The Center for Bioethics & Health Law celebrated its 30th anniversary in 2016. It now seems obvious that the University of Pittsburgh, with its world renowned academic medical center and top-ranked departments of both philosophy and the history and philosophy of science, would have launched one of the earliest and most prestigious centers for medical ethics. In the 1980s, however, contemporary bioethics was in its nascency. Hiring faculty to conduct bioethics research and develop educational programs in clinical ethics was visionary.
Founding. Creating the Center for Medical Ethics was part of the vision of Thomas Detre, MD, who came in 1973 to the University of Pittsburgh from Yale to be Director of the Western Psychiatric Institute and Clinic (WPIC) and Chair of the Department of Psychiatry. To a Yale colleague’s warning that “planes fly over Pittsburgh, they do not land there,” he is known to have responded, “They will land when we land.”
Dr. Detre did not land alone. Among the approximately thirty faculty he recruited to Pittsburgh from Yale was Alan Meisel, JD, who co-founded, with Loren Roth, MD, MPH, the Law & Psychiatry Program at WPIC in 1974.
In 1982, Prof. Meisel was invited to join the staff of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, where he helped draft the commission’s report, Deciding to Forego (sic.) Life-Sustaining Treatment, which led him to write The Right to Die: The Law of End-of-Life Decisionmaking (published in 1989 and regularly updated since). In 1984, Dr. Detre was named Senior Vice Chancellor for the Health Sciences. In 1986, Prof. Meisel co-founded the University’s Center for Medical Ethics with Kenneth Schaffner, MD, PhD, of the Department of History and Philosophy of Science (HPS), to gather together faculty investigating the conceptual and ethical foundations of health-related research and clinical practice. (Dr. Schaffner is now Distinguished University Professor Emeritus of History and Philosophy of Science. Prof. Meisel, now Emeritus Professor of Law, was named the inaugural incumbent of the Dickie, McCamey & Chilcote Endowed Chair in Bioethics in 1997.)
Early growth. In 1988, Robert Arnold, MD, was the first faculty member hired specifically to conduct research in bioethics and to provide ethics education to medical students and residents. Dr. Arnold is now Distinguished Service Professor of Medicine, Chief of the Section of Palliative Care and Medical Ethics, and Chief Medical Officer of the Palliative and Supportive Institute of UPMC.
Laura Siminoff, PhD, now Dean of the Temple University College of Public Health, joined the Center in 1989 as Director of Research. In 1997, Howard Degenholtz, PhD, was hired into that position. He is now Associate Professor of Health Policy and Management (HPM), and Director of his department’s Doctoral Program in Health Services Research and Policy. In 1991, Lisa Parker, PhD, was recruited back to her alma mater and into the Center to teach medical ethics and serve as a resource to researchers and clinicians throughout the University and its associated hospitals. (In 2016, she was named the Center’s director.)
Clinical ethics education. In 1988, Dr. Arnold developed the School of Medicine’s Clinical Ethics Training Program and Fellowship Program in Medical Ethics. Dr. Roth originated the School of Medicine’s curriculum for the Patient-Doctor Relationship Block, the forerunner of the Introduction to Being a Physician that today constitutes students’ first experience in medical school.
Today, Center faculty also participate in several national and international training programs and provide bioethics education across the Schools of the Health Sciences. In addition to education provided to medical students and residents, Center faculty teach ethics courses in the Schools of Nursing and Public Health, provide lectures in the School of Pharmacy, and are collaborating to develop ethics offerings in the School of Health and Rehabilitation Sciences.
Bioethics education. In 1989, the Center collaborated with the Department of History and Philosophy of Science to create a track in medical ethics within the Master’s degree in History and Philosophy of Science. In 1994, programs with the School of Medicine and School of Law were established to enable pursuit of MD/MA and JD/MA joint degrees. In 1998, the medical ethics track was replaced by a new degree program—the Interdisciplinary Master of Arts Program in Bioethics, a program of the Dietrich School of Arts & Sciences (DSAS). The School of Medicine’s Area of Concentration in Medical Humanities and Ethics was developed for the medical students in 1997 by Center faculty.
Today, in addition to the Bioethics Program and its joint degrees with law and medicine, the Center is collaborating to develop in DSAS a graduate-level Certificate in Bioethics and an undergraduate Certificate in Health Humanities. Beyond these degree and curricular programs, the Center has hosted bioethics colloquia and interdisciplinary research seminars, and since 2015, the Health Humanities Lecture Series.
