity: Research & Writing
  • ELA Writing Assignment: Identify another scarce resource in healthcare and medicine, in history or today. Describe the resource, what it’s used for, and who needs it. Research reasons why the resource is scarce. Research how the resource is currently allocated. Apply ethics principles to the method of allocation–what values influence the decisions? Are benefits maximized? Are burdens or risks minimized? Is allocation fair, is it equitable?Would you change the current allocation method? Why or why not?   
    • Examples of scarce resources students might select: 
      • RSV vaccines for older people
      • Kidney or other organ transplants 
      • The COVID vaccine rollout 
      • Ventilators or PPE during COVID 

Additional Resources

Further readings about key topics covered in the Episode

More About the ``God Squad``

God Panels, Then and Now, Massachusetts General Hospital Proto Blog, 2020 

The Seattle ‘God Committee’: A Cautionary Tale, Health Affairs, 2009 

More About Contemporary Scarce Resource Allocation

Who Should Be Saved First? Experts Offer Ethical Guidance, The New York Times, 2020 

COVID-19 Resources: Treatment Allocation, University of Pittsburgh Center for Bioethics & Health Law 

Careers Mentioned

The following is a list of different careers and specific professionals mentioned in the Episode.

Careers

The following is a list of different careers and specific professionals mentioned in the episode.

Medical Historian
Richard “Rick” Mizelle, Jr., PhD, MA (American history, history of
medicine)

Physician
Belding Scribner, MD, MS  (nephrology)
Catherine “Kate” Butler, MD, MA  (nephrology, surgeon)

Bioethicist
Catherine “Kate” Butler, MD, MA

About this Lesson Plan

The playing god? in the classroom resources are free and open to use for non-commercial purposes. For other uses and more information, please contact [email protected].

Authors & Acknowledgments

Authors

Amelia Hood, MA
Mrigaanka Sharma

Editors

Jeffrey Kahn, PhD, MPH
Anna Mastroianni, JD, MPH

Advisor

Kenji Nomura, MS

To develop these materials, the Berman Institute has collaborated with a group of teachers participating in the U.S. Department of Energy’s Albert Einstein Distinguished Educator Fellowship Program, which provides accomplished K-12 STEM educators the opportunity to spend 11 months working in federal agencies or in U.S. Congressional offices, applying their extensive knowledge and classroom experiences to national education program and/or education policy efforts. Eight of the Fellows, drawn from public and private schools across the country, formed an advisory board that is helping shape, review, and pilot the educational materials.

The playing god? Podcast is a production of the Johns Hopkins Berman Institute of Bioethics Dracopoulos-Bloomberg iDeas Lab. Season One was co-produced with Pushkin Industries with support from the Greenwall Foundation.

© 2024 Johns Hopkins Berman Institute of Bioethics

The Podcast Episode and this lesson plan are not designed to answer patient-specific clinical, professional, legal, or ethical questions. Information contained herein is not intended as a substitute for professional consultation.