Medical ethicists are consultants, teachers, researchers, and policy makers in the field of medical ethics, the branch of philosophy that addresses the moral issues involved in medical practice and research.
Medical Ethicist Career History
Medical ethics as a distinct field arose in the 1960s, although, of course, the realization that an ethical code is an essential aspect of the practice of medicine goes back to ancient times. Physicians throughout the Western world traditionally took the Hippocratic oath (named for the Greek father of medicine) in which they pledged to put the patient’s well being ahead of all other considerations and to observe confidentiality in all doctor-patient transactions. They promised to respect human life and refused to perform abortions or assist in suicides.
By the middle of the 20th century, however, the explosion in medical technology had made ethical decision-making far more complex. At the same time, patients were demanding the right to be actively involved in making decisions about their medical treatment; they were no longer willing to passively accept the paternalism of the traditional “doctor always knows best” model of health care.
Recognition of the urgent need for a new emphasis on medical ethics had already been triggered by the revelations of the post-World War II Nuremberg trials in which the world learned of the appallingly inhumane medical experiments carried out by Nazi physicians on human beings. During the next few decades, accounts of unethical medical research projects in the United States also emerged. One notorious case was the Tuskegee Syphilis Study in which medical treatment for syphilis was deliberately withheld from a group of black men so that the progress of their disease could be studied.
Medical ethics addresses the complex questions involved in modern medical treatment and research. Medical breakthroughs in recent decades have saved lives but have also created new dilemmas. In the past, people were considered dead when they stopped breathing and the heart stopped beating. Now, however, brain-injured persons unable to breathe on their own can be kept alive indefinitely in a persistent vegetative state by means of artificial ventilators that breathe for them and artificial alimentation (feeding). Is this life? Who has the right to decide? What would the patient want? What about the people waiting for transplants who would benefit from the organs of the person being kept alive on the ventilator?
The questions are endless: How is competency to make life-or-death decisions for oneself defined? What if parents want to withhold lifesaving treatment from their severely handicapped newborn baby? How do we decide who gets organ transplants? What about the use of fetal-tissue transplants to treat Parkinson’s disease and other conditions? When people are suffering intense pain from incurable illness, should physician-assisted suicide be allowed? What are the implications of high-tech reproductive developments, such as in vitro fertilization, artificial insemination, and surrogate motherhood? What about gene splicing and cloning?
The identification of all 30,000 genes in human DNA as part of the Human Genome Project has created a new world of possibilities —and dilemmas—that medical ethicists will help doctors and patients confront.
The Patient Self-Determination Act (PSDA), which took effect in 1991, requires hospitals, hospices, and nursing homes to inform competent patients that they have the right to accept or reject treatment and to draw up a living will or other advance directive making their wishes clear. The PSDA obviously provides some parameters for the rights of individuals but leaves many questions unanswered. More and more, patients, family members, physicians, and other medical personnel are turning to medical ethicists for assistance in clarifying the issues and making decisions. Medical ethicists acting in this role are known as ethical consultants.
Medical Ethicist Job Description
Most medical ethicists are involved in some combination of teaching and research in an academic setting: a medical school, seminary or divinity school, or the department of philosophy and/or religion at a college or university. Some hold academic positions and also have a private practice as ethical consultants for local health care institutions. A small but increasing number of medical ethicists work full-time as consultants in private practice. Others are employed as researchers and policy developers by federal, state, and private agencies.
A typical workweek for a medical ethicist employed in academia includes about 10 to 15 hours of teaching classes or holding private conferences with students. Classes typically attract students from a wide range of professional programs (law, medicine, nursing, and religion) as well as graduate students in ethics. They spend the remainder of their time conducting research, writing papers, attending to department business, and serving on institutional review boards (IRB). As part of an IRB, medical ethicists approve biomedical and behavioral research protocols for clinical trials, help hospitals and universities consider the rights of patients, and guard against scientific misconduct, such as may occur when commercial entities sponsor research.
Medical ethicists who are employed at a hospital or medical center help medical professionals address ethical issues by participating in individual ethics consultations with patients or staff members. Some requests are quite simple, such as a patient wanting to talk about making a living will. Others are more complex, involving a patient’s refusal of treatment or disagreements between doctors and family members about treatment options. Although competent adults have the right to refuse treatment, a life-or-death decision should not be made without serious discussion. In many cases, competency to make an informed decision is a difficult matter to determine. When the patient is clearly not competent (an infant or a person in a coma) and has not left an advance directive (a living will or assignment of durable power of attorney), ethical problems multiply. And what happens if a patient’s condition becomes critical but the person to whom he or she has given durable power of attorney cannot be located? While ethical issues arise in all hospital departments, ethics consultations are frequently requested by the ICU (intensive care unit) or in connection with organ transplants, premature births, and difficult pregnancies. Medical ethicists also spend time working on IRBs, committees, and attending to administrative duties, such as planning budgets. Research, writing, and participation in professional organizations are also important parts of a medical ethicists job.
