'Bioethicists' Proliferate Despite Undefined Career Track

Bioethics is "definitely a growth industry," says Norman Fost. So you want to be a bioethicist. Join the rather crowded, ever-growing club. Bioethics centers and programs continue to proliferate as doctors, lawyers, and persons of every conceivable background remain intrigued by issues ranging from human cloning to managed health care. As Arthur Caplan, the director of the Center for Bioethics at the University of Pennsylvania, puts it, bioethics has moved from "infancy into adolescence." There's something of a transition under way: Traditionally viewed as a multidisciplinary area, bioethics, which first started to pick up steam in the early '70s, has started to come into its own as a legitimate interdisciplinary field. Most persons currently working in bioethics got their formal training not in bioethics programs, but in fields like law, medicine, philosophy, religion, or sociology. That appears to be changing as degree programs gain popularity. "It certainly seems like there's been a growth of formal higher degree programs," says Alta Charo, a professor of law and medical ethics at the University of Wisconsin, Madison, and a member of the National Bioethics Advisory Commission. "And that's probably going to continue because the field has gotten 'sexy.'" "I think now we're starting to see people who know early on that they want to do bioethics," says David Magnus, director of graduate studies at Penn's bioethics center. "There are more educational opportunities to offer them specialized interdisciplinary training in bioethics than used to be available." Although the number of bioethics professorships is increasing, the academic sector is far from able to meet the demand. And despite the bioethics boom, related jobs--academic and otherwise--remain relatively few in number, though rich in variety. "It's definitely a growth industry," says Norman Fost, director of the medical ethics program at the University of Wisconsin School of Medicine. "But it also depends on what you define as a job within bioethics." Only a select few will make adopt bioethics as a full-time career; most will instead opt, out of choice or necessity, to accept bioethics as an avocation or as one aspect of a career that might not explicitly include bioethics in its job description. "There's no set of credentials for a bioethicist, which makes it kind of hard to figure out what the core of a degree would be," says Charo. "It's going to take a while before we know whether those degrees are going to be respected degrees that will actually have a career path associated with [them]." Five to 10 years ago, it looked as though clinical ethicists would be a hot commodity. Hospitals and health care systems were expected to begin hiring individuals, say Ph.D.s in philosophy, who would be designated bioethicists and would act on cases as needed. Though there still are positions out there, the advent of managed health care has made such arrangements economically difficult and the need for the full-time clinical ethicists has not met initial expectations. Also problematic, says Jonathan Moreno, director of the University of Virginia's Center for Biomedical Ethics: A good bioethics consultant would inevitably generate patient-care policy issues for a hospital once in a while. "I think you're more and more going to see the people going to the model where they have an ethics committee ... who are unpaid [advisers]," maintains Magnus. He points out that such an arrangement may, in fact, be for the better. The Joint Commission on Accreditation of Healthcare Organizations requires that hospitals have a mechanism to deal with ethical problems; this usually takes the form of an ethics committee. According to Magnus, masters-level and certificate-level bioethics programs have started to give people at least some training in bioethics in more units throughout an institution, making professional clinical ethicists with dedicated salaries unnecessary. "Hospital ethics committees are expanding somewhat, not a lot," remarks Fost. Now that these committees exist in virtually all hospitals, part-time patient relations people are needed to address "frontline" bioethics problems like end of life issues, informed consent, and residents' involvement with care. Says Fost, "As somebody who hires those people, I can tell you bioethics training on a C.V. would be a big plus." Right now, philosophers and other non-medical doctors are, strictly speaking, permitted to do clinical ethics consultation. Establishing a system of accreditation for health care professionals dealing in bioethics appears to be, at this point, a bit premature. According to an October 1998 report from the American Society for Bioethics and Humanities entitled "Core Competencies for Health Care Ethics Consultation," guidelines should, for now, be enforced on a voluntary basis. Moreno suggests that the report didn't receive a lot of attention since clinical ethics consultation work has not met expectations in terms of money and jobs. Fost, though, emphasizes its importance. "The bottom line of [the report], which I agree with completely, is that this is not a field that is ready for credentialing," he remarks. "There is no core agreement on what the core ingredients of this area of expertise are." He adds that it'd be worth taking a second look at credentialing in another five to 10 years. "Whether you could ever get all of these warring factions together to agree on it politically, I don't know. ... Anybody and everybody can call themselves an ethicist now. So it's not surprising that we can get people with a wide range of knowledge [and] competence." Bioethics jobs in the government sector, meanwhile, continue to hold promise. They include staff positions working with congressional health committees, state and legislative health subcommittees, and executive branch health policy-related committees. Also available are National Institutes of Health positions such as those affiliated with the Ethical, Legal, and Social Implications (ELSI) Program of the National Human Genome Research Institute (NHGRI). Moreno supposes that the U.S. Public Health Service agencies will always need people to keep up with literature and take on advisory roles with regard to legislation. The recent biomedical research explosion has also bred an increase in the number of grants available for bioethics research, especially within the fields of nursing and medicine. "I think that's an area where in the last five years there's been a huge growth," remarks Magnus. "It's a lot easier to publish bioethics these days in mainstream journals in medicine and nursing, and it's a lot easier to get NIH grant funding and money to support research in bioethics if it's of an empirical sort." Perhaps the most common bioethics-related vocation is as a member of one of the many academic Institutional Review Boards (IRBs) cropping up all over the country. Responsible for reviewing potentially ethically volatile research, university IRBs, based primarily at medical centers, have grown in number as both the amount of research being conducted and the regulatory demands on that research continue to increase. "These days, companies seek out investigators and aggressively court people in academic centers to do projects for them," remarks Fost. "You don't have to apply to the company; they'll come looking for you .... It's becoming a major source of support for people in academic [centers]." Independent IRBs, though much fewer in number, have also started to recruit persons with formal bioethics training. Most independent IRBs focus primarily on new drug and device reviews, whereas academic IRBs also do so-called investigator-generated protocols that involve more cutting-edge, controversial, time-consuming studies such as in fetal tissue research. The Olympia, Wash.-based Western IRB (WIRB), the nation's largest, currently employs two bioethicists and, according to WIRB President Angela Bowen, they'd like to hire a few more. Bowen notes that a law or medical degree in conjunction with bioethics training is particularly helpful for the sorts of cases WIRB reviews. But formal training isn't always necessary: A number of WIRB staff members, such as lawyers and clergymen, have been "anointed" as ethicists despite their lack of formal bioethics training. American Society for Bioethics and Humanitieswww.asbh.org The American Society of Law, Medicine & Ethics www.aslme.org Association for Practical and Professional Ethics php.indiana.edu/~appe/home.html Canadian Bioethics Society www.bioethics.ca/english The Center for the Study of Bioethics at the Medical College of Wisconsin www.mcw.edu/bioethics Center for Bioethics at the University of Pennsylvania www.med.upenn.edu/bioethics/index.shtml Ethical, Legal, and Social Implications Research Program of the National Human Genome Research Institute www.nhgri.nih.gov:80/About_NHGRI/Der/Elsi The Hastings Center www.thehastingscenter.org National Reference Center for Bioethics Literature www.georgetown.edu/research/nrcbl National Bioethics Advisory Commission www.bioethics.gov Job opportunities aside, many bioethics and biomedical ethics centers often explicitly make the point that their programs are not intended as a means to a career. "We make that very clear," says Magnus of the Penn program. "It's even part of the application process. If somebody says, 'I want a masters degree so I can become a professional bioethicist,' that would be almost certainly grounds for not admitting [them] except under very rare circumstances." At the University of Virginia (UVA), many biomedical ethics masters students who have chosen a clinical course track rather than "public policy" or a "theory in method" track participate in the university hospital's ethics consultation service. Programs continue to search for the right mix of theoretical and practical training: Should the core of the discipline be a shared knowledge of stories, i.e., how they've affected people, created political interests, and shaped patterns of ethical analysis? Should it be a moral philosophy? Some say an emphasis on empirical bioethics, statistic- and data-based research, is the direction programs are headed. Empirical methods have been used, for example, to gauge how well different informed-consent processes work. In the case of a gene therapy trial, researchers might make measurements and test new protocols to find the best way to conduct a genetic counseling session so that people fully understand the terms of participating in an experimental trial. Magnus embraces the move toward empirical ethics, but he worries that while many students are well trained in the empirical methods, they don't have the philosophical grounding that they need to make the research really interesting. "You've got these really precise, nice methods but are asking really boring questions," he says. Moreno would like to see more students with social science backgrounds enter the fray. "It's a problem to say you're going to do empirically based ethics and not have anybody who really knows about descriptive ethics," he says. Moreno does, however, generally characterize the quality of bioethics program applicants as "amazing," despite the lack of real job growth. "I guess it's just such interesting stuff and people really like to do it. They're just hoping they'll find a way."

'Bioethicists' Proliferate Despite Undefined Career Track

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