Transferring the Baton to a New Generation of Bioethics Leaders
Happy Thanksgiving! I hope while maintaining the necessary precautions with COVID surges and the flu season that everyone has been able to find ways to connect with loved ones and friends. Thank you for continuing to watch and be part of the birth and growth of Bioethics Alliance.
During the weeks leading up to Thanksgiving, I have spent considerable time thinking quietly about the “greats” in the field of Bioethics that we have lost in the last two months and what implications these losses may have for the foreseeable future.
My career in Bioethics was largely informed by personal medical experiences, a quest to contribute to the therapeutic relationship in clinical medicine as a non-MD, recognizing that as medicine and technology continued to progress an increasing need would surface for thoughtful non-biased engagement of ethical analyses, and, lastly but most importantly, the many leaders of the field who informed my training, experiences, and expertise.
Since the end of September 2020, the field and discipline of Bioethics has lost,
Judith Jarvis Thomson, Professor Emeritus of Philosophy at MIT and influential moral philosopher
Robert Veatch, Professor Emeritus of the Kennedy Institute and Georgetown University, and Fellow of the Hastings Center
Albert Jonsen, Emeritus Professor of Ethics in Medicine the University of Washington School of Medicine and co-founder of the Program of Medicine and Human Values at Sutter Health’s California Pacific Medical Center, and Fellow of the Hastings Center.
Dan W. Brock, Emeritus Professor, Harvard Medical School, Center for Bioethics, Professor of Philosophy and Biomedical Ethics, and Director of Center for Biomedical Ethics at Brown University; member of President’s Commission for the Study of Ethical Problems in Medicine and Clinton’s Task Force on National Health Reform, Fellow and Board of Directors member of the Hastings Center
I, personally, have experienced a bit of a shock to my system as I have learned of each of these four renowned ethicists’ passing. With this shock has been an increasing sense that the leadership field of Bioethics is shifting to the next generation. And, I wonder what that will mean for the future.
Bioethics, began largely as a hobby for doctors — a hobby where many doctors’ devoted countless non-billable, volunteer, and “spare” time. Time often reserved for leisure and families. This volunteerism was focused on informing on organizational ethical issues in their health systems, to being present at the bedside and in ethics committee deliberations on cases regardless of their notoriety, informing the great development in research ethics, and quantifying the value of the practice of Bioethics.
Today, our small but mighty field continues to struggle to transition from an unsustainable volunteer-driven practice to a credentialed and formalized clinical practice. This practice requires the full buy-in and support of hospital administration and clinical practices. While, this effort is moving forward — thanks to the efforts of many to inform value-driven data, algorithms, and similar compelling matrixes — we are retroactively creating a clinical practice and formalizing a discipline. In full honesty, we are at a great disadvantage in this retroactive positioning when other young specialities are incorporating training and expertise from the field of Bioethics as naturally assumed practices of all practitioners. After all, we all aspire to be innately ethical and by assuming various oaths we affirm our commitment to always be ethical in our practices. Why then, some ask, is there really a need for a separate field - Bioethics, especially Clinical Ethics?
There is a great tension that continues to exist in physician-led approaches wherein, “armchair” ethics consults are far too prevalent and innate matter-of-fact assumptions that a clinician is an expert in Clinical Ethics. I do not question clinicians’ inherent desire and efforts to always engage patients’ and their loved ones in a fashion that fully embodies the premises of Clinical Ethics. But, I do question armchair practices and whether self-awareness of one’s biases and nuances in the clinical encounter are always deliberated by and each all clinical team members.
As we transition the baton naturally from a generation of founding leaders and greats in the field of Bioethics, I sincerely hope we continue to ask the challenging moral questions, engage in robust ethical analyses despite the comfort level and personal values of those engaged in the analyses, not shy away from publicized and private hard cases, strive for expertise that can withstand testimony and examination, and finally, remember that the bedside is where, indeed, our ethics cases come to life. Bioethics, clinical ethics specifically, cannot occur in a vacuum — from the comfort of our offices as we scrutinize records and various reports of what other’s have conveyed as the patients’ and involved clinical team-members narratives. If we adhere to these, among many more, teachings from our “greats” and collaborate among the many different generations of Bioethicists today, this young field has and will succeed in actualizing the vision of the “greats” who have given us the tools to create and practice this clinical discipline.
Happy Thanksgiving, stay safe, and thank you to all who are in the trenches taking care of us, to those in laboratories studying this novel virus, performing ethical research clinical trials, and helping develop treatments and vaccinations.
Emma J. Kagel, JD, MBE, HCE-C
Bioethics Alliance, Founder