2.4: Chapter 7: Considerations of Equitable Standards in the Implementation of Assistive Technology
Introduction
The creation of Alberta Education’s (2010) Inspiring Education Policy has helped to promote a shift in the focus of teaching towards student-centred learning, the expansion of traditional methods of instruction, and more license for creativity in instruction and programming. Within the guiding principles of Inspiring Education exist specific initiatives conducive to this shift. One of these initiatives, the Learning and Technology Framework Policy, provides a guide for educators in understanding how technology in the classroom increases opportunities and support for students (Alberta Education, 2010). This initiative has helped increase understanding among educators of the importance of technology in providing students with opportunities in the classroom that might not otherwise exist. With the increase of educational and instructional technology in classrooms, the need for technologies that assist and support students with special needs has become more obvious.
The interest among educators in using technologies to support students with disabilities has promoted the implementation of assistive technology in classrooms. Assistive technology is defined as “any item or piece of equipment or product system either acquired commercially, off the shelf, modified, or customized and used to increase, maintain, or improve functional capabilities for individuals with disabilities” (Johnston et al., 2007, p. 4) . Many educators have a simplified understanding of assistive technology as technology and tools that support student learning by removing barriers and obstacles, increasing engagement, and promoting a feeling of success. The Alberta Government’s (2020) Inclusive Education Framework outlines the principles of inclusive education, including assistive technology as a key factor in supporting students with exceptional needs. The Alberta Government’s (2010) Inspiring Education Policy was created to provide pedagogical and ethical standards that outline inclusive education practices. These practices promote a sense of belonging through positive learning experiences for students, and address the need for educators to understand the importance of using assistive technology. These policies provide guidelines for supporting students with disabilities; however, no set educational government mandate ensures that the needs of students are met (Inclusive Education, 2020). Within these principles, guiding questions are asked around the implementation of assistive technologies in school. These questions consider issues such as how data is being used to inform the selection, implementation and evaluation of assistive technology for learning at the classroom, school and authority level, and what expertise and resources are available to support implementation of assistive technology for learning ( A Guide to Support Implementation: Essential Conditions [New Tab], Edmonton Regional Learning Consortium, 2016).
Vignette
Decisions around implementation of assistive technology in K-12 settings are made at the school level. The implications of this can be both negative and positive, as administration at schools may not view assistive technology as a necessary tool for students and may decide to allocate funding to the resources instead. For example, in my current role as an assistive technology consultant, I help make decisions about allocation of devices and equipment for students with special needs in the school district. Other schools may not have a specialist or consultant, or may not include them in decision-making.
During my time in this position, I have developed a process to determine which students receive assistive technology. When I started the position, there were no specific guidelines for this process. My experience as a special education teacher and special education consultant, using a multitude of assistive technologies to support students in their learning, guided my decisions on student access to assistive technology. To create a pedagogically sound policy, it was necessary to work with a multidisciplinary team to ensure that the needs of students were met. I collaborated with school psychologists, teachers in the field, learning consultants, and the educational technology team to develop a series of questions that outline a student’s learning needs, the professionals involved with the student, and how a device and applications would support their learning. Using a Google form, responses are collected in such a way that priority students can be identified. This process provides the information that I need to determine the device and programs that will best support a given student.
The struggle is that this process is sustainable only if the funding and the budget allow for it. With recent cutbacks and the possibility of the assistive technology budget diminishing, I have had to reimagine a different process that will still provide the necessary assistive technology to students with special needs. I have spoken with other school districts around the topic and about how they support students with assistive technology. Every school district seems to have a different process, and, in some cases, there is nothing in place. The question then arises, how should school districts implement a model of assistive technology for students with diverse needs that supports equitable standards?
Full Disclosure
Using Farrow’s (2016) framework for ethical perspectives, this paper will address the question above and consider why ethical perspectives need to be part of the implementation of assistive technology in classrooms, taking into consideration deontological, consequentialist, and virtue ethics.
There is a vast amount of research on the benefits of access to assistive technology for student learning. Assistive technology educator and researcher Joy Zabala is known for her work in this area, advocating for the successful implementation and evaluation of assistive technology in classrooms. Zabala et al. (2005) created the Student, Environments, Tasks, and Tools (SETT) framework as a guide for educators in using assistive technology. The SETT framework can guide educators in carefully assessing the needs of students in these areas and in making informed decisions in implementing and evaluating assistive technology tools (Zabala et al., 2005). The framework helps educators answer questions about individual student learning needs, such as who is involved supporting these students, what prior experience they have with students using the same or similar devices, and what comfort level they have with students using devices (Zabala et al., 2005).
