As the Center for Bioethics & Health Law approaches its 30th anniversary, it now seems obvious that the University of Pittsburgh, with its world renowned academic medical center and top Departments of Philosophy and History & Philosophy of Science, would have launched one of the earliest and most prestigious centers for medical ethics. But in the 1980s, contemporary bioethics was in its nascency. Hiring faculty to conduct bioethics research and develop educational programs in clinical ethics was visionary.
Fortunately, it was part of the vision of Thomas Detre, who came to the University from Yale to be Director of the Western Psychiatric Institute and Clinic and Chair of the Department of Psychiatry, to support faculty investigating the conceptual and ethical foundations of medical research and clinical practice. He brought Alan Meisel, JD, from Yale to co-found, with Loren Roth, MD, MPH, the Law & Psychiatry Program at WPIC in 1974. Just over a decade later, Professor Meisel and Ken Schaffner, MD, PhD, from the Department of History & Philosophy of Science co-founded the Center for Medical Ethics, the forerunner of today’s Center. Robert Arnold, MD, recently named Distinguished Service Professor at the University of Pittsburgh, was the first faculty member hired, in 1988, specifically to conduct research in bioethics.
Faculty from Law & Psychiatry and the Center for Medical Ethics pioneered interdisciplinary research—empirical and conceptual—on foundational bioethical concerns: patients’ rights, professional responsibilities, informed consent, assessment of competence, confidentiality, ethics in research, and the right to die. Today, the “right to die,” initially the logical extension of a right to refuse medical intervention, has evolved toward consideration of assistance in dying. Our attention to ethical issues in research is today more focused on specific domains of research (genetics, neuroscience, community-based participatory research) and on questions demanding more nuanced analysis than either aspirational guidance documents or federal regulations can supply.
Moreover, while the later 20th century’s shift from medical paternalism to patient autonomy supports respect for all patients and their values, today we are acutely aware that patients differ not just in their values and preferences, but in their social identities, economic circumstances, and cultural backgrounds. We appreciate that these differences have ethical significance as patients interact with a healthcare system. Medicine and public health increasingly recognize and make use of the biological and cultural diversity of the populations they serve to provide more effective and efficient healthcare to enhance patient and population health. But we also recognize the need to ensure that Big Data, learning healthcare systems, and precision medicine do not exacerbate health disparities.
Bioethics—always at the intersection of the medical and social sciences, law, and the humanities—now draws increasingly on the methods and insights of gender studies, critical theory, behavioral economics and decision theory, and frameworks of social justice and human rights. Responding to some of these developments, the Center recently developed a partnership in bioethics with Carnegie Mellon’s Center for Ethics & Policy, as well as Pitt’s Institute for Precision Medicine.
Our Center has always been at the forefront of innovation in bioethics education. In the 1980s, 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. Center faculty initiated the Dietrich School’s Interdisciplinary Master of Arts Program in Bioethics, followed by joint programs with the Schools of Law and Medicine.
Today, Center faculty also participate in several training programs and provide bioethics education across multiple schools. Recognizing the need to develop tools to address intersecting sources of injustice within healthcare and biomedical research, we are proposing a graduate certificate program in bioethics in collaboration with the Gender, Sexuality, and Women’s Studies Program. Responding to the interests of Pitt undergraduates, Center faculty are developing an undergraduate certificate program in medical humanities. We have also launched Medical Humanities Mondays, with the support of the Humanities Center and the Provost’s humanities and diversity initiatives.
Along with the field of bioethics, our Center has come of age. The range of issues and projects we undertake to address them continues to expand. Our commitment to excellence and collegial collaboration remain unchanged.
Lisa S. Parker
Director