Penn Center for Bioethics

The Penn Center for Bioethics / Department of Medical Ethics was a leader in bioethics research and its deployment in the ethical, efficient, and compassionate practice of the life sciences and medicine. The Center had over 20 senior fellows and eleven associates with appointments in a number of University of Pennsylvania schools and departments including medicine, law, nursing, business, education, philosophy, psychology, sociology, religious studies, public policy, and public health. Five full-time faculty held primary appointments in the Department of Medical Ethics.

Activities of the Center / Department focused on empirical, interdisciplinary research. Projects were devoted to key issues such as genetic testing and engineering, informed consent, human subject research, end-of-life care, reproductive technologies, patenting, resource allocation, vaccine ethics, and transplantation. Faculty members spoke at community meetings, testified before Congress and the United Nations, and provided commentary to journalists. The Center sponsored public lectures, symposia, and workshops on timely ethical issues.

The Center / Department's education mission included a Master of Bioethics program; an undergraduate bioethics concentration; teaching in the medical school; teaching and advising in other schools within the University of Pennsylvania; continuing and executive education courses, conferences, and seminar; clinical consultation; and a high school bioethics program.

 

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  • Publication
    Improving Informed Consent: The Medium Is Not the Message
    (2003-09-01) Agre, Patricia; Campbell, Frances A; Goldman, Barbara D; Kass, Nancy; Boccia, Maria L; McCullough, Laurence B; Merz, Jon F; Miller, Suzanne M; Mintz, Jim; Rapkin, Bruce; Sugarman, Jeremy; Sorenson, James; Wirshing, Donna
    An important type of research on informed consent involves empirically testing interventions designed to improve the consent process. Here we report on the experience of eight teams that conducted research involving interventions designed primarily to impact one of three categories: decision-making, knowledge, and the therapeutic misconception.
  • Publication
    What Mediators Can Teach Physicians about Managing 'Difficult' Patients
    (2015-03-01) Fiester, Autumn
    Between 10% and 12% of patients are considered difficult by their treating physicians,1 indicating a widespread problem. Many physicians report feeling at a loss to know how to effectively manage challenging patient interactions.2 In extreme cases, physicians resort to refusing to treat hostile patients or dismissing them from their clinical practice.
  • Publication
    Weaponizing Principles: Clinical Ethics Consultations & the Plight of the Morally Vulnerable
    (2014-07-05) Fiester, Autumn
    Internationally, there is an on-going dialogue about how to professionalize ethics consultation services (ECSs). Despite these efforts, one aspect of ECS-competence that has received scant attention is the liability of failing to adequately capture all of the relevant moral considerations in an ethics conflict. This failure carries a high price for the least powerful stakeholders in the dispute. When an ECS does not possess a sophisticated dexterity at translating what stakeholders say in a conflict into ethical concepts or principles, it runs the risk of naming one side’s claims as morally legitimate and decrying the other’s as merely self-serving. The result of this failure is that one side in a dispute is granted significantly more moral weight and authority than the other. The remedy to this problem is that ECSs learn how to expand the diagnostic moral lens they employ in clinical ethics conflicts.
  • Publication
    Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure
    (2014-05-27) Fiester, Autumn
    Clinical ethics consultations (CECs) are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult’s endpoint runs the risk of overemphasizing the conflict’s resolution at the expense of the consult’s process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient “closure” for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as “bioethics mediation.”
  • Publication
    When It Hurts to Ask: Avoiding Moral Injury in Requests to Forgo Treatment
    (2014-03-01) Fiester, Autumn
    Clinicians commonly believe that "there is no harm in asking" patients with life-threatening illnesses if they would like to forgo aggressive therapy. In fact, many clinicians believe that the question is not only appropriate, but obligatory on grounds of patient empowerment and autonomy: Patients should be given all options, including the option to stop treatment. But in this piece, I argue that there is, indeed, serious -- and even traumatic -- harm in asking patients to forgo treatment if that request is perceived by the patient as evidence that the clinician devalues or questions the integrity of that patient's life. When such requests are perceived to imply: "Your life is not worth saving," the effect of the "ask" is insult and offense, not empowerment. I then argue how clinicians can avoid moral injury in conversations about withholding or withdrawing treatment.
  • Publication
    The "Difficult" Patient Reconceived: An Expanded Moral Mandate for Clinical Ethics
    (2012-05-01) Fiester, Autumn
    Between 15%-60% of patients are considered “difficult” by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed “difficult.” But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as responses to problematic interactions related to healthcare delivery. If there are grounds to reconceive the “difficult” patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.
  • Publication
    'Quality Attestation' and the Risk of the False Positive
    (2014-01-26) Fiester, Autumn
    The Quality Attestation Presidential Task Force’s recent proposal for “quality attestation” (QA) of clinical ethics consultants was advanced on the premise that, “[g]iven the importance of clinical ethics consultation, the people doing it should be asked to show that they do it well.” To this end, the task force attempted to develop “a standardized system for proactively assessing the knowledge, skills, and practice of clinical ethicists.” But can this proposed method deliver? If the proposed QA process is flawed, it will label clinical ethicists as qualified to do clinical ethics consultations (CECs) when they are not. The result will be the creation of a new, likely intractable, problem of CEC “false positives:” consultants who have passed QA without actually possessing the requisite knowledge and skills to perform CECs. To avoid the risk of false positives, the QAPTF needs to conduct a rigorous analysis of the skills that the QA process will be positioned to judge and those that are simply beyond the scope of its current metrics. Rather than “attesting” to overall CEC “quality,” QA needs to be precise about the skill inventory it can confirm yet honest about the skills it has no basis to assess. I will argue here that QA has strong prospects for accurately assessing consultants’ competence in ethical analysis but very weak prospects for determining competence in two other skills listed as essential by the QAPTF: value-neutrality and conflict resolution.
  • Publication
    Pilot Study: Does the White Coat Influence Research Participation?
    (2002-07-01) Merz, Jon F; Rebbeck, Timothy R; Sankar, Pamela; Meagher, Emma A
    In health care, the white coat symbolizes professionalism, trustworthiness, and competence; it also represents power. This suggests that the wearing of a white coat could influence the decisions of potential subjects who are asked to participate in clinic-based research.
  • Publication
    Teaching Nonauthoritarian Clinical Ethics: Using an Inventory of Values and Positions
    (2014-08-29) Fiester, Autumn
    One area of bioethics education with direct impact on the lives of patients, families, and providers is the training of clinical ethics consultants who practice in hospital-based settings. There is a universal call for increased skills and knowledge among practicing consultants, broad recognition that many are woefully undertrained, and a clear consensus that CECs must avoid an “authoritarian approach” to consultation—an approach, that is, in which the consultant imposes his or her values, ethical priorities, or religious convictions on the stakeholders in an ethics conflict. Yet little work has been done on how to teach CECs not to impose their values in an ethics consultation, or even on the dimensions of this problem. In this essay, I propose a tool for bioethical instruction that targets this question: how can CECs be taught a nonauthoritarian mode of ethical analysis and consultation that can avert the problem of values imposition?
  • Publication
    Commentary: The Questions We Shouldn't Ask
    (2012-01-01) Wahlert, Lance; Fiester, Autumn