Pediatrician nurtures growth of ethics program

Medical ethics program marks silver anniversary A quarter century ago, with the financial and institutional support of a handful of visionary Wisconsin administrators, Norman Fost created UW–Madison’s program in medical ethics. Based in the Department of the History of Medicine, it’s among the longest- running interdisciplinary bioethics programs in an American medical school. Three other ethicists, –Daniel Wikler, Alan Weisbard and Alta Charo, all highly respected in their own right — have joined Fost as faculty members. Two more are expected to be hired soon. In their teaching, the faculty provide UW medical, law and philosophy students the analytical tools needed to address such difficult questions as: Should all Americans have the right to health care? Should people be tested for genetic diseases even if there are no cures? Should terminally ill patients have the freedom to end their lives with the help of a physician? Fost has introduced undergraduate students to these kinds of thorny issues in the popular bioethics course he’s taught every spring for the past 25 years. The UW medical ethicists serve as members of presidential bioethics commissions and other blue-ribbon panels charged with establishing guidelines on complex issues such as cloning, fetal-tissue research and cross-species organ transplantation. Through their involvement in recommending policy, and their teaching, research, and contributions to public debate in the media, they’re helping to frame ethical standards for the nation.

Even as a young medical student at Yale in the early 1960s, Norman Fost pressed for answers to difficult questions.

“What’s the point of even considering treatment options for this patient?” he asked during discussions concerning an elderly, comatose patient who would have no place to go and nobody to care for him if he survived.

The stunned physicians and students who huddled in the corner of the critically ill patient’s room ignored the question. Fost was later scolded and told to never bring up such inappropriate issues during rounds again.

“I knew then I was on to something,” says Fost. He also knew he would encounter many ethical quandaries once he became a pediatrician. He spent the next 10 years trying to find a way to make medical ethics the focus of his career, including earning one of Harvard University’s first master’s degrees in public health with a concentration in ethics.

Initially, mentors and friends were dubious at best. Debating philosophical issues of medical practice could never sustain a career, they reasoned. Deans and department chairs at prestigious East Coast medical schools were less charitable. They thought the idea was absurd–physicians at the time simply weren’t trained to discuss those kinds of subjective, personal issues.

But Fost pushed beyond the rejection and more than a few dark moments of self-doubt, and his tenacity paid off. Today, thanks in no small measure to his continuing leadership, medical ethics is widely appreciated as a highly relevant field with the potential to profoundly affect individual lives as well as national policy.

Loose ends started to knit together for Fost in 1972 when he stopped in Madison, almost on a whim, as he made his way to a job in California. In impromptu meetings and enthusiastic discussions with key UW administrators, the idea of a full- fledged program in medical ethics caught on, and Fost signed with UW–Madison.

From his Madison observation point, Fost has seen his chosen field expand from academia to capture the attention of government officials, the media and the public at large.

Fost, viewed usually as reasonable but at times controversial, is sought out for his perspective on topics as diverse as doping in sports, growth hormone therapy and research involving human subjects. His forums range from meeting rooms at the National Institutes of Health, to the pages of the Chronicle of Higher Education, to the New York City studios of “Nightline.”

The attitudes of his fellow physicians have also shifted radically since he was first rebuked as a student. “Most physicians today want to talk about it, hear lectures about it, read articles about it,” says Fost, a frequent guest speaker, seminar leader and consultant. “Bioethics has developed into a significant growth industry.”

On his home turf at UW Hospital and Clinics, where he has maintained his involvement in clinical pediatrics, Fost has served as long-time chair of the hospital’s ethics and human subjects committees. In their meetings, he and colleagues deliberate difficult issues with an eye to helping patients and families come to terms with some of the most agonizing dilemmas of their lives.

Students may have had the most enduring interest in ethical issues over the years, says Fost. Since the beginning, searching and thoughtful students have elected to take the classes he and his associates offer. “Students are inherently interested in these issues that have such a human dimension,” he says.

The heartland was possibly the likeliest place for it all to happen, reflects Fost. “This is the kind of place where innovative things can really happen, where people aren’t afraid to ask difficult questions.”