The answers to these questions provide important insight into programming for a student’s unique learning needs. However, who within the school holds responsibility for using the SETT framework and assessing the assistive technology needs of a student? How is funding determined and allocated for students receiving support, and who ensures that the process is based on equitable standards? Equitable standards that should be considered are:
- sustainable process that provides equal access for all students,
- learning technologies that provide additional supports (not substitution of professional expertise for student’s assessment and achievement), and
- informed decision-making policies that are grounded in best practice and that consider student voice.
Privacy and Data Considerations with Using Supportive Technologies
Among the concerns raised about equitable standards in implementation and student use of assistive technology are the ethical issues related to privacy and informed consent with users. In the last decade, educational and assistive technologies have exploded, and teachers are using a myriad of educational programs to support student learning across the curriculum (Regan & Jesse, 2018). Assistive technologies have become popular among teachers as a way of increasing access to curriculum materials, and of adapting and differentiating instruction for students with exceptional needs. Many of these programs employ a personalized learning system, which is geared at providing students with lessons and activities based on their current academic levels. For example, programs such as Mathletics have built-in assessment, whereby students respond to a series of math questions, and their responses are used to identify their current math ability and grade level. A-Z Learning is a reading program that works in the same way, assessing students through standardized questions in order to determine a grade level for them to begin at and work through.
Deontological Theory
There are several ethical considerations related to the use of educational and assistive technology applications, specifically with personalized learning systems. These programs are intuitive, and the end result of initial and then ongoing interactions is a snapshot of a student’s ability, which informs how questions and activities are generated to focus on increasing the student’s skills. However, there is little information available on how a student’s information is used to determine their ability, and even less information on student demographics. In the case of students with special needs, their learning style may be quite different from the average student, and their achievement in certain areas may be lower than their capabilities if the program does not consider the accommodations that need to be in place for learner success.
Regan and Jesse (2018) state that “a critical ethical concern raised with personalized learning is whether such programs constitute tracking and sorting of students that might be considered discriminatory” (p. 168). They caution that in the United States, the tracking and sorting of students has led to divided classrooms of race, gender, and class. Today, tracking is happening behind a screen, hidden from students and parents (Regan & Jesse, 2018). When examined from a deontological perspective, which focuses on “responsibility, intention and duty” (Farrow, 2016, p. 102), attention should paid to understanding the intended use of these programs and to ensuring that teachers recognize that personalized learning systems collect student information without any consideration of their exceptional needs. These systems should be considered an additional or supplemental learning resource and not an authentic assessment of a student’s learning ability or needs. Furthermore, students and parents should be made aware of how these systems collect information and whether and how this information is used by teachers in planning and programming.
Consequentialist Theory
Most teachers use educational and assistive technology programs as an alternative means to support student learning. Personalized learning systems provide opportunities to provide students with engaging one-to-one learning. Bulger (2016) describes personalized learning systems as having the “potential to revolutionize learning” (p. 3) despite vague research findings on whether and how these systems do improve learning outcomes for students. This raises the question of how teachers are using these programs to improve students’ academic skills and whether they are an appropriate measure of achievement.
A second ethical consideration for the use of educational and assistive technologies for personalized learning is whether the use of these systems is replacing expertise available through school districts. Even the most intuitive and customized personalized learning system cannot replace the expertise of school professionals, whose responsibility and role is to assess, adapt, and help identify the best way to support students in their learning.
Virtue Theory
The use of personalized learning systems in K-12 classrooms is increasing at a rapid rate. School districts have an increased responsibility in deciding what educational applications can be used without the breach of student privacy. However, teachers have access to a vast range of free educational programs that can be downloaded and used without exploring the consequences. Very similar to the focus of virtue ethics on individual character and a strength on “making good choices,” teachers may unknowingly expose their students to programs that collect student’s data without consent and increase the risk of privacy concerns. The use of these programs in education has become mainstream, and the potential for personalized learning has been noted by Facebook developer Mark Zuckerberg. Zuckerberg and his wife, Priscilla Chan, invested US$45 billion into advancing personalized learning and establishing the Chan Zuckerberg Education initiative (Bulger, 2016). It is not surprising that educators are turning to technology to enhance and engage students when it is so widely supported by influential people in the digital world. Teachers want to make a difference for their students and to provide opportunities for personalized and individualized learning; however, they may not recognize the risks involved.
