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Pondering medicine's moral issues


The questions keep coming, through e-mails and phone calls, in formal meetings and chats: Should fetal tissue be used in research? Should the hospital allow couples to pay exorbitant prices for the donated eggs of women with beauty and intelligence? When does life begin?

Across the Johns Hopkins Medical institutions, scientists and physicians are trying to make sense of the moral questions that haunt their work. And increasingly, they are tapping the Hopkins Bioethics Institute.

Established a few years ago, the institute's faculty are grappling daily with some of the toughest and most pressing issues in modern medicine. They're getting so many requests for help that its director worries they won't be able to reach them all. But quietly, the center is influencing the way scientists do research and physicians practice medicine.

"It's not like we have a pipeline to the moral truth, and we're going to give it to you. It's, you've got the wisdom, you live it, and we have some tools that can help you think through it," said Ruth Faden, the institute's director. "Our moral reflection has to keep pace with our scientific and medical advances."

New efforts

That broad mission translates into many new efforts across the university and health system. A physician is teaching the ethics of the end of life to undergraduates at the School of Arts and Sciences. Researchers are investigating how seriously ill patients give consent to be in early phase clinical trials. Scholars are developing an ethics curriculum for researchers who work in developing countries.

To infuse ethics into the culture of the institution, the bioethics center is working on a strategic plan to train everyone engaged in patient care at Hopkins, said Faden, a widely respected scholar who led the national committee that investigated the human radiation experiments.

Lecture today

Today, the institute will be the host of a public lecture on the ethics of Medicare reform, followed by a two-day, off-the-record symposium next year involving key national players on all sides of that debate. The program, sponsored by the family of Robert H. Levi, a Baltimore businessman and philanthropist who was on the board of trustees at the hospital and university, aims to spark a dialogue and influence public policy.

The center has quickly moved to the forefront nationwide, making its mark with its work in contentious areas such as international research and genetic privacy.

"Hopkins was late to the gate for its ethics program, but they've really exploded once they made the decision to go for it," said Thomas Murray, president of the Hastings Center, one of the country's oldest and most prominent bioethics centers. "They're really in the top tier."

Larger operations

Though all hospitals have bioethics committees that deal with specific cases and policies, bioethics centers are more like think tanks that do research and education. About 50 of the country's 125 academic medical centers have these institutes, but most are small operations of just a few people. A handful, such as the University of Chicago and University of Pennsylvania, have larger operations like Hopkins', which has 24 faculty members.

The institute just launched a five-year, $26 million fund-raising initiative, and leaders say they are about a third of the way to their goal.

The center's unusual structure, being universitywide and independent of all the schools, gives it freedom to comment on the cutting-edge, often politically sensitive work of researchers.

For instance, when the Hopkins School of Public Health came under fire for clinical trials in Africa that compared experimental therapies to prevent mother-to-baby HIV transmission with placebos, the bioethics institute jumped into the fray.

Scholars brought attention to often-neglected elements: the moral perspective of researchers from developing countries, as well as those countries' political and economic conditions.

Stem cell debate

Faculty members of the Bioethics Institute also got involved in the firestorm of debate over stem cells. (These parent cells, from which all tissues develop, could someday be used to help diseased organs.) Using private funding, Hopkins researchers isolated these cells from the tissue of aborted fetuses. They were donated by women who had made up their minds to have abortions and who had no connection to the scientists.

But the Hopkins work, along with that of another team's, sparked a national controversy. In the aftermath, the Hopkins researcher who did the work, Dr. John D. Gearhart, a professor of obstetrics and gynecology, turned to Faden and her colleagues.

"We needed help," he said.

Now, he seeks their counsel routinely.

There were no laws or guidelines in place for obtaining fetal tissue, so he said the bioethics scholars came up with a series of five or six procedural recommendations on how to do that.

"You just can't go shooting from the hip," Gearhart added. "You want to make sure that what you're doing is right with a capital R."

Madison Powers of Georgetown University will deliver the Robert H. Levi Lecture at 3: 30 p.m. today at Shriver Hall on Hopkins' Homewood campus.

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