A Lawyer, a Doctor, and a Corporate Convert:
The Career Paths of Three MBE Alumni
The story of how David Sontag L’03 G’03 ended up in the master’s of bioethics (MBE) program should resonate with anyone who’s ever been bitten by the bioethics bug.
“I’d taken an undergrad class in medical ethics and was fascinated by it. I thought that’s what I wanted to do in life,” he says. “My mom, ever the pragmatist, said, ‘Well, who’s going to pay you to do that?’”
She was by no means the first parent to ask such a question about a grown child’s passion. (As anyone who’s footed the bill for a theater arts degree can attest.) But Sontag’s career path is one example of how bioethics has matured into a discipline with myriad professional outlets.
After deciding to go to law school, Sontag narrowed his choices down to programs that offered the possibility of pursuing additional education in bioethics or public health. Penn emerged as the best option. According to Law School Dean Michael Fitts, between seven and 10 law students a year now get a bioethics degree in conjunction with their law education.
“It attracts a lot of students to us,” says Fitts. “If you think about bioethics, it’s substantively, economically, and philosophically one of the most important areas in the world and in our economy. It raises almost every fundamental issue in society: ethical issues about our bodies, personal questions, economic issues, everything. And that’s what great about law. Lawyers and the law faculty spend their time thinking about problems that are large and interrelated. So on our faculty, we probably have five or six people—which given our size is a lot of people—who focus in that area.”
For Sontag the attraction was more intellectual than professional. “Whether it will help me get a job or not, I didn’t so much care,” he recalls. “Bioethics teaches you how to think about problems in a different way. It’s not so much a substantive education as it is a philosophical one.”
After graduating from the Law School, Sontag clerked for a federal judge in the Eastern District of Pennsylvania, then worked at firms in Philadelphia and Boston, focusing on health law.
“A lot of my practice was based on financial transactions—deal-related work that involved some private equity firm buying one health-care-related company over another,” he says. “But part of the practice was advising hospitals and other health care providers on how they should be acting—whether to comply with the law, or, from a moral and ethical standpoint, how they should be reacting to certain situations that come up in everyday provider lives. I realized that’s the part I liked the most, because there was sometimes an intersection with bioethics.
“Sometimes there are black-and-white answers in the law that say you have to do X, Y, or Z,” he elaborates. “But there are plenty—and probably more—areas of gray, where you can justify doing it this way, or that way … so how should we do it? Sometimes those are bioethical questions. So I tried to find a position where I could do that if not all the time, then at least more often.”
Last June he found one, as associate general counsel for Beth Israel Deaconess Medical Center in Boston. His new job lets him delve into patient-care-related issues at a more “granular level,” working through issues like health care proxies, medical guardianship, and informed consent. “Nowadays I do use more of the bioethics in that way,” he says.
“I liked my jobs in the past,” he adds. “I love this job.”
Jill Baren G’02 enrolled in the MBE program as a mid-career professional, seeking to bolster her teaching in the medical school, where she is a professor of emergency medicine.
“Even though I was a health-services researcher and doing some clinical-trials work, the things I got tremendous enjoyment out of were the humanistic aspects of medicine,” she says. “For example, I was a doctoring instructor in the medical school. I enjoyed lecturing and teaching on end-of-life care. I was always getting involved in any kind of initiatives that had to do with professionalism and the patient experience. These were a little tangential to my research, but they were professional activities that gave me a lot of pleasure.
“I wanted to really enhance my teaching of my specialty—how to weave in ethical issues and how to construct appropriate ethical arguments and understanding the theory behind bioethics,” she adds. “So one of the reasons I wanted to undertake the formal training was to have credibility around those issues.”
But once she got going, new goals emerged.
“The way I went into the program was very different from the way I emerged,” Baren says. “I recognized that there was a tremendous need in my specialty of emergency medicine for learning better how to conduct clinical trials within an ethical framework in the emergency setting.
“In order to study conditions which affect critically ill and injured patients,” she explains, “we’re dealing with patients who are incapacitated, so they’re are not able to provide informed consent. Someone in cardiac arrest, someone who has traumatic brain injury, someone who is in septic shock, someone who has exsanguinating hemorrhage from trauma: if we’re going to study those conditions—how we can intervene in those conditions, or how we can construct clinical algorithms around treating those conditions—we can’t obtain consent from the patient … If we don’t, for example, intervene within the first five minutes of a patient who has status epilepticus, we may miss the opportunity to test the efficacy of the drug. So if one thinks about a valid informed consent process that’s robust and meaningful, that can’t be accomplished in five minutes.”
There is a special set of federal regulations governing research undertaken without prospective informed consent, and Baren became “somewhat of an expert” on applying them in an emergency setting.
