The Bioethics of the Bedside

Posted in GUMC Stories

On March 15, hundreds will gather in Georgetown’s Leavey Center to honor the life and work of 92-year-old Edmund Pellegrino, MD, MACP — a physician and scholar known as the “father” of bioethics in America, and a man who has received, as one admirer said, every award possible.

The day-long symposium, titled Facts of Illness/Acts of Profession: Edmund Pellegrino and the Ethics of Health Care, includes top scholars in the bioethics field. The day ends with the unveiling of Pellegrino’s portrait and a dedication: Georgetown University Medical Center’s Center for Clinical Bioethics will be formally renamed in Pellegrino’s honor. That makes sense — he founded the center 22 years ago. The soon-to-be-named Edmund D. Pellegrino Center for Clinical Bioethics is one of a handful of centers devoted to clinical bioethics located on a medical center campus.

Pellegrino is now professor emeritus of medicine and medical ethics at Georgetown University Medical Center. He is also an adjunct professor of philosophy at Georgetown, where he directed two other ethics centers — the Kennedy Institute of Ethics and the Center for the Advanced Study of Ethics. Among his other accolades Pellegrino was president of Catholic University; president and chairman of the Yale-New Haven Medical Center; and chairman of the President’s Council on Bioethics from 2005-2009. He is regarded as one of Georgetown’s pre-eminent scholars.

Overseeing the event will be G. Kevin Donovan, MD, MA, the bioethicist and pediatrician named last September to step into Pellegrino’s proverbial shoes as director of the center.

“That won’t be possible,” says Donovan with a laugh. “To choose between metaphors, I can’t stand in his shoes. But I can stand in awe of him.”

Donovan knows Pellegrino well. He spent a sabbatical on a 1989-90 bioethics fellowship studying with Pellegrino at Georgetown prior to founding, and directing for two decades, the Oklahoma Bioethics Center. And like Pellegrino, he is a practicing physician and educator, as well as a bioethicist. At the University of Oklahoma College of Medicine, he was chief of pediatric gastroenterology and interim chair of the department of pediatrics. At Georgetown, in addition to directing the center, Donovan teaches medical ethics in the School of Medicine and spends a portion of his time treating young patients with gastrointestinal issues.

And also like Pellegrino, Donovan is Catholic, skilled and dedicated to fostering interdisciplinary, inter-religious and cross-cultural dialogue to increase the understanding of the Roman Catholic tradition of medical ethics, and the Ethical and Religious Directives for Catholic Health Care Service.

The Pellegrino center is focused on “the bioethics of the bedside,” Donovan says. Although multifaceted, involving teaching, research and publishing, that mission is most obviously seen in its consultation service. Five Georgetown faculty members, including Donovan, rotate to respond to the needs of individual patients and those caring for them when bioethics questions arise.

Do no harm

Many of those questions concern human life issues. The center stands at the heart of an increasingly complex medical and ethical dialogue over a variety of life and death issues.

Many of these issues focus on end-of-life care, Donovan says. “These are big, perennial issues, such as how to treat patients who are severely ill. We never want patients to suffer or receive treatments that are not beneficial, “ he says. “We want to respect a natural life, from beginning to end.” That includes, of course, no practice of abortion or assisted suicide, but there are many ethical issues in between these two extremes, Donovan says. “We don’t want to pull away from care that is beneficial, but also recognize when care may only prolong suffering,” he says.

“Day to day, all of us who practice medicine need to ask how we can best become the kind of physician who would do the right thing for our patients,” Donovan says. “Do no harm is more than just three words we all learn, but, rather, a starting place for developing the habit of excellence in the service of our patients.”

Bioethicists at the Pellegrino center also confront issues in medical care and research that are emerging or on the horizon. Genetic research and especially genetic testing is such a topic, Donovan says. “Who should be tested and why, what information is available, how is that information used and who is entitled to it?”

Neurobioethics is also demanding attention. “Research is delving into the brain, and we can look forward to pinpointing areas linked to aggression, self control, compassion, pain and suffering. Should we control those areas — how much can we change people’s behavior, and how much should we, even if it promotes quality of life?” Donovan asks.

“This is an extraordinary time in biomedical research — one in which technological advances and scientific discoveries introduce new and challenging ethical questions,” says Howard J. Federoff, MD, PhD, executive vice president for health sciences and executive dean of Georgetown’s School of Medicine. “Because of these new challenges, our Center for Clinical Bioethics is a critical aspect of our mission. The center has been a leader in the bioethics field for many years and with Dr. Donovan’s direction, Georgetown will continue to make significant contributions in advancing our understanding complex ethical issues while upholding traditional Jesuit values.”

Donovan is working now to revitalize the Pellegrino center — there has not been a full-time director for nearly three years — and then he wants to expand it. While he continues to consult key stakeholders before finalizing his vision for the center, he says one step he wants to make is to re-establish the master degree in bioethics once offered through the medical school.

“We want to build on what Dr. Pellegrino and his colleagues have created here,” Donovan says.

And he quotes an expression that Pellegrino liked to borrow from Einstein to describe the continuing mission of the Edmund D. Pellegrino Center for Clinical Bioethics: “Science can tell you how things relate to each other — science will never tell you what you ought to do.”

Facts of Illness/Acts of Profession: Edmund Pellegrino and the Ethics of Health CareA symposium celebrating the life and work of Edmund Pellegrino, MD, in his 93rd Year

Friday, March 15, 2013; Leavey Center
Symposium 8:00 am – 4:00 pm
Pellegrino portrait unveiling 4:00 pm

RSVP by 5pm March 11:

By Renee Twombly, GUMC Communications

(Published )