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How One Bioethicist Navigates the Role of Life-and-Death Bioethical Consulting

Challenges to the diagnosis of brain death, religious objections to treatments, and controversies in organ donation: These are only a few of the ethical issues Dr. George Hardart, M.S. in Bioethics program faculty affiliate, researches and provides guidance on. In addition to teaching in the program, Hardart is a Professor of Pediatrics at Columbia University Irving Medical Center (CUIMC). The medical center and its faculty members are an integral part of the School of Professional Studies M.S. in Bioethics program.

As an experienced clinician, Dr. Hardart also brings his experience as a bioethics consultant at NewYork-Presbyterian/Morgan Stanley Children’s Hospital (MSCH) to the program.

In a recent interview, Dr. Hardart discusses the role of ethics consultants at hospitals, explains how he approaches his SPS course, Pediatric Ethics, and shares his advice to students in the M.S. in Bioethics program. 

Tell us a bit about your background. 

My bioethics career began when I decided to pursue a career in pediatric critical care medicine. I wanted my academic pursuits to address and ameliorate some of the many ethical issues faced in intensive care units. Since coming to Columbia 20 years ago, I’ve worked to build a strong clinical and scholarly pediatric ethics program. We have a very robust pediatric ethics committee and pediatric ethics consult service at the Morgan Stanley Children’s Hospital, and the Program in Women and Children’s Bioethics has served as the academic home for ethics scholarship in pediatrics and maternal fetal medicine for 13 years. 

What are your primary research interests?

Within the broader fields of pediatric and critical care ethics, my primary research focuses on the role of family interests in medical decision-making and in ethical issues related to death and organ donation. The challenges have included exploring incorporation of the interests of the family into decision-making for children; examining the policies of implementing organ donation after circulatory death (DCD) in pediatrics, and working to address the clinical and policy challenges to the diagnosis of brain death in pediatrics as well as religious objections to the diagnosis of brain death.

What brought you to the M.S. in Bioethics program? Why did you decide to teach your course, Pediatric Ethics?

The Program in Women and Children’s Bioethics at MSCH is fortunate to have an extraordinary faculty with a wide breadth of experience and perspective in pediatric and maternal fetal ethics, and it was only natural to have this group bring their knowledge and experience to the Bioethics master’s program. 

Pediatric ethics has become a distinct field of study and expertise over the past 20 years, and I think that the master’s curriculum can only be enhanced by offering a course taught by practicing pediatric ethicists. 

You’ve been on several adult and pediatric ethics committees, including at CUIMC. Tell us a bit about what that involves. 

When I arrived at MSCH a couple of decades ago, I was honored to bring state-of-the-art structures and policies to the committee that Dr. John Driscoll founded at the Babies’ Hospital over three decades ago. This reinvigoration was based on my training and on the terrific ethics committee that I served on at Boston Children’s Hospital. I’ve learned that it is critical to gather a robust group of actively involved members of the hospital community from a wide range of backgrounds, including family representatives so that the committee truly represents all of the hospital itself.

Given the nature of your work, you often have to make difficult decisions about patient care. How do you approach those situations?

Ethics consultants do not have authority to make decisions, so their role is to create a comprehensive framework that will help the families and health-care providers make optimal choices. Using ethical theories and standards is the surest way to provide good guidance and minimize bias and opinion, which have no place in this type of consultation.

What is the best part of your work?

It is a joy to demystify ethical issues and help the entire community understand challenging decisions and situations. Through discourse and knowledge, everyone can be empowered to act in effective and principled ways and do so with a degree of moral peace as opposed to moral distress.

What’s one lesson you hope students take away from the M.S. in Bioethics program?

I encourage them to question assumptions, authority, and the familiar, and do so through reason and reflection. My advice is to use the reasoning skills they’ve honed in the Bioethics program to determine what guidance they should provide, as opposed to simply accepting what they have been told to think. I think that is the purpose of any ethics instruction, and it certainly is the primary goal of ours.

About the Pediatric Ethics Course

In this course, students explore the moral and legal status of children and parents in American society and beyond; fully break down and frame the ethical standards and foundations of medical decision-making in pediatrics from the earliest stages to the adolescent; comprehensively discuss the most paradigmatic cases and issues faced by experts in pediatric bioethics; distinguish the ethical standards guiding pediatric research from those guiding clinical care; and begin to develop the skills needed to both analyze pediatric bioethical issues conceptually as well as address them clinically in health-care ethics consultation.

About the Program

Columbia University’s Master of Science in Bioethics grounds students in interdisciplinary approaches and models to address pressing bioethical challenges such as stem-cell research and health-care reform. The program prepares students to act as responsible and responsive leaders in this new and ever-growing field. It also includes a concentration in global bioethics—the first of its kind in the U.S. Columbia’s Bioethics program offers a range of degrees and courses.