by Craig Klugman, Ph.D.

Being at a university on the quarter system means that my academic calendar is different than most faculty’s. So as many are returning from spring break, I spend mine grading the term that has just ended and preparing for the one that is about to begin. I recently received a message from my university administration suggesting that we look at open source books for the classes starting in a week. According to a University of California white paper, the cost of textbooks creates stress for 89% of students. Nearly half of students have not purchased a textbook even though they knew they needed it. And 80% of students did not arrive at the first day of class having purchased the book.

Two years ago, I was excited to publish an edited textbook written specifically for my undergraduate introduction to bioethics classusing a health humanities perspective. The book was great with one exception: The book cost $200 per copy. For the very first term I wanted to use the book, the publisher gave me permission to give the students a PDF copy if they were willing to complete an evaluation of it. But when students had to start paying full price, I spoke with the publisher concerned that the book I arranged around this very class was unaffordable to the students for which it was intended. This was the best book for this class, but its high price caused a financial harm to the students. The publisher said that if the university library purchased an electronic copy, then all students could access that at no cost to the individua students.

The dramatic rise in textbook costs is blamed on bundling—the industry practice of selling books alongside access to online materials. Sometimes the instructor wants these and sometimes not. What is available behind the paywall can be notes, practice tests, and problem sets. The publishers work with instructors and encourage them to adopt these new technologies, and, thus, increase the price of books. From 2006 to 2016, textbook prices increased 88 percentwhile inflation only rose 17.6%.

What is the effect of this trend in bioethics? One of the most popular undergraduate bioethics books is Munson’s, Intervention & Reflection. The current tenth edition costs $127.48 while the first cost $72.95 ($121 in 2019 dollars). A seventh edition of The Principles of Biomedical Ethicscosts $72.95 in softcover. A first edition in cloth cost $13.95 ($23.14 in 2019 dollars) when it was released. Vaughn’s 3^rdedition of Principles, Issues and Cases retails for $93.95. The first edition cost $66.48 ($78.33 in 2019 dollars). More recent books include Moskop’s Ethics and Health Care: An Introduction (first edition) that retails for $116. What is clear from this brief comparison is that even in bioethics, the increases in book prices is far higher than the rate of inflation.

There are some good sources for open source bioethics material. The Hastings Center offers briefing bookson several topics. The National Library of Medicinehas some basic material available. OER Commonsoffers a very limited selection. Georgetown also has archived reports from the various Presidential Bioethics Commissionswhich are another good open source. Whether these can be compiled in a way that speaks to masters, medical, graduate, or undergraduate learners is another question and something that each instructor will have to work to put together. None of them will be as comprehensive and easy-to-use as a well written textbook.

These books are not cheap and while bioethics may not have seen the excessive inflation of books in other fields (such as science and engineering), we need to be aware of the costs of books on our students. This is one reason when negotiating with publishers for my forthcoming book, we talked about their expected pricing and what could be done to keep the cost down.

The cost of books unjustly affects students of lower socioeconomic status than those of higher strata. Thus, keeping book prices affordable or finding open source alternatives is an imperative if we want bioethics instruction to be available to everyone.