Caplan examines 'moral laboratory'

Arthur Caplan, director of the University's Center for Bioethics, has come a long way since teaching his first medical ethics class as a Columbia University graduate student. "It was a bomb," Caplan remembered. "The students laughed at me." But the disheartening experience did not deter Caplan from pursuing a medical career in 1976 and discovering a "moral laboratory" during his medical school rotations. According to Caplan, the atmosphere was one of "hard choices with real outcomes" where medical decisions were burdened with a newfound ethical content. He recalled the 1970s as a decade consumed with ethical questions surrounding test-tube babies, euthanasia and organ donation. And, as Caplan noted, the issues have not drastically changed. Assisted suicide, genetic intervention, organ rationing and AIDS testing in pregnant women are at the forefront of bioethics debates today. In response to increased student and faculty demand for a forum in which to discuss the ethical implications of new technologies, the University's Health System created the Center for Bioethics in 1994. The center works in conjunction with the Medical School and the Hospital of the University of Pennsylvania, in addition to communicating with the various schools on campus. Caplan, his eight colleagues and 20 additional faculty members receive about 2,000 inquiries a year -- mostly from high school students, medical students and the media -- on a range of topics. And the center's World Wide Web site -- which features articles from top experts in the field -- caters to 30,000 visitors a week. Caplan noted that the site received 50,000 visitors in the first few days of the sheep cloning controversy. As Sociology Professor Paul Wolpe noted, "bioethics thrives on crises." Since the center was founded, it has integrated more ethics into the curriculum than any other medical school, according to Caplan. Citing the center's recently initiated "Curriculum 2000" as an educational plan, he stressed the importance of physician-patient interaction. He said the center seeks to achieve a medical environment that reinforces values of sensitivity and quality of work rather than efficiency and speed. But Caplan worries that significant changes in the medical curriculum will not be enough to combat the real-world constraints of managed care and cost containment. "You can teach somebody to be a good communicator, but if they only have a minute to see each patient, they're not going to have much of a chance to use those skills," he said. As Caplan explained, "Good bioethics is pro-active -- good bioethics stays right up where science and medicine is at, and Penn is a good environment for that." Before the media exposed sheep cloning as a potentially fateful step in the slippery slope of genetic manipulation, the center was aware of the possibility of cloning animals, Caplan said, who perceives the public's frenzy over cloning as a reaction based on the public's lack of understanding of the "social genetic evolution" and its distrust of science. He compared the cloning to the Wright brothers' first airplane flight. Since no one knows how to do it safely and reliably, the technology will probably not be applied to human beings any time soon. "We made Dolly and we made about 10 or 12 deformed female sheep," Caplan said. "That might be OK if you're talking about lamb chops, but we're talking about people here." Insisting that bioethicists are not just a group of "Ayatollahs" looking to tell people what to do, Caplan said they are "Socratic" in their approach to raising questions about morality and dignity. He recommends that students suffering from the "bioethics bug" should investigate the center's new graduate program in Bioethics through the College of General Studies. But he warned that obtaining a job as a bioethicist entails a degree in another field, such as nursing, public health or philosophy. For interested undergraduates, the center is currently negotiating with the History and Sociology of Science Department to develop a concentration in Bioethics as early as next fall.