Medical Ethicist Career Requirements
To become a medical ethicist, you should take a well-balanced college preparatory course load in high school, including classes in science, math, history, literature, and languages. Dr. Richard Zaner, professor emeritus and former director of the Vanderbilt University Center for Clinical and Research Ethics, emphasizes the importance of including courses that encourage the development of imagination and creativity, such as literature, art, and music. Good communication skills are also important, so speech and English classes are also recommended.
Students with many different college majors go into the field of medical ethics. Most people working in medical ethics first obtain their formal training not in medicine or bioethics, but in law, medicine, philosophy, religion, or sociology.
A good liberal arts program that includes laboratory sciences, social sciences (especially psychology and sociology), and humanities (philosophy, religion, history, and literature) provides a solid foundation for graduate work in ethics. Dr. Zaner recommends philosophy or religious studies as the best undergraduate majors for studying the human experience and traditions of ethical reflection.
Medical ethicists often earn a Ph.D. from a department of religion or philosophy, with a concentration in medical ethics. At Vanderbilt, for example, ethics is one of the fields within the graduate department of religion. Some programs, such as Vanderbilt, emphasize the clinical side of medical ethics (involving hands-on experience); others, most notably the University of Chicago, place a heavier emphasis on public policy.
Because medical ethics is a newly emerging field and is highly interdisciplinary, it is important not to focus solely on issues of medical ethics. Students need to learn a broad base spanning the entire field of ethics, as well as study such related areas as psychology and sociology.
Many medical ethicists approach their work from the perspective of a commitment to a particular religious tradition; for example, some ethicists are ordained clergy. However, regardless of whether medical ethicists have a secular or religious perspective, it is essential that they develop the ability to demonstrate sensitivity and understanding toward people who may have opposing convictions.
Dr. Zaner emphasizes the importance of getting supervised clinical training during a graduate program. “You need that experience at a hospital bedside talking with patients and doctors,” he says. Analyzing ethical problems in a seminar room is very different from being involved in actual life-and-death situations.
In addition to clinical experience, Ph.D. programs require several years of course work beyond the master’s degree, comprehensive exams (also known as qualifying exams), reading exams in (usually) two foreign languages, and the writing of a dissertation based on original research.
Certification or Licensing
There is no universal certification or licensing entity for medical ethicists. Most medical ethicists have at least a master’s degree; many have a Ph.D. and several years of experience in a clinical, academic, or theological setting. Because medical ethicists come from such varied backgrounds and fill varied roles, there is not yet a consensus in the field on who should be allowed to serve as a medical ethicist.
Public Responsibility in Medicine and Research is a national membership organization that offers a certification exam to candidates serving on an institutional review board (IRB). As part of an IRB, medical ethicists approve biomedical and behavioral research protocols for clinical trials, help hospitals and universities consider the rights of patients, and guard against scientific misconduct, such as may occur when commercial entities sponsor research.
When asked what personal qualities are important for a career as a medical ethicist, Dr. Zaner puts listening skills at the head of the list. “You also need to have flexibility and a balanced temperament, the courage to explore the unknown, and the ability to live with moral uncertainty,” he adds. Dr. Zaner has coined the term “possibilizing” to sum up the imaginative quality of “thinking for the possibly otherwise.”
Medical ethics is not the right profession for people who expect to find easy, clear-cut answers or prefer to avoid dealing with the tough questions of life and death. Clinical consulting in medical ethics also requires the patience and emotional maturity to work day after day with people who are suffering and in pain.
Since a career as a medical ethicist often requires a Ph.D. or at least a master’s degree with some clinical and/ or life experience, it is obviously essential to have good academic skills and to enjoy studying. However, learning does not stop when your formal education is complete. Because the field changes so often and so rapidly, medical ethicists must read up on every development and possible policy change that will affect his or her job. Medical ethicists today are confronting issues created by technological advances that would have been dismissed as science fiction not long ago.
