My journey from bench scientist to clinical ethicist
Posted by Michael Szego, on 1 June 2011
Four and a half years ago I was introduced to the field of clinical ethics while nearing the end of my Doctorate in Molecular Genetics at the University of Toronto. After attending a talk given by Kerry Bowman, a clinical ethicist at one of the University teaching hospitals, I approached him with some additional questions. The ensuing discussion led to a productive working relationship. Initially, I helped him perform an ethics analysis of a complicated genomics project. He then invited me to participate in some of his other professional responsibilities, opening a door into a new profession. This foray into clinical ethics had a lasting effect; in short order I decided to retire my pipette and pursue a career in clinical ethics.
At the beginning of my PhD, my intention was to pursue a career as an academic scientist. Like many graduate students I experienced both euphoric moments when critical experiments worked and frustrating periods when experiments were not informative. While I enjoyed the scientific process, I had a nagging feeling that a scientific career was not the perfect fit for me. Accordingly, I tried to keep an open mind and got involved in extracurricular activities. I participated in student governance, got involved in science outreach and taught with a non- governmental organization overseas. I also regularly attended a life science career development seminar series meant to expose graduate students to careers outside of academic science. I first met Kerry when he talked about clinical ethics at one of these seminars.
What immediately captured my imagination was the interesting breadth of activities performed by clinical ethicists. In Canada, most large hospitals either employ their own clinical ethicist(s) or have access to a regional clinical ethics service. Clinical consultations are the bread and butter of most clinical ethics programs and are usually triggered by an ethical tension in the provision of patient-care. A conflict regarding a treatment decision or plan, complicated end-of-life decision making, whether to withdraw life support, consent and capacity issues, and disagreement about discharge planning are all examples of clinical cases that may benefit from clinical ethics support. On the organizational level, many ethicists are also involved in the development of hospital policy since good policies may help mitigate future ethical tensions. Teaching is another important facet of clinical ethics. Education serves to raise awareness about ethical issues and can increase the capacity of healthcare workers and researchers to deal with ethical issues in their practice. Many ethicists also conduct independent research and serve on hospital research ethics boards (the Canadian equivalent of research ethics committees).
After deciding on a career track, I knew I needed more education. To address my knowledge gap, I enrolled in a Bioethics Masters program at the University of Toronto. I was fortunate enough to get a scholarship and worked hard over the two year degree to immerse myself into the field of bioethics. I took a generalist approach and chose a course-based professional masters program, which allowed me to take more courses compared to the thesis-based program that was also offered. I completed the degree and am currently a fellow in clinical and organizational ethics at the University of Toronto Joint Centre for Bioethics. The fellowship program is analogous to an apprenticeship program in ethics. Each fellow rotates through the ethics programs of four partner healthcare institutions over the course of a year (3 months is spent at each site). This unique and wonderful experience has given me practical ethics experience that complements the theoretical knowledge I learned in graduate school.
How has a PhD in molecular genetics prepared me for a career in ethics? Interestingly, several of my patients and non-ethicist colleagues have asked about my background and only about half immediately appreciate why a background in genetics might be useful in ethics. The other half usually can’t get over the fact that most of my training is not in philosophy. I view my background in science to be of great relevance. I am able to understand the science behind many emerging technologies in medicine, which is critically important in order to discuss the ethical implications of new technology and recommendations on how to proceed. My science training also heavily contributed to the development of my analytic, writing and presentation skills, which nicely compliments my bioethics education.
The combination of science and clinical ethics training is still quite unusual and has afforded me some unique opportunities. For example, I have been embedded in a genomics centre at a large research institute to work on ethical issues in parallel with scientific innovation. I have also been invited to speak at several interesting venues on topics involving genetics and ethics. As my fellowship is drawing to an end, I am seeking out clinical ethics positions that will allow me to perform all the clinical activities I described earlier and also use my genetics knowledge in a research ethics capacity. I hope to continue working closely with scientists and work on the ethics of the new research as it is being developed. Although not yet employed as a clinical ethicist, I was recently asked to give a talk about clinical ethics at the same seminar series that first introduced me to the field. I graciously accepted and am looking forward to describing my exciting field to other life science students.