Michele A. Carter, PhD
Frances C. and Courtney M. Townsend, Sr., M.D. Professor in Medical Ethics
Associate Professor, Institute for the Medical Humanities and
Department of Preventive Medicine and Community Health
Director, Institutional Ethics Program
Research Subject Advocate, General Clinical Research Center
BRINGING BIOETHICS TO THE BEDSIDE
A UTMB oncologist faced an ethical dilemma: He'd just received the test results confirming that one of his patients had a rare lymphoma that would kill her. He knew he had a moral obligation to give her the bad news; but because she was emotionally fragile, he also felt pulled to protect her. As a caring, compassionate physician, he wanted to do the right thing. The problem was, what he knew was right clashed with what he felt. He turned to the bioethicist who regularly accompanied his team on rounds as part of the Ethics Consultation Service.
In this case, the bioethicist was the service's director, IMH faculty member Michele Carter.
“Having the doctor feel comfortable expressing these concerns in teaching rounds shows that the program is working,” says Carter, who spent 10 years as an oncology nurse before earning her doctorate in philosophy. “Ethics consultation gives the doctor permission to recognize the ambiguity inherent in many health care decisions. Physicians are so used to having to be certain in medical judgments, but frequently they encounter moral uncertainty in other areas of practice.”
Rather than tell the oncologist what to do, Carter helped him define the issues involved and gave him guidelines for reaching an ethical decision. He was always firm in his obligation to be honest. He said, “I know that this is a moment where I'm faced with how to be a good doctor and how to communicate the hurtful stuff in a way that's best for the patient. I just needed to talk to someone and work this out.”
The oncologist made an appointment to break the news to the woman the next day. “That was an example of acting in a morally courageous way, of understanding and accepting the feelings he had and somehow transcending them to put the interests of the patient first,” Carter notes. “My role was to guide him toward what he knew was right. It wasn't to judge.”
Physicians, nurses, allied health workers and clergy can all call in UTMB's Ethics Consultation Service. So can any patient or family member. In addition to Carter, the service includes three other IMH bioethicists—Gene Boisaubin, Ron Carson and Bill Winslade.
Carter also teaches bioethics to medical students and to IMH graduate students and takes her work beyond UTMB, serving on research review committees, like those the National Institutes of Health has convened to study breast cancer. She contributes her understanding of the complex ethical issues that arise in research involving human subjects. Some of that comes from her clinical experience, some from her work as a philosopher trained in critical thinking and concept analysis.
Helping health care practitioners understand the role of the bioethicist is one of Carter's challenges. She sees herself “as a citizen of a democratic process, rather than a detached moral expert.” That's why, even when physicians prod her to make ethical decisions for them, she resists. Ethical ambiguities will always come up in patient care, Carter explains, and they will always need to be dealt with individually.
“You may be able to resolve a particular dilemma, but the moral questions are always there,” she says. “We have to be able to live with them and through them and not have this goal of achieving absolute certainty.”