Health law education. Prof. Meisel founded the University’s Health Law Certificate Program in 1996 to afford law students in-depth study of legal issues that arise in the operation of a health care institution, as well as the legal foundation necessary to develop health policy. Since 2018, Mary Crossley, JD, who has particular interest in disability law and in public health law, has directed the Program, as well as a joint program in Law and Public Health. Associate Dean for Equity and Inclusive Excellence Tomar Pierson-Brown, LLM, JD, who joined the law faculty in 2015, serves as Director of the Health Law Clinic, which operates as a medical-legal partnership with UPMC-Children’s Hospital of Pittsburgh. Greer Donley, JD, a former NIH Bioethics Fellow, joined the law faculty in 2018 and directs the joint program in Law and Bioethics.
In recognition of the University’s and Center’s strength in health law—and most importantly because ethical issues and legal issues frequently intersect in general and in healthcare and public health—in 1998, the Center’s name was changed to the Center for Bioethics & Health Law. In 2006, the Certificate in Disability Legal Studies was established and is currently the only formal program focused on disability studies at the University.
Continuing education. In 1990, with a grant from the Vira I. Heinz Endowment, the Center launched its Consortium Ethics Program (CEP) to provide continuing ethics education to healthcare institutions in the region. The Program resulted from the collaboration of Alan Meisel, Lisa Parker, and Rosa Lynn Pinkus, PhD, who served as its director until her retirement in 2013. In 2014, pediatric surgeon and bioethicist Aviva Katz, MD, MA, became the Director of the CEP until her death in January 2018. Valerie Satkoske, PhD, currently serves as the Program’s Director.
What began as a pilot program for 12 acute-care hospitals became a self-supporting membership-based program in 1996, and today continues to provide education to health systems, hospice facilities, in-home healthcare, and regional hospitals serving urban and rural communities. During its first three decades, the CEP not only expanded clinical ethics expertise in the region’s healthcare institutions, but also helped advance the careers of three now prominent bioethicists, who served as the Program’s associate directors: Mark Kuczewski, PhD, now the Fr. Michael I. English, S.J., Professor of Medical Ethics and Director of the Neiswanger Institute for Bioethics and Health Policy at Loyola University, Chicago; Mark Aulisio, PhD, now the Susan E. Watson Professor and Chair of the Department of Bioethics at Case Western University; and James Dwyer, PhD, now Professor of Bioethics and Humanities at Upstate Medical University.
In 1991, the Center initiated its annual spring conference series. This Interprofessional Ethics Conference now showcases the long-standing Ira R. Messer Memorial Lecture, named for a University of Pittsburgh class of 1927 graduate. In 1996, the Center launched its Visiting Professor Program to bring to campus leading bioethics scholars to present colloquia and give Grand Rounds lectures in clinical departments of Medicine (the Tisherman Lecture), Pediatrics (the Donald N. Medearis, Jr., MD, Memorial Lecture), and Obstetrics, Gynecology and Reproductive Sciences, and in the School of Public Health.
Today, the Center is also collaborating with the UPMC Palliative and Supportive Institute to offer a Healthcare and Spirituality Lecture Series, and with the Mid-Atlantic Regional Public Health Training Center to develop ethics education programming for the public health workforce.
Consultation. From 1991 until 2011, Center faculty staffed the 24/7 Ethics Consultation Service for three University hospitals of UPMC—Presbyterian, Montefiore, and Shadyside—and served on their ethics committees. Consultants typically took call for one month in rotation. As the UPMC health system expanded, Center faculty no longer served as consultants. They continue to volunteer their time serving on ethics committees at Presbyterian, Montefiore, and Shadyside University Hospitals of UPMC, and also at Magee-Womens Hospital of UPMC, Children’s Hospital of Pittsburgh of UPMC, and Western Psychiatric Hospital of UPMC.
The Center’s experience in ethics consultation has been highly influential in the field of clinical ethics consultation. Beginning in 1998, the Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation met to develop a set of core competencies for the conduct of clinical ethics consultation. Together with Stuart Youngner, PhD, from Case Western Reserve University’s Department of Bioethics, Drs. Arnold and Aulisio drafted the Task Force Report, which was subsequently adopted by the American Society for Bioethics and Humanities. In July 2000, on behalf of the Task Force, they published a position paper summarizing the Report’s content.
Today, Center faculty members also serve as research ethics consultants to the University’s Institutional Review Board/Human Research Protection Office, Clinical and Translational Science Institute, Institute for Precision Medicine, and Human Stem Cell Research Oversight Committee. In 2020, Center faculty were asked to staff the Research Ethics Consultation Service (RECS), as part of the University’s Research, Ethics and Society Initiative.
Research and policy development. From its founding, faculty of the Center, along with colleagues in the Law & Psychiatry Program, pioneered interdisciplinary research—conceptual, empirical, and legal—on foundational bioethical concerns: informed consent, competence assessment, confidentiality, research ethics, and the right to die. As demonstrated by their current research portfolios, Center faculty members’ research programs have evolved to keep pace with developments in medico-scientific research and challenges in healthcare and public health. Center faculty have collaborated with University and national colleagues on several research projects resulting in widely adopted policies.
