The Importance of Formal Education and Training in Clinical Medical Ethics for the 21st Century

Abstract

In 1972, soon after I started the first medical intensive care unit (MICU) at the University of Chicago, a unit whose patients raised multiple, serious ethical issues, I created the new field of Clinical Medical Ethics (CME) in the Department of Medicine at the university. In my view, both in 1972 and today, CME is an intrinsic part of medicine, surgery and all medical disciplines, and is not a branch of bioethics or philosophical ethics or legal ethics or theoretical ethics. Rather, it is a central component of clinical care that must be practiced and applied by licensed clinicians in their routine, daily encounters with patients. Although bioethicists may provide theoretical insights to clinicians, bioethicists cannot practice medicine or examine patients or provide care to patients. During the past 49 years, CME has become a transformative field in medicine and surgery that aims to improve both the clinical and ethical quality of care and outcomes that clinicians provide their patients (Singer et al., BMC Med Ethics 2:1, 2001). In ordinary clinical practice, CME addresses many clinical ethical issues, including truth-telling, informed consent, confidentiality, surrogate decision-making, the risks, benefits and alternatives to surgical or medical procedures, end-of-life care, and also encourages personal, humane, compassionate, and fair interactions between doctor and patient.

The goals of CME are to improve patient care and outcomes by helping physicians, surgeons and other health professionals identify and respond to clinical-ethical challenges that arise in the ordinary care of patients. As Edmund Pellegrino, Peter A. Singer and I wrote 30 years ago: “The central goal of CME is to improve the quality of patient care by identifying, analyzing and contributing to the resolution of ethical problems that arise in the routine practice of clinical medicine” (Siegler et al., J Clin Ethics 1:5–9, 1990). Similar to cardiology and oncology consultations, ethics consultations are a small component of a much larger field, just as the consultations in cardiology and oncology or CME are certainly not at the core of cardiology, oncology or Clinical Medical Ethic.

This article will discuss the following five topics: the origins of the field of CME; the goals and methods of CME; the relationship between the larger field of CME and the narrower practice of ethics consultations; the contributions of the MacLean Center at the University of Chicago in developing the fields of Clinical Medical Ethics; and how CME has improved the practice of medicine and surgery (Siegler, J Clin Ethics 30:17–26, 2019).

Appendices

Appendix 1: The 33rd Annual MacLean Fellows Conference on Clinical Medical Ethics. November 12–13, 2021

Each year for the past 33 years, the MacLean Center has hosted a conference at which former MacLean Fellows and current faculty discuss major issues in Clinical Medical Ethics. The MacLean Center for Clinical Medical Ethics at the University of Chicago is the oldest, largest, and most distinguished clinical ethics program in the world. Since the MacLean Center was founded in 1984, the Center has trained more than 625 Clinical Ethics Fellows, and they include more than 500 physicians. In 2016, Dr. Mark Siegler and the MacLean Center received the prestigious Meyerhoff Award from the Johns Hopkins Berman Institute of Bioethics. The award stated, “The training program established by the MacLean Center has had a greater impact than any other Clinical Medical Ethics training program in the world.”

This year’s MacLean Conference, on November 12–13, will include more than 40 exceptional lectures on the following topics: Clinical Ethics Decision-Making, Covid-19 Clinical Ethics, Health Policy and Health Disparities, Surgical Ethics, Pediatrics and Family Ethics, and End-of-Life Care.

Please refer to this year’s brochure and schedule: https://drive.google.com/file/d/1QDVQMYEXu7_rc5pK_rZ_7pwttKrjPXDy/view?usp=sharing

Appendix 2: The 2021–2022 MacLean Center Summer Intensive Program for the Fellowship in Clinical Medical Ethics. July 6–30, 2021

The MacLean Summer Intensive Program is unique and remarkable. This year, it offered fellows a four-week intensive experience that included more than 80 lectures and seminars presented by more than 37 MacLean Center Faculty. This year’s summer program offered courses on topics that included: Clinical Medical Ethics, Philosophical Ethics, Ethics Consultation, End-of-Life Care, Health Policy and Health Disparities, Law and Ethics, Surgical Ethics, Pediatrics and Family Ethics, Transplantation Ethics, Reproductive Ethics, Genetic Ethics, and Psychiatric Ethics.

Please refer to this year’s brochure and schedule: https://drive.google.com/file/d/1XU_nGvQTn1ZUR469XwoIAq6-hSrVcs9L/view?usp=sharing

Appendix 3: The MacLean Center’s 40th Annual Lecture Series. The History of Medicine and Ethics. Wednesdays 12:00–1:30 PM CT

In 1981, Mark Siegler and Richard Epstein organized a year-long, University-wide interdisciplinary lecture series on “Medical Innovation and Bad Outcomes: Legal, Social and Ethical Responses.” The success of that initial lecture program and of the book published based upon those lectures, demonstrated that there was great interest at the University of Chicago in creating a sustainable interdisciplinary forum to discuss health-related subjects with colleagues from the entire University campus. Each year since 1981, the MacLean Center for Clinical Medical Ethics has organized an annual lecture series of 20 or more lectures to examine the ethical aspects of one key health-related issue. Recent annual lecture series topics have included: Reproductive Ethics; Organ Transplantation; Pediatric Ethics; Global Health; Health Care Disparities; Pharmaceutical Innovation and Regulation; End-of-Life Care; Neuroethics; Trauma, Violence and Trauma Surgery, and Improving Value in the US Healthcare System. In the past two years, our lecture series topics were “The Present and Future of the Doctor-Patient Relationship” (2019–2020) and “Ethics and the Covid-19 Pandemic: Medical, Social and Political Issues” (2020–2021).

Please refer to this year’s brochure and schedule: https://drive.google.com/file/d/11oE4ynx1yclNv2r_3EMx7RJo__mMb891/view?usp=sharing