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Most medical ethicists are involved in some combination of teaching and research in an academic setting: a medical school, seminary or divinity school, or the department of philosophy and/or religion at a college or university. Some hold academic positions and also have a private practice as ethical consultants for local health care institutions. A small but increasing number of medical ethicists work full time as consultants in private practice. Others are employed as researchers and policy developers by federal, state, and private agencies.
A typical workweek for a medical ethicist employed in academia includes about 10 to 15 hours of teaching classes or holding private conferences with students. Classes typically attract students from a wide range of professional programs (law, medicine, nursing, and religion) as well as graduate students in ethics. They spend the remainder of their time conducting research, writing papers, attending to department business, and serving on institutional review boards (IRB). As part of an IRB, medical ethicists approve biomedical and behavioral research protocols for clinical trials, help hospitals and universities consider the rights of patients, and guard against scientific misconduct, such as may occur when commercial entities sponsor research.
Medical ethicists who are employed at a hospital or medical center help medical professionals address ethical issues by participating in individual ethics consultations with patients or staff members. Some requests are quite simple, such as a patient wanting to talk about making a living will. Others are more complex, involving a patient's refusal of treatment or disagreements between doctors and family members about treatment options. Although competent adults have the right to refuse treatment, a life-or-death decision should not be made without serious discussion. In many cases, competency to make an informed decision is a difficult matter to determine. When the patient is clearly not competent (an infant or a person in a coma) and has not left an advance directive (a living will or assignment of durable power of attorney), ethical problems multiply. And what happens if a patient's condition becomes critical but the person to whom he or she has given durable power of attorney cannot be located? While ethical issues arise in all hospital departments, ethics consultations are frequently requested by the ICU (intensive care unit) or in connection with organ transplants, premature births, and difficult pregnancies. Medical ethicists also spend time working on IRBs, committees, and attending to administrative duties, such as planning budgets.
The Patient Self-Determination Act (PSDA), which took effect in 1991, requires hospitals, hospices, and nursing homes to inform competent patients that they have the right to accept or reject treatment and to draw up a living will or other advance directive making their wishes clear. The PSDA obviously provides some parameters for the rights of individuals but leaves many questions unanswered. More and more, patients, family members, physicians, and other medical personnel are turning to medical ethicists for assistance in clarifying the issues and making decisions. Medical ethicists acting in this role are known as ethical consultants.
Research, writing, and participation in professional organizations are also important parts of a medical ethicist's job.