WUSM physicians take proactive approach to ethics

An operating room trauma team is told their unconscious patient is a Jehovah’s Witness with religious objections to blood transfusions, but the patient has lost a lot of blood. Doctors are faced with ethical dilemmas such as this in hospital rooms and doctor offices around the nation every day. To help deal with these issues, the Center for the Study of Ethics and Human Values at Washington University offers monthly surgical ethics sessions as a way to contemplate the emotional, humane and legal implications of medical decisions. Read more from the St. Louis Post-Dispatch.

Washington U. ethics center brings bright minds together

(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Business section on Thursday, April 21, 2005)

By Judith VandeWater
Of the Post-Dispatch

A secretary’s call to the operating room informed the trauma team that its unconscious patient was a Jehovah’s Witness with religious objections to blood transfusions.

No blood was given. The patient survived surgery, but died within 36 hours in the intensive care unit at Barnes-Jewish Hospital.

Dr. Kim Lu, a surgical resident who assisted in the operation, was frustrated. “It was a preventable death,” he said recently.

Lu, now a fellow in colon and rectal surgery at Washington University School of Medicine, raised the case at one of the first ethics forums for surgical residents. These optional, monthly sessions – called surgical ethics and pizza rounds – began a few years ago as a way to give harried students pause to contemplate the emotional, humane and legal implications of their medical decisions.

Trauma surgeons work under extreme pressure and frequently are called on to make decisions of grave consequence. When life is slipping away, there is no time to convene a committee, said Dr. Mary Klingensmith, program director in general surgery at Washington University. She started the ethics rounds with Dr. Ira J. Kodner, a professor of colon and rectal surgery.

Kodner, an ethicist by avocation, said he had been bothered for years by the lack of mentoring in the pedal-to-the-floor surgical training program.

“We hire the most brilliant young minds to come into surgery, and we haven’t given them a forum for intellectual discussions of huge controversies that they face every day,” Kodner said.

Klingensmith recalled that no one in Lu’s discussion group understood the basis for the religion’s prohibition on transfusions. Kodner arranged a follow-on session with Jehovah’s Witnesses, who explained the underlying principles and values.

Kodner is adept at making connections within the university and between the institution and the community. He works that muscle as director of the interdisciplinary Center for the Study of Ethics and Human Values at Washington University.

The center gives grants, up to $5,000, to allow faculty to drive ethics training into curriculum and to encourage students to explore issues ranging from academic integrity to end-of-life care.

Stuart D. Yoak, the center’s executive officer, said the grants are funded by individual and foundation gifts. The Arthur and Helen Baer Charitable Foundation gave a $100,000 leadership grant last year. Yoak said the university supports the center’s operating expenses.

In recent months, it has sponsored separate forums on the scientific justification for stem cell research and a religious perspective on cellular cloning. Last fall, at the invitation of the Internal Revenue Service, it held an ethics forum for tax practitioners.

Kodner relishes the possibilities of intellectual matchmaking. For example, he plans to introduce Edward Lawlor, a health policy specialist and dean of the George Warren Brown School of Social Work, to Dr. Katherine Mathews, an obstetrician-gynecologist hired by the Alvin J. Siteman Cancer Center to do outreach in under-served communities.

“These two people need to know the other exists,” he said. “They need to talk about the problem” of under-served populations. “I’m going to see if they need resources.”

The concept behind the Center for the Study of Ethics and Human Values was to bring the university’s large talent pool together as issues arose.

“I know just within our own complex here and through outreach to the community, there are people who have huge expertise, interests and, in some cases, resources to solve these problems,” Kodner said. “They just haven’t talked to each other yet.”

Charlie Robin, executive director of the Edison Theatre on the university campus, contacted the ethics center when he began preparations for this weekend’s performances of “Hiroshima Maiden.” The puppet theater production, 8 p.m. tonight and Saturday, dramatizes the story of 25 young Japanese women disfigured by radiation from the atomic bomb that the United States dropped on their city at the end of World War II. The women were shunned and condemned to lonely lives before being brought to America in 1955 for reconstructive surgery.

“For 10 years, they had been locked in their rooms,” Robin said.

Edison and the ethics center on Wednesday sponsored a discussion on the ethics of beauty and post-combat responsibility. The discussion was led by professors of reconstructive surgery, history, anthropology and gender studies.

In keeping with the theme, the audience passed through the art show, “Inside Out Loud: Visualizing Women’s Health in Contemporary Art,” en route to the auditorium.

“We’ll be doing an event like this every year,” Robin said.

Out of the silo

The ethics center has modest offices on Washington University’s campus in Clayton. It does not position itself as a moral authority, said Robert Wiltenburg, dean of the University College and head of the center’s governance committee. Instead, the center has the ambitious charge of making issues so vivid, so well understood, that people feel compelled to respond.

Wiltenburg said the center has been “enormously successful” in engaging graduate professional students in ways that get them out of their intellectual silos.

For example, graduate students in law, medicine and engineering in January put together a forum on medical malpractice and tort reform. And the work of students of law, medicine and social work is supporting development of a palliative care service at Barnes-Jewish Hospital.

Wiltenburg hopes the lessons of social action and responsibility will be long-lasting.

“You just don’t stay in your professional bowl,” he said. “Instead, you are out there provoking conversation with people with whom you have interesting things to exchange.”

Starting conversations

A sampling of programs sponsored by the Center for the Study of Ethics and Human Values:

  • October 2004 – An ethics forum for tax practitioners
  • February 2005 – Business ethics lecture by Bob Kerrey, president of New School University in New York and co-chair of the 9/11 Commission
  • February 2005 – Stem Cell Research: Current and Future Challenges
  • Spring 2006 – American Indian tribal leaders will discuss cultural perspectives and trust issues related to genetic investigations. Indians are a prime population for genetic study.

Reporter Judith VandeWater
E-mail: jvandewater@post-dispatch.com
Phone: 314-340-8201

Copyright 2005 St. Louis Post-Dispatch, Inc.