The Lancet Student

The importance of bioethics training - by Kyle Galbraith

This blog was submitted by TLS editor on 29th February 2012.
Tagged with Bioethics
Kyle Galbraith

Why should the coming generation of healthcare providers study bioethics? With my background in the humanities—or perhaps because of my rural Kentucky upbringing—I find that “why” questions are often best answered through story-telling. Bear with me while I spin a short yarn.

I was diagnosed with type 1 diabetes when I was 15 months old. In my rural part of the state, I didn’t know any other diabetic children. In my mind, I stuck out as the kid who couldn’t eat cake at your birthday party. Fortunately, my mother is a registered nurse and my father served in the U.S. military. Both parents cared deeply for me, so I had access to the health care I needed and a support system that taught me how to responsibly care for myself as I grew into adulthood. When I left home to attend college, I had aspirations of becoming a pediatric endocrinologist so that I could help other diabetic children who faced the same issues I faced growing up. As I navigated my way through the MCAT pre-requisite courses, I found that little of what I learned in the classroom resonated with my lived experiences as a child with diabetes. Learning about metabolic pathways, polar reaction processes, and formulas for differential equations is important for a physician-in-training—I would not want to be treated by a physician who has no understanding of basic metabolic processes!—I felt like there was a crucial element that was missing from my curriculum. So, I wondered down the hallway and enrolled in courses in philosophy and religious studies. It was in those courses where I heard the language of care, compassion, healing, and justice, themes I considered to be integral to my understanding of the medical profession. I continued that course of study until I earned a PhD in Religion with an emphasis in medical ethics. I never became a pediatric endocrinologist, and I have no regrets about that decision.

So why am I giving you a short biography? In my clinical ethics consultation work, I typically start my conversations with patients and/or family members with a short, friendly question: “How are you doing?” In those discussions, the people with whom I speak do not describe their circumstances with the language of a clinical case report. They do not tell me about their most recent A1c, their elevated white blood cell count, or their high creatinine level. They do not ask me to recite the mechanism by which NADH becomes NAD+ or about the biochemical reasons their anti-depressant has destroyed their libido. Ask the experienced providers around you, and I strongly suspect they’ll agree that most patients don’t speak about their concerns in that way.  Instead, healthcare providers are faced with questions rooted in the lived experiences of their patient:

    “Will I be able to run the marathon in three months?”

    “How long until I can get back to work?”

    “My husband and I were planning to go to Italy next month. Is there anything special we need to do for my condition while we’re traveling?”

    “Can my son have a piece of cake at his friend’s birthday party?”

To answer questions like these, the rigorous analytical training you receive as a medical student is absolutely necessary—but it is not sufficient. Patients ask these questions because they want to know how those numbers—their elevated levels, their chances of survival, the timeline of their recovery—fit into the larger story of their lives. To help them integrate your medical knowledge with their experiences and expectations, you need to know something about your patients as people. You need to learn about what they value, how they make decisions, and how their backgrounds flesh out their self-understanding. You need a degree of cultural competency, compassionate and active listening, and an openness to the humane side of medicine.  In other words, you would be well-served by some training in bioethics.

Kyle L. Galbraith is the manager of the Human Subject Protection Office at Carle Foundation Hospital in Urbana, Illinois. He recently earned a PhD in Religion from Vanderbilt University and completed a fellowship in Clinical Ethics Consultation through Vanderbilt’s Center for Biomedical Ethics and Society.

1 comment

Renaud on 14th March 2012 4:53pm

Thank you Kyle for this post; I always find it interesting to learn about the motivation of people working in bioethics.

For readers interested to learn more about upcoming bioethicists, the Cambridge Quarterly of Healthcare Ethics recently put together a very interesting special issue: It showcases short auto-biographical accounts authored by the 'upcoming generation of bioethicists'. An interesting read for those who will be working with bioethicists as part of their clinical practice.