Empirical Research, Consultation, and Training in Medical Ethics




© Springer International Publishing AG 2017
Laura Weiss Roberts and Mark Siegler (eds.)Clinical Medical Ethics10.1007/978-3-319-53875-4_3


3. Empirical Research, Consultation, and Training in Medical Ethics



Daniel P. Sulmasy 


(1)
Georgetown University, Pellegrino Center for Clinical Bioethics, Washington, DC, USA

 



 

Daniel P. Sulmasy



Abstract

Mark Siegler is one of the founding figures of the subfield of bioethics known as clinical medical ethics. This brief chapter outlines his contributions in developing a program of empirical research in medical ethics, an ethics consultation service, an approach to medical student ethics teaching, and a fellowship training program. These activities have become the cornerstones of clinical medical ethics.


Keywords
BioethicsClinical medical ethicsResearchEmpirical methodsEthics consultationTeachingFellowship trainingMark Siegler


Mark Siegler, M.D., the Lindy Bergman Distinguished Service Professor in the Departments of Medicine and Surgery and the Director of the MacLean Center for Clinical Medical Ethics at the University of Chicago , is one of the founding figures in the field of medical ethics. This volume, which collects some of his most important papers and makes them available in one place, represents an important contribution to the bioethics literature.

Siegler is most known for his contributions to a subcategory of bioethics called clinical medical ethics. Clinical medical ethics is a field that examines the practical, everyday ethical issues that arise in encounters among patients, doctors, nurses, allied health workers, and health care institutions. The goal of clinical ethics is to improve patient care and patient outcomes. Most authorities date the beginning of the contemporary era of bioethics to the 1960s. In the early days of this movement, before Siegler began his career , with the exception of the work of Edmund Pellegrino, most medical ethics was being written by philosophers and theologians. Siegler became interested in ethical questions first and foremost as a physician who was grappling with these questions at the bedside. He was an internist charged with running his hospital’s new intensive care unit. He was constantly confronting ethical questions about life, death, and the proper use of new technologies such as the ventilator. He had no formal training in ethics but decided he needed to learn more. He pursued such knowledge informally through discussions and directed readings with colleagues at the University of Chicago such as James Gustafson, an ethicist and a theologian at the divinity school who had already started thinking about medical ethics. Siegler soon began sharing his own insights, publishing papers on ethics in major medical journals, beginning in 1975 with his seminal article in the New England Journal of Medicine, “Pascal’s Wager and the Hanging of Crepe” [1], reprinted on page 308 in this book. Although it might not seem extraordinary now, it was a remarkable achievement at that time—to write an article not about medical science, diagnosis, or treatment but about ethics and the care of the dying in the world’s most prestigious medical journal.

To appreciate Siegler’s contributions , one must always realize that he thinks about medical ethics first and foremost as a physician. He has never been one to theorize from afar. He reflects upon his clinical experience and draws eclectically from other people’s theories in order to help himself develop answers to pressing ethical questions at the bedside. This perspective has shaped his career from the beginning. He was a member of a medical school faculty in the 1970s, surrounded by basic scientists and clinical trialists, and his approach to ethics was powerfully affected by his environment. He knew that for medical ethics to survive where it counted—in medical practice—it needed a niche that would be respected in the world of academic medicine, a world dominated by science. As he worked in that world, his way of thinking almost instinctually led him to start doing for medical ethics what he saw his colleagues doing in oncology and cardiology: observing and counting. In order to do this with some measure of rigor, he turned to the methods of the recently developed field of clinical epidemiology and applied these methods to questions of medical ethics. As such, he became a pioneer in the use of empirical methods to do medical ethics research , through both his own work and the work of the fellows he trained.

Philosophers divide ethical scholarship into normative ethics, meta-ethics, and descriptive ethics. The normative questions concern how people are to act. The meta-ethical questions concern the foundational concepts, language, and logic of ethics. The descriptive ethical questions concern how people actually do think and act in normatively significant situations. One of Siegler’s most important insights was that descriptive work, using the tools of other medical researchers in survey and data collection, could be of service to normative medical ethics and could also provide a vehicle for bringing medical ethics to the attention of physicians accustomed to reading empirical studies. He stands as one of the architects of the “empirical turn” in bioethics.

The first of these descriptive ethics papers was published in the New England Journal of Medicine in 1982, with the title “Confidentiality in Medicine: A Decrepit Concept” [2] reprinted on page 159 in this book. What Siegler did in this paper was to observe and to count. He simply asked, “How many persons have legitimate access to the chart of a patient during a hospitalization?” His answer, which was at least 25 and possibly 100, was stunning. It raised questions about how the centuries-old Hippocratic commitment to patient confidentiality could hold up in modern medicine. In the era of the electronic medical record, the challenges this paper raised have only been magnified.

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Sep 8, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Empirical Research, Consultation, and Training in Medical Ethics

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