The chance to make an immediate impact on the lives of children with complicated medical problems drew Kelly Michelson, MD, MPH, ’04 GME, to the pediatric intensive care unit. But it was the skill and compassion her mentors showed when talking with families in the midst of very challenging and often tragic circumstances that inspired Michelson most.
“I was impressed by the impact physicians can have as they guide families through their worst tragedy or an incredibly uplifting outcome,” says Michelson, Julia and David Uihlein Professor of Bioethics and Medical Humanities.
This interest in helping families through difficult circumstances led Michelson to study how physicians talk with families of critically ill children about end-of-life care during her fellowship at Children’s Memorial Hospital, now the Ann & Robert H. Lurie Children’s Hospital of Chicago, from 2001 to 2004. Today an attending physician at the same hospital, and an associate professor of Pediatrics in the Division of Critical Care at Feinberg, Michelson continues that line of research with support from the Patient-Centered Outcomes Research Institute and American Cancer Society.
Michelson explains that there are many bioethical questions that arise at the bedside for physicians, parents and patients. For example, how far should clinicians go with technology, now capable of taking over many bodily functions, to keep a patient alive when survival is unlikely? And how much of a say should parents, patients and physicians have in the decisions made along the way?
As director of Northwestern’s new Center for Bioethics and Medical Humanities, Michelson hopes to bring together clinicians, residents, fellows and the community to tackle these and other ethical challenges in medicine. Her appointment has generated a lot of excitement, says Z. Leah Harris, MD, head of Pediatric Critical Care Medicine at Feinberg and Lurie Children’s.
“There is a need to have a Center for Bioethics and Medical Humanities leader who is a triple threat — ethicist, clinician and investigator,” Harris says.
The new center will build on the work of Northwestern’s former Medical Humanities and Bioethics program, which played an important role in the education of medical students at Feinberg for more than 25 years.
Notably, Michelson wants to expand the center’s reach beyond medical students to include residents and fellows. Already, Angira Patel, MD, MPH, ’10, ’11 GME, assistant professor of Pediatrics and Medical Education, has begun developing the