In 1992, for example, Center faculty serving on the UPMC Medical Ethics Committee, chaired by Michael DeVita, MD, developed the nation’s first policy on Organ Donation following Cardiac Death Declaration using traditional circulatory-respiratory criteria (aka non-heartbeating organ donation). The effort took 18 months, and involved over 100 UPMC staff and dozens of external reviewers. The result was a widely recognized policy that serves as a template for hospitals and organ procurement organizations nationally. The Kennedy Institute of Ethics Journal published a special issue in June 1993 on development of the policy.
The Committee also developed and implemented, in 2002, the nation’s first policy permitting and regulating research involving deceased individuals, a previously unregulated practice, and established the University’s Committee for Oversight of Research and Clinical Training Involving Decedents.
Since the COVID-19 pandemic began, Center faculty member and UPMC Endowed Chair for Ethics in Critical Care Medicine Douglas White, MD, has led policy development initiatives with colleagues nationally to address ethical issues in the allocation of scarce critical care interventions like ventilators and scarce medications, which in turn have influenced discussion of coronavirus vaccine allocation. Center faculty are consulting on the distribution of vaccine within University and UPMC populations.
Looking to 2021, Center faculty have formed the Religion, Medicine, and Healthcare Research Initiative to bring together University and UPMC scholars and researchers, as well as colleagues from nearby research institutions to develop an infrastructure to engage in interdisciplinary research at the intersection of religion/spirituality with health and well-being, healthcare, health law, and health research.
Evolution in an evolving context. In 2016, Lisa Parker, PhD, was named as the Center’s director. She initiated additional collaborations to expand the Center’s programming throughout the health sciences and the University. In 2019, she was appointed to the Dickie, McCamey & Chilcote Endowed Chair in Bioethics.
Just as a foundational issue from the time of the Center’s founding—the “right to die”—has evolved from its conceptualization as the logical extension of a right to refuse medical intervention to analysis of assistance in dying, the field of bioethics and the Center have evolved to address scientific advances and newly recognized challenges to health and well-being. Since the Center’s inception, bioethics research methods have evolved, and new conceptual tools and frameworks have emerged and been honed.
The interdisciplinarity that seemed rather novel at the Center’s founding has become widely embraced, even if it remains challenging to implement fully within academic institutional infrastructures. Healthcare is delivered by interprofessional teams, and clinical ethics education is poised to be delivered to interprofessional groups of clinical learners. Legal scholar and critical race theorist Kimberlé Crenshaw articulated the conceptual lens of intersectionality in 1989, and by means of feminist bioethics, it has gradually made its way into bioethical analysis to help illuminate interlocking barriers to achieving justice in healthcare and health research.
Contemporary bioethics—“born” amid 20th century social movements of patients’, women’s, and civil rights—eventually effected a shift from medical paternalism to a framework recognizing patient autonomy and supporting respect for all patients and their values. But bioethics, like society, has been forced to recognize that patients differ not just in their values and preferences, but in their social identities, economic circumstances, and cultural backgrounds. As a Center, we appreciate that these differences have ethical significance as patients interact with a healthcare system and as people seek health and well-being in society. The COVID-19 pandemic made evident how much not just differences in material conditions, but structural injustices affect people’s health, healthcare, and reasons to trust or mistrust scientific and public health experts.
Bioethics—always at the intersection of the medical and social sciences, law, and the humanities—increasingly draws on the methods and insights of gender studies, critical race theory, behavioral economics and decision theory, and frameworks of social justice and human rights. Responding to this evolution, the Center developed a partnership in bioethics with Carnegie Mellon’s Center for Ethics & Policy, and is collaborating with Pitt’s Gender, Sexuality, and Women’s Studies Program, Department of Africana Studies, Center for Health Equity, and Institute for Precision Medicine.
Medicine and public health increasingly employ the biological, environmental, and cultural diversity of populations to understand human health and disease. Studying these differences may provide more effective healthcare to enhance patient and population health. As Center faculty we also recognize the need both to avoid inappropriate reductionism and to ensure that Big Data, learning healthcare systems, and precision medicine do not exacerbate health disparities or social prejudices. As a Center we remain committed to addressing the challenge articulated by Harold Edgar, the lawyer who represented men who were enrolled in the Tuskegee Syphilis Study: “the Human Genome Project will bring to the forefront of human consciousness awareness of the range of variability not only among individuals but among groups. To acknowledge these differences, while insisting on their irrelevance for individual dignity and equality of right, is a challenge we shall have to face.”
(Updated January 2021)