Summary
The use of personalized learning systems as digital tools to support diverse students’ learning needs requires close examination. Educators cannot rely on the results or scores that are often embedded in personalized learning systems as authentic assessment for student learning. All students — not only those with diverse learning needs — have unique learning abilities, approaches, and needs. Educators are responsible for understanding the abilities and needs of their students and for providing classroom experiences that tap into students’ strengths and help address needs.
Avoiding Harm and Risk in Implementation of Assistive Technologies
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The current COVID-19 crisis caused a major uprooting and shift for educators across the globe. When Premier Jason Kenney announced school closures on March 7, 2020 for most school districts across Alberta, superintendents and educators across the province responded to the situation with a plan for K-12 education to take place at home.
For many school districts, this meant a shift from in-class teaching to delivering curriculum content and connecting with students online. It also meant a complete reimagining of assessment and feedback for students. For some educators, this has proved a daunting shift — one for which they were not at all — while other teachers are adjusting to this change, having had some experience in the digital world of teaching and learning.
One of the major concerns for districts has been to ensure that students have access to technology at home in order to access the delivery of online content and to connect with their teachers. In my role working with assistive technology, the shift to remote teaching brought about many questions concerning how best to support students with diverse learning needs. I had to ensure that students had access to their assigned devices and also had support in using these devices at home. Some of questions that emerged as a result of the shift to online learning were as follows:
- How will students who are supported by assistive technology in schools gain access to their one-to-one device at home?
- Who is responsible for ensuring students’ continued support from assistive technologies?
- How will the one-to-one devices be distributed for home use and how will I manage their return?
- How much will it cost to ensure that students have access to technology?
- What about students who are not coded, and who use assistive technology at school, but do not have access to these technologies at home? (Reasons vary and include financial constraints, parent’s level of understanding of assistive technology resources, and so on.)
One of the many challenges that educators face in today’s classroom is ensuring that the unique needs of every student are met. Some students have mental health needs, and also social, behavioural, and emotional needs. For others, struggles in specific areas of learning pose cognitive support needs. The dynamics of a classroom can be overwhelming for many teachers, with pressure to meet provincial standards, combined with the need to support the emotional, physical, and learning needs of all students, and also to remain attuned to parent involvement and demands. Research findings from the Alberta Education’s Severe Disabilities Profile Review revealed that only “56 percent of the files related to students with severe disabilities met the ministry’s policy requirements” (Alberta Teacher’s Association, 2011, p. 1), which means that just over half of the needs of students with disabilities were being funded. As a result, the mandate Setting the Direction for Special Education in Alberta was launched in 2008, along with a framework for special education from Grades 1 through 12.
In 2009, a committee brought their concerns and suggestions to the Alberta Minister of Education. Informed by these concerns, a new framework was established based on the principle to create “one inclusive education system where each student is successful” (Alberta Teachers’ Association, 2011, p.1). The Inclusive Education committee’s vision was to ensure that the educational needs of students would be recognized as changing, and therefore so would their opportunities for success. The framework identifies three areas of priority — “curriculum, capacity and collaboration — and recommends a vision of an inclusive education that repositions education within the broader education system” (Alberta Teachers’ Association, 2011, p.1).
The inclusive education system is guided by fairness and equitable standards; however, issues can arise when resources and technology support come with a high price tag to districts, combined with varying levels of government funding. Although most educators are vigilant in reaching for the goal of fairness and equality for every student in their classroom, they are often met with the harsh fiscal reality that the educational and assistive technology that can better support students is simply not available.
Fast forward to the current situation in which educators are dealing with instruction and assessment for all of their students using some means of online delivery, and the issue becomes even more complex. How can educators ensure an equitable standard for all students now that they are teaching online, and students are learning from home?