“Because we are foregoing prospective informed consent, we must do certain activities before the trial in order to demonstrate the acceptability of the trial in the community in which it is conducted,” Baren says. “So we do community consultation, we do public disclosure, we go through an exercise where we look at the scientific trial design in and of itself and put that forward to the IRB [institutional review board] so they can see how the scientific and ethical issues interrelate. Essentially, it’s a much longer and different process that you put forward as an investigator, in contrast to, say, a cancer trial.”
Determining who makes up “the community” in the context of something like a trauma-care trial is challenging. “The federal regulations talk about two kinds of communities: geographical, and the community of individuals who are likely to be affected by the disorder being studied,” says Baren, who now consults on such trials. “I help people strategize and develop methods to satisfy the requirements for community consultation.”
Her interest in the patient experience remains strong, and she believes bioethics mentoring has a key role to play in improving the way medical providers deal with thorny dilemmas at the bedside.
“We’re very good at teaching in the medical system how to work through a problem in a clinical sense, but we’re not always good at teaching how to work through a problem in an ethical sense,” she says. “And I think as we get better at that, the improvement that really will come out of the patient-provider relationship will be substantial.
“A perfect example is having a policy on the books at the University of Pennsylvania that talks about withdrawal of life-sustaining therapy in patients with persistent vegetative states,” she elaborates.
“[It’s a] well-constructed policy, [with] thoughtful information provided by experts, very grounded in ethical principles, supported by legal counsel … But if we have myriad patients in the hospital who don’t have providers who can execute those conversations with families, then we have a big problem on our hands. We have the continued creation of suspicion and mistrust when information isn’t being given, when the issues aren’t framed properly for the family at the bedside.
“Having the policy is wonderful,” she concludes. “But teaching people how to apply it, how to have those conversations, that I think really makes the difference.”
Sheldon Sloan G’08 was another mid-career matriculant in the MBE program—but he enrolled at a turning point in his second career. Sloan was a gastroenterologist in academic practice, specializing in gastroesophageal reflux disease, until he made the leap to industry in 1997 by joining Johnson & Johnson in a clinical-research role.
In the years that followed, he slowly found himself assuming roles that were more managerial in nature.
“In 2004, I began a new role in the Johnson & Johnson corporate office of science and technology, administering programs to help scientific collaboration across the corporation,” he says. “I was also responsible for issues related to our research enterprise that might need corporate oversight or input. One activity was the preclinical aspect of our research engine, which got me involved in animal welfare issues—not only helping to internally shape our guidance and policies, but also to represent J&J on non-profit boards, which allowed us to share best practices and discuss common issues.”
Soon thereafter, he started shopping around for formal bioethics training, initially considering distance-learning programs like one run by Loyola University in Chicago. One day at work Sloan found himself at Centocor, a J&J company that has since been renamed Janssen Bioetech, where Art Caplan was giving a talk about the history and ethics of human-subjects research. Afterward, Caplan talked Sloan into applying to Penn.
Caplan sees the corporate employment of bioethicists as an incipient trend. “You can see them just starting to hire that way a little bit,” he says. “Law firms, too. It sort of gives you a little leg up now when you say, ‘Oh, I do bioethics.’”
Sloan’s experience attests to that. “I grew personally and professionally, expanding myself and stretching myself,” he says. The company also footed his tuition bill.
“By having a diverse curriculum, the program allowed me to explore several aspects of how bioethics is practically applied,” Sloan elaborates. “One course in particular, ‘Bioethics Goes to Washington,’ heightened my interest in policy. Coming from a corporate perspective, I wanted to understand how some of these policies get generated, discussed, and implemented, which is important on the professional side.
“Research ethics was also a core course for me,” he adds, while animal-welfare ethics proved to be “key in understanding all sides of a very complex issue” for his work at Johnson & Johnson.
Now he’s applying what he learned in the Penn MBE program at J&J.
“I got more involved in bioethics policies” after graduating from the MBE program, Sloan says. “I got much more comfortable tackling them for the corporation.
“My current job is overseeing a portfolio of products—primarily gastrointestinal products—which involves human-subjects research. Bioethics principles and dilemmas are part and parcel in overseeing human-subjects research. Beyond my role as a portfolio leader, I am also on a newly formed Johnson & Johnson ethics team—having been a graduate of the Penn bioethics master’s program allowed me to be considered as a candidate.”
Sloan adds a point that other MBE alumni echo, which is that his relationship with Penn’s bioethics program didn’t end at graduation. Through colloquia and other events, many MBE alumni stay connected.
“Another benefit of being a Penn bioethics graduate is my familiarity with the Penn faculty,” Sloan says. “They are a body of experts that I know and feel comfortable to call upon. We’ve consulted with Penn faculty, and part of that was my experience knowing their strengths.”
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