Congratulations to Geisel School of Medicine’s new Swigart Fellows—Edel Auh ’22, Julia Berkowitz ’20, and Colin McLeish ’22.
Now in its third year, the Olive M. and Joesph F. Swigart Ethic Fellowship Program is an opportunity for faculty and students to collaborate on scholarly research projects around ethics issues in patient care and medical education, and to share new knowledge with both the medical school and Dartmouth-Hitchcock. The yearlong projects have resulted in drafting several manuscripts for publication, professional conference and poster presentations, and new focuses in medical education and clinical care.
Funding for the Swigart Fellowship is provided by the Olive M. and Joseph F. Swigart Fund for Practical Education in Medical Ethics, established through a bequest from Olive “Polly” Swigart, a teacher, and Joseph Swigart, who worked in finance. The fund reflects their shared concern for the ethical practice of medicine and their belief that training in ethics should be integral to medical education. Twenty years later, their fund continues to support ethics education—a powerful example of the enduring impact of endowments.
“The thing that impresses us is not only the quality of the work, but the range and importance of the ethics issues these projects are examining,” says Bill Nelson, PhD, MDiv, a professor of psychiatry and of community and family medicine and The Dartmouth Institute for Health Policy & Clinical Practice, who, with James Stahl, MD, MPH, an associate professor of medicine, directs the Swigart Fellowship . “The students have done a great job with their projects, which have the potential of making a difference in both clinical care and medical education.”
This fits with the goal of encouraging fellows to expand the understanding of healthcare ethics, Stahl says. “There is this idea that ethics only deals with birth and death issues—but ethics permeates every aspect of our lives including how we deliver healthcare,” he says. “It touches everything we do as physicians.”
Pursuing his enthusiasm for philosophy and ethics in medicine, McLeish is working with Stahl on the nature of autonomy, which is essential to our understanding of how people make decisions and how physicians deliver care. “The concept of how we define autonomy is far more complex that what people understand,” Stahl says. “When we were approached with this particular project—I have a background in decision science and decision theory—it raised an intriguing question about identity and how we understand the ability to make choices, but the idea of it is really about a core concept central to ethics and to healthcare ethics in particular.
“In decision science,” Stahl notes, “there are attitudes toward risk and toward ambiguity, both of which affect people’s comfort and willingness to make decisions, so digging deeper into that is an important project.”
By critiquing “the dominant theories of autonomy in medical ethics, many of which originate from the moral philosophy of Immanuel Kant,” McLeish says his goal is reconstructing a theory of autonomy that is built on Kantian ideals—such as good will, sincere ethical action, and the requirement to never treat persons as means—which also compels us to accept the full content of altruistic morality.
“I am enormously grateful to the Swigart Fellowship for the opportunity to pursue my endless curiosity about philosophy and ethics in medicine, and to share this enthusiasm alongside a faculty mentor and two of my peers,” he says. “I look forward to a year of rigorous study and writing.”
Though not intentional, there is an interesting overlap between Auh’s research and McLeish’s—both are looking at decision making. Auh, who has worked as a hospital interpreter, is examining the effect of language barriers in decision making. She is working with a Dartmouth College-based medical and psychological anthropologist, Elizabeth Carpenter-Song, PhD, an adjunct associate professor of psychiatry at Geisel, who has done extensive research in how culture and bias influence decision making.
“I will be working with Professor Carpenter-Song studying the various challenges of effectively conveying uncertainties to patients in the presence of language barriers,” Auh says. “We are particularly interested in the difficulties of obtaining proper informed consent because of these communication barriers and the roles that interpreters play in addressing these issues.”
Collaborating with Matthew Duncan, MED ’01, an assistant professor of psychiatry and an associate dean of student affairs, Berkowitz is taking on a the nationally prevalent problem of medical student and physician burnout.
“The purpose of this project is to determine key barriers to mental wellness and key contributors to student burnout at Geisel, and develop implementable recommendations to Geisel faculty and administration,” Berkowitz says. “We’ll also present our findings to medical students with the hope of reducing stigma and the sense of isolation that exists around burnout and mental health challenges.
“I am extremely grateful for the opportunity to work with Dr. Duncan through the Swigart Fellowship—it would be wonderful for Geisel to be a leader in addressing this critical issue that is pervasive throughout medical education, training, and beyond.”
Back in 2016, when Nelson and Stahl began creating the fellowship program, their goals were modest. When they launched the project, their intention was for faculty and students to get together to really explore and become knowledgeable about a specific ethical concern. Stahl notes, “Each year, I am more impressed with how both faculty and students are embracing the idea and taking the lead in identifying projects that we need to begin exploring and developing new knowledge. We’ve come a long way in a short time, and I hope the fellowship program continues expanding both in range of ideas and scope.”
Nelson says, “When we first started constructing the program, we weren’t quite sure how it would go. I echo what James said—we’re impressed with how students have taken on their projects and have created outcomes that are significant and important. I think the fellowship has made a difference in the lives of our students and many of them want to carry the nature of the work into their careers. Our hope is to expand the program beyond two or three fellows each year—and to grow not only in substance but in recognition. So far, we are really happy with the outcome.”