Deontological Theory
The deontological theory “emphasizes moral obligation and the rule-based nature of morality” (Farrow, 2016, p. 101), which is the foundation for inclusive education practices both in the classroom and in the current ‘at home’ learning state. For some students, ensuring their needs are met requires adjustment to instructional methods and flexibility in the way they produce and show their work. Accommodations through technology can assist and support these students in a multitude of ways by removing barriers and obstacles to learning so that they can reach outcomes and goals. For some students with diverse learning needs, the shift to online learning has been positive, as lessons are delivered digitally, and assistive technology are in place to support students with areas of weakness, such as reading and writing. Some students have reported that they like learning at home and using Google Classroom, because they do not feel the same time constraints to complete their work that they sometimes experience in the classroom. However, the negative impact is also present, as some students struggle with attending to tasks and require more one-to-one support with learning strategies. Such students may become frustrated and anxious with the daunting task of independently managing their work. Furthermore, teachers are now faced with their own challenge of ensuring the success of students with assistive technologies. Rather than working with students and assessing their assistive technology needs at school, they are supporting students’ use of these technologies through online instruction.
Consequential Theory
In order to achieve a process for implementing assistive technology that ensures equity among students with diverse learning needs, all stakeholders must be involved. Both budget roadblocks and the need to train teachers in implementing technology in the classroom must be addressed and discussed with key individuals, such as administrators, parents, and district support service personel.
Bugaj and Norton-Darr’s (2010) Guide to Assistive Technology in Public Schools notes that “the ‘Education for All’ concept spreads from the top down as an administrative philosophy as well as from the bottom up with teachers working together within classrooms to ensure that every student is successful” (p. 124). The message surrounding the implementation of assistive technology in the classroom must come from school districts leaders and must communicate a universal commitment to supporting students online using a range of learning technologies.
Virtue Theory
Alberta Education’s Action on Inclusion framework (Alberta Teachers’ Association, 2011) promotes a universal understanding of inclusive classrooms. Therefore, it is imperative that teachers take on the responsibility for all their students in a value-based approach. Such an approach requires a shift in mindset, as teachers are ultimately responsible for ensuring the success of each student. A virtuous approach recognizes the importance of inclusive practices for students, while high expectations are put on teachers to provide differentiated instruction and accommodations that may include technologies they have no experience using.
Summary
When implementing assistive technologies in support of students with diverse learning needs, a collaborative approach between school administration, instructional leaders, learning coaches, and teachers must be taken. The approach must consider teachers as key in implementation, while also recognizing their different levels of comfort and experience when it comes to using technology. Now more than ever, as learning shifts completely online, teachers are experiencing increasing demands on their role. Building capacity by providing training to teachers has also shifted to online instruction; this approach to professional development works well for many teachers, but has proved challenging for some who are more comfortable with in-person training. Online professional development for teachers requires interactive instruction and participation in order to personalize learning and make it more meaningful (Francis & Jacobson, 2013). Interestingly, Francis & Jacobson (2013) found that teacher experiences with an online learning platform were consistent with the “inquiry approaches to learning” (p. 335) that exists in Alberta’s current curriculum. Francis & Jacobson (2013) found that participant engagement increased through collaboration and inquiry (using interactive whiteboard activities) which in turn sparked conversations amongst teacher participants around the important of discovery in learning with their students.
Although classrooms are now digital, educators and leaders are still required to carefully research digital resources and provide support and assistance to teachers in using them so they can ultimately do the same for their students. Learning communities, demonstrations, and hands-on activities need to be provided for teachers using effective approaches to online professional learning (citations needed here, see notes).
Implementing and Connecting Assistive Technology to Personal Autonomy, Multiple Perspectives, and Finding a Voice
Vignette
With the recent turn of events due to COVID-19 and learning at home, the question for many school districts was how to ensure that students with diverse learning needs had access to technology. In my role, I had to make plans for students to gain access to their assigned assistive technology devices to use at home. However, there were many students who did not have access to technology at home to engage in online learning. A process for administrators was determined for the families that required technology and did not have assigned assistive technology devices. These students may not be coded and therefore are ineligible to receive one-to-one assistive technology devices; however, these are very much in need given diverse financial dynamics and constraints at home. Leaders had to come together to explore the possibilities of using resources to support diverse student needs, including collecting older devices for students who did not have access to suitable technology.
There are certainly concerns around participant autonomy and independence when implementing assistive technology for students with diverse learning needs. For all matters, including education, parents and guardians are the voices and advocates for their children. Ultimately, parents make the final decision regarding programming and supports that will best meet the learning needs of their child and ensure their social and emotional wellbeing. Many factors can impact programming and the use of assistive technology, and these need to be discussed between schools and parents.
Deontological Theory
Ideally, when planning for a student’s education needs, teachers and parents work together to ensure a child’s learning needs are met. However, there can be obstacles and concerns that keep equitable access from being achieved. For example, there may be cultural or linguistic perspectives or beliefs about learners with special needs that prevent children from receiving such support. There may be resistance to specialized programming, including assistive technology. In other cases, there may be resistance to a child receiving specialized support for fear that the child looks different than their peers and becomes socially isolated. In situations like this, how does the school support the student through adaptation, modifications, and accommodations if the parents are resistant or do not agree with the recommendations? Is it the teacher’s duty and responsibility to implement support for a child even when a parent is not in agreement? Or, do parents make the final decision in such cases? Complex issues and situations and ethical decisions like this are amplified for schools, teachers, and parents during a pandemic and during a shift to remote instruction.
Consequential Theory
Within the consequential theory of ethics, “responsibility, intention and duty” (Farrow, 2016, p. 102) lie at the forefront. School districts that adhere to government mandates in this situation, such as Alberta’s Education Act (2020), behave according to the premise that educators are bound by law and respect “clear moral boundaries” (Farrow, 2016, p. 102). Alberta’s Education Act (2020) states that teachers are obligated to provide students with instruction and learning at their level as outlined in the curriculum and consistent with the goals outlined by the act. The Education Act (2020) also states that teachers must “encourage and foster learning in students” (p. 130) in a safe and caring environment. In the present context, educators may feel pressured by policy and less willing to adhere to a parent’s concern (voice). It becomes a balance between keeping a relationship with parents and respecting their rights and authority with their child, and also supporting a child’s right to education.
In situations concerning parent disagreement of supportive services for their children, it is important to keep an open and communicative relationship. Farrow (2016) describes how, according to the consequential theory, the balance between parent and teacher relationship represents the voice of a child by “incorporat[ing] multiple perspectives” (p. 102) and using “a practical approach” (p. 102). School boards are obligated to provide a safe and nurturing environment for children that encourages active learning, and this must include ensuring that students are supported in their academics and experience success. This legal and pedagogical responsibility involves addressing the role that parents play in their child’s education and supporting parents in understanding this responsibility. According to Alberta’s Education Act (2020), a parent’s responsibility in their child’s education includes “co-operat[ing] and collaborat[ing] with school staff to support the delivery of supports and services to the child” (p.38). For parents who may be hesitant due to cultural differences, this means including the multicultural team in helping parents understand the benefits to implementing supports, specifically assistive technologies. For parents concerned about their child standing out, the conversation should focus on how technology is used universally in the classroom as a digital resource that supports all students in their learning.
Virtue Theory
From a virtue ethics perspective, the key principle is that every student is entitled to the support they need to experience success in school. This perspective considers teachers and parents as the voice for a child with diverse learning needs. Furthermore, the equitable standards within the virtuous theory considers those students who may not have the voice of a parent to advocate for them. Unfortunately, there are students who do not receive support through assistive technology because their parents may not be involved in their schooling. The question then needs to be addressed, who is the voice for these students? Not all students who need support are coded, and if parents are not their voice to advocate for their child, then how can equitable standards be put in place to ensure these students receive the supports that they need to be successful?
Educators can be the voice for students and can help to advocate for the supports that will enable a student’s learning to occur. This is difficult when a student is not coded, as funding supports and resources are often established under these parameters. Teachers turn to their administration for support in purchasing devices and programs, but schools are also limited by budget constraints. In some cases, a solution may be to ask to reuse older devices for students who need them. While a viable option, this can snowball into other concerns, such as who maintains and supports these devices, if anyone does, and who determines which students receive them, and how (Floyd, 2010).
Summary
The key to ensuring students with diverse learning needs have a voice in their learning is establishing an educational support team of expertise for students, including teachers, parents, technology leaders, and therapists. The common interest among this team should focus on providing the student with the learning conditions and digital technologies that best support learning and also promote independence.
Conclusion
Over the last decade, there has been a major shift in schools toward including and supporting students with diverse learning needs in regular education instruction settings. This inclusion is a visual representation of society’s desire for progression in social justice. The extent to which inclusion exists from province to province is an indication of society’s willingness to embrace and promote fair and equitable social policies in education.
Implementing assistive technology into the classroom provides students with diverse learning needs with the opportunity for positive classroom experiences by removing barriers to learning and by providing tools for success. Ensuring equitable standards for all learners should be the foundation of any model of implementation of assistive technology. In recognizing these standards, teachers must be aware of obstacles that may exist with using assistive technology. Simpson et al. (2009) explain that “a ‘one size fits all’ approach is never appropriate for assistive technology selection. All students are different, and therefore their assistive technology needs are different” (p. 174). An effective and equitable model of implementing assistive technology for inclusive education will address and overcome budgetary constraints, involve meaningful and appropriate training for educators, consider and address parental concerns, and implement assistive technologies that are inclusive and universally accessible.
References
Alberta Education. (2013). Learning technology policy framework . Alberta Government. https://inspiring.education.alberta.ca/initiative/learning-and-technology-policy-framework/
Alberta Government. (2020). Inclusive education. https://www.alberta.ca/inclusive-education.aspx
Alberta Government. (2010). Inspiring education: A dialogue with Albertans. https://open.alberta.ca/dataset/45370ce9-3a90-4ff2-8735-cdb760c720f0/resource/2ee2452c-81d3-414f-892f-060caf40e78e/download/4492270-2010-inspiring-education-dialogue-albertans-2010-04.pdf
The Alberta Teachers’ Association. (2011, January). Alberta’s action on inclusion: Transforming diversity into possibility. Leadership Update, 7 (5), 1-3. https://www.teachers.ab.ca/SiteCollectionDocuments/ATA/Publications/School-Administrators/Leadership-Update/COMM-118-56%20v7n5.pdf
Bugaj, C. R., & Norton-Darr, S. (2010). Practical (and fun) guide to assistive technology in public schools: Building or improving your district’s at team . International Society for Tech in Ed. https://ebookcentral-proquest-com.ezproxy.lib.ucalgary.ca/lib/ucalgary-ebooks/detail.action?docID=3317679
Bulger, M. (2016). Personalized learning: The conversations we’re not having . Data and Society Research Institute. https://datasociety.net/pubs/ecl/PersonalizedLearning_primer_2016.pdf
Education Act, S.A. 2012, c E-0.3. (2020) https://www.qp.alberta.ca/1266.cfm?page=E00P3.cfm&leg_type=Acts&isbncln=9780779816774
Farrow, R. (2016). A framework for the ethics of open education. Open Praxis, 8 (2), 93-109. https://doi.org/10.5944/openpraxis.8.2.291
Floyd, K. (2010). Book and software review: The practical (and fun) guide to assistive technology in public schools.
Journal of Special Education Technology
,
25
(4), 65-66.
https://doi.org/10.1177/016264341002500407
Francis, K., & Jacobsen, M. (2013). Synchronous online collaborative professional development for elementary mathematics teachers. The International Review of Research in Open and Distributed Learning , 14 (3), 319-343. https://doi.org/10.19173/irrodl.v14i3.1460
Johnston, L., Beard, L. A., & Carpenter, L. B. (2007). Assistive technology: Access for all students. Columbus, OH: Pearson Merrill Prentice Hall.
Regan, P., & Jesse, J. (2018). Ethical challenges of edtech, big data and personalized learning: twenty-first century student sorting and tracking. Ethics And Information Technology , 21 (3), 167-179. https://doi.org/10.1007/s10676-018-9492-2
Simpson, G.C., McBride, R., Spencer, V.G., Lowdermilk, J. & Lynch, S. (2009). Assistive technology-supporting learners in inclusive classrooms. Kappa Delta Pi Record , 45(4), 172-175. https://doi.org/10.1080/00228958.2009.10516540
Zabala, J., Bowser, G., & Korsten, J. (2005). Sett and Resett: Concepts for AT Implementation. Closing The Gap, 23 (5), 1-4. https://www.rockyview.ab.ca/assets/archive/learning/teaching/assistive-technology/atl-assets/SETT.pdf
Appendix A
| Principle | Duties & Responsibilities (deontological theory) |
Outcomes
(consequentialist theory) |
Personal Development
(virtue theory) |
|---|---|---|---|
| Full disclosure |
|
|
|
| Privacy, data security, and informed consent |
|
|
|
| Avoiding harm and minimizing risk |
|
|
|
| Autonomy and independence |
|
|
|