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Medical Ethics Make Good MDs

March 7, 2003

Heather Heilman

hheilman@tulane.edu

"Moral issues are often communication issues at heart," said Robert Martensen. Doing the right thing requires listening to all the relevant voices, considering each and putting them in proper context to each other. Martensen is the first holder of the James A. Knight, M.D., Chair of Humanities and Ethics in Medicine.

The chair is named after psychiatry professor James Knight, who developed the first course in medical ethics at Tulane and served for more than 10 years as dean of admission. The search committee wanted someone for the job with a rich background in both medicine and the humanities. As an emergency room physician in a San Francisco hospital with a patient population as diverse as the United Nations, Martensen became fascinated by his patients and their different beliefs about medicine and the workings of the body.

Sometimes the relatives of Chinese patients would come in at night to perform practices of traditional medicine, often unbeknownst to the hospital's doctors. "The Western system assumes that the brain is dominant in the body, but other systems look at it differently," Martensen said. "Ours is the only system that is concerned with anatomy and uses dissection, yet we assume that's the only way to know things."

His curiosity piqued, he returned to school at the University of California San Francisco to acquire a doctorate in the history of medicine. His book, The Cerebral Body and Its Alternatives, grew out of his dissertation and will be published this fall. He comes to Tulane directly from the University of Kansas School of Medicine, where he headed the Department of History and Philosophy of Medicine, building the size and scope of the program. He hopes to do similar things at Tulane.

"Of course, many people at Tulane have been involved in humanities and ethics for some time," Martensen said. "Many students choose Tulane because of its reputation of being supportive of the humanities."

First- and second-year medical students at Tulane already take classes in ethics, and the school does a good job of helping students develop and maintain interests in the arts and humanities throughout their training. Martensen would like to extend classes in ethics into the third year and beyond and to expand the presence of the humanities at the health sciences center. He'll also be a presence uptown, working with the Murphy Institute of Political Economy and teaching classes on the history of medicine and history of disease.

Part of his job involves consulting with doctors, patients and their families about ethical dilemmas. The terminally ill and their families, for example, often seek him out for help in making decisions about end-of-life issues. And he's often called to speak at conferences about ethical problems that arise in the wake of scientific advances such as gene therapy.

"Historically, I think ethics has almost always been reactive. A new practice or technology will be developed and we have to figure out how to use it." But he's been thinking ahead at least a little bit. One of his new writing projects is a book on the future of genomics, tentatively titled "Welcome to Genomia."

Although ethical standards are malleable, they can provide a framework that helps doctors make good decisions in the increasingly complicated environment in which they work. People still tend to assume that a physician's first loyalty is to the patient, but things get convoluted when a third party is paying the bill, when specialists of various sorts are brought in, when malpractice insurance rates become exorbitant.

"There's always been a tension in professional life between the model of selfless service and the need to pay the bills. But it's become more pronounced."

What he wants to give to students is essentially an expanded perspective. He wants them to have a deep understanding of the system in which they work, an ability to synthesize different perspectives, and a basic appreciation of different cultures and worldviews.

"Most of medicine is really about forming an opinion," Martensen said. "The more information you have to draw on, the better your opinions will be."

Besides the pleasure and refreshment the humanities offer doctors, they also help in that broadening of perspective necessary to making good judgments. One class takes students to the New Orleans Museum of Art to see what they can tell about the subjects of paintings just by looking at them, then doing the same thing with photographs of patients. "The humanities help develop a sense of narrative and the ability to see things holistically," he said.

Heather Heilman can be reached at hheilman@tulane.edu.

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