Exploring Medical Ethicist Career
Sometimes it is possible for high school students to get personal exposure to the work of medical ethicists. On several occasions, Dr. Richard Zaner has arranged for an interested high school student to spend a few weeks shadowing him, which includes accompanying him on hospital rounds, attending his classes and committee meetings, and sitting in on discussions with patients and doctors. Perhaps there is a medical ethicist in your community who would be willing to offer you a similar educational experience. If not, there may be opportunities to do volunteer work at a hospital, which would give you an idea of the kinds of issues that arise in medical settings. You might be able to interview the chair of a hospital ethics committee or other people who are involved in the field. Keep up to date on the latest developments and controversies in medical ethics by reading newspapers and magazines or watching news programs on television.
Most medical ethicists are employed by academic institutions and university-related medical centers. Typically, they teach at medical and nursing schools, colleges, universities, seminaries, and divinity schools. They often do consulting at university-related and/or local health care facilities as part of a hospital ethics committee or institutional review board. For most, ethical consulting is part of their academic jobs, but some maintain private consulting practices along with their teaching positions. A new and growing trend in the field of medical ethics is to become a full-time private entrepreneur with a client pool made up of various local hospitals and health care agencies. New policy requiring all hospitals to have ethics committees has created a demand for these independent ethics professionals.
Other medical ethicists, generally those who are more interested in research and policy development than in direct involvement with the clinical aspects, work for federal agencies. For example, medical ethicists are employed by the Department of Energy for its radiation-exposure study.
Medical ethicists also work for the National Institutes of Health on the Human Genome Project. The Ethical, Legal, and Social Implications Program of the Human Genome Project considers ethical dilemmas presented by new genetic knowledge.
State agencies usually do not hire medical ethicists for full-time positions, but this may change in the near future. There are also employment opportunities for medical ethicists at private agencies, institutes, and foundations, such as the Rockefeller or Eli Lilly foundations.
Medical ethicists learn about job openings through personal contacts, professional journals, and listings published by professional organizations. Students looking for their first professional position in medical ethics should turn to their graduate school professors, especially their dissertation committee members, for advice on current job openings.
Medical ethicists in academic institutions advance by being promoted from assistant professor to associate professor to full professor. Advancement is measured by professional achievement, such as success in teaching, research, writing, and/or consulting work. Some medical ethicists become directors of major research projects or of centers for ethical study in university settings, government agencies, or private foundations. Advancement for consultants in private practice is gauged by increased reputation and a larger client base.
A 2004-05 salary survey by the American Association of University Professors found the average yearly income for all full-time university teachers was $68,505. It also reports that professors averaged the following salaries by rank: full professors, $91,548; associate professors, $65,113; assistant professors, $54,571; instructors, $39,899; and lecturers, $45,647. Medical schools tend to pay more than other academic institutions. Medical ethi-cists who are employed as consultants for hospitals have incomes that are comparable to college teachers. Upper-level salaries for medical ethicists are usually $100,000 or more.
Medical ethicists work in a variety of settings. Those teaching and conducting research will have a dramatically different work environment than those who attend patients in an intensive care unit. In general, ethicists specialize in the area they are most suited for, whether it is a fast-paced hospital, a crowded classroom, or a quiet library. However, as previously mentioned, many medical ethicists combine these duties. As a result, their work environment can be constantly in flux.
Medical Ethicist Career Outlook
Medical ethics has been a growing industry for the last 10 years, and this trend should continue. The sheer quantity of issues demanding attention from medical ethicists will undoubtedly continue to expand as advances in technology, like the mapping of the human genome, are made.
However, despite the bioethics boom, jobs remain relatively few in number. Only the most qualified experts make medical ethics a full-time career; most will supplement their work teaching or consulting in their area of expertise, such as law, religion, or medicine. The advent of managed health care has made it difficult for most institutions to hire full-time medical ethicists. Also, as more universities offer master’s level and certificate-level programs, they can provide current employees with medical ethics training, rather than providing openings for new staff members.
While colleges or universities employ many medical ethicists, the academic sector alone cannot provide jobs for everyone entering the field. Medical ethics jobs in the government sector will provide additional opportunities. Government staff positions include working with congressional health committees, state and legislative health subcommittees, and executive branch policy-related committees.
Institutional research boards (IRBs) also provide jobs for medical ethicists. IRBs have grown in number as both the amount of research being conducted and the regulatory demands on that research continue to increase. Most IRBs are affiliated with hospitals or universities, but some independent IRBs offer consulting on new drug and device reviews.
One thing to keep in mind is there is a high level of competition for jobs. Medical ethics has become an exciting field that is often in the news. As a result, it has attracted many students, resulting in a large number of graduates seeking out a limited number of positions.