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After 35 years of creating and running the world’s leading clinical medical ethics fellowship program, Mark Siegler, MD, will step down as founding director of the MacLean Center for Clinical Medical Ethics at the University of Chicago Medicine.
Siegler will assist with the transition to his successor while he continues to practice medicine as a general internist at UChicago Medicine, as he’s done for more than 50 years. He will continue to direct the Bucksbaum Institute for Clinical Excellence.
“It is my hope that the MacLean Center, and the field of clinical medical ethics, both flourish going forward,” said Siegler, the recipient of many prestigious honors, including being appointed as UChicago’s Lindy Bergman Distinguished Service Professor of Medicine and Surgery.
Siegler not only established the clinical medical ethics field, he made the University of Chicago the world’s leader in the medical specialty.
Clinical medical ethics was born at UChicago Medicine in 1972, while Siegler was directing the hospital’s first Medical Intensive Care Unit (MICU). While treating the hospital’s sickest patients, he identified all sorts of questions and ethical issues for which there was nowhere to turn for answers. Things like, do you tell a patient’s family the truth about their loved one’s condition? Or, when there are a limited number of beds available in the MICU, who gets a bed? The sickest person, who has little chance of survival? Or a less sick person with a higher chance of survival?
One evening in 1972, while Siegler and some of the MICU team were relaxing at Jimmy’s Woodlawn Tap, his residents and students informed him that they always tell a MICU patient’s family that their loved one was going to die. This stunned and upset Siegler, but his co-workers argued that it prepared the family for the worst, took pressure off the doctors, and made them look like heroes if the patient survived. Siegler was immediately troubled by what he had learned, and started to do research on such topics.
“What drew me into this was the importance of ethics in the day-to-day practice of medicine,” Siegler said. “It’s not just about the occasional, complicated case. I think the field applies to every patient we see, inpatient or outpatient.”
The field of clinical medical ethics continues to be vitally important.
A few years later, in 1975, Siegler published his first paper on clinical ethics in the New England Journal of Medicine, titled “Pascal’s Wager and the Hanging of the Crepe.” The title references the wager over whether God exists. The “hanging of the crepe” is a ritual meaning someone was going to die.
Siegler would go on to write 300 other journal articles and book chapters, plus five books on the topic of clinical ethics. The 1982 textbook he co-authored with Albert Jonsen and William Winslade, “Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine,” is being prepared for its 9th edition, and has been translated into 11 languages.
“The field of clinical medical ethics continues to be vitally important,” Siegler said. “It’s contributed to better patient care, to shared decision-making and to better doctor-patient relationships.”
Thanks to multi-million dollar donations from the MacLean Family, Siegler established the MacLean Center. Since its creation in 1984, the center has trained more than 450 fellows in clinical ethics. Many of these fellows now lead clinical ethics programs at hospitals and universities around the world. Thirty-five new ethics fellows will join the MacLean Center on July 1, 2019.
The MacLean Center offers an annual conference, a year-long lecture series and an unparalleled 80-lecture Summer Intensive Course.
“The Fellowship training established by the MacLean Center has had a greater impact than any other clinical ethics program in the world,” states the wording on Johns Hopkins University’s Harvey M. Meyerhoff Leadership in Bioethics Award, which Siegler recently received.
In 2011, to extend the hospital’s work on the doctor-patient relationship, UChicago established the Bucksbaum Institute for Clinical Excellence. The institute was created with a transformational endowment gift of $42 million from Matthew and Carolyn Bucksbaum and the Bucksbaum Family Foundation.
The goal of the Bucksbaum Institute is to prepare physicians to be highly skilled practitioners as well as caring, compassionate and ethical providers of care. Since 2011, Siegler has served as the institute’s founding executive director.
Siegler’s work has addressed issues such as truth-telling, informed consent, confidentiality, shared decision making and end-of-life care. He also established an ethics consultation service, which in the past 35 years, has advised physicians on more than 2,000 complicated cases involving difficult ethical issues.
Advances in science and technology constantly provide new clinical ethical issues to study.
“There’s so much going on, and so many changes,” Siegler said. “My goal has been to train enough clinicians to become experts in clinical medical ethics. And the University of Chicago is the best place in the world to do that.”