Reflections from a clinical ethics intern

This is the forth in an ongoing series by Center for Medical Ethics and Health Policy summer interns, undergraduate/graduate students interested in emerging ethical issues.

“How to become a clinical ethicist” is a phrase I have Googled more times than I’m willing to admit. My interest began after attending a lecture on bioethics at a National Student Leadership Conference during my junior year of high school. The lecturer introduced the complexities of medical decision making as well as the four main pillars of bioethics: autonomy, beneficence, nonmaleficence and justice. I was instantly intrigued.

In the years since, I have tried to familiarize myself with the different guidelines and recommendations that career advice websites have to offer about what being a clinical ethicist looks like. No Google search, however, could have given me the answers and confidence that I found during my eight-week clinical ethics internship at Baylor College of Medicine.

The bulk of the internship activities occurred at Houston Methodist’s Neuro, Cardiovascular and Cardiac Intensive Care Units, where my fellow intern and I followed different faculty members through hospital rounds, family meetings and conversations with each patient’s care team.

Each morning began at hospital rounds or checking in with the care provider who consulted with ethics. These meetings provided information about the patients we would then use while conversing with their families. Most of our conversations with families involved values elucidation, where the ethicists focused on learning about who the patient was before they became incapacitated in order to understand more about what kinds of healthcare decisions they would likely make for themselves.

Outside of the hospital, my time as an intern was also spent attending a variety of meetings and participating in mentored research with the Center for Medical Ethics and Health Policy’s faculty. Each week, I observed and took part in handoff meetings with the team at Baylor St. Luke’s Medical Center and those at Houston Methodist, where the ethicist on call would share information about active cases for their colleague who would be replacing them for the week. Other meetings included center check-ins, journal club discussions, bi-weekly debriefs, the fellowship seminar series and Texas ethics consortium gatherings.

These activities allowed me to interact with ethicists from various backgrounds such as medicine, law, philosophy, theology and sociology. As part of my research, I was paired with Dr. Janet Malek and Dr. Trevor Bibler based on my interest within the field. With their guidance, I was able to do a deep dive into genetic modification, parental obligation, reproductive ethics and spirituality’s impact on medical decision making.

Each day was different from the last, but I found comfort in asking as many questions as possible and saying yes to everything. I scheduled one-on-one meetings with many faculty members to discuss my educational and career path, shadowed at the hospital whenever possible and asked to attend meetings that were not on the itinerary given to me at the beginning of my internship. Two things remained true during my time at Baylor, which was that I was given access to a treasure-trove of knowledge and unwavering commitment that everyone at the center has for investing in the future of the field.

Before arriving at Baylor, I of course had expectations and assumptions surrounding the experiences I was about to have. From this, I was most surprised to see how fast paced the clinical side of the job can be and I was amazed by the deep and thoughtful analyses I got to play a part in. My prior understanding of clinical ethics had led me to believe that the field was extremely fractured, so I was pleasantly surprised by the camaraderie and collaborative environment that I was immediately welcomed into.

The faculty and fellows I worked with reminded me time and time again that I am not alone in my confusion and uncertainty about what lies ahead, reassuring me that there are always people there to support me along the way. They taught me that it is okay to ask questions and that cold-emailing people is a lot more common (and less scary) than I had thought.

My colleagues and experiences at Baylor taught me that you learn most from the people around you. As a college student I am aware that most of my learning about my career field will happen outside of the classroom, which is something I had yet to experience before this internship. Every person you meet can teach you so much if you listen to their stories, ask them meaningful questions and watch their eyes light up when they solve a problem or talk about their interests.

I entered this internship program hoping to solidify my career goals and engage in exciting conversations with people whom I share interests with. While I believe that I have fulfilled these goals, I am also leaving having learned so much about who I am, who I want to be and how I am going to get there.

Clinical ethicists give voices and consideration to people who cannot share or express their own wishes. I think that the meaningfulness of this appeals to Gen Z individuals like me, who want to make significant impacts on the world around them.

Emily Peugh, clinical ethics intern, Center for Medical Ethics and Health Policy at Baylor College of Medicine; rising senior at California State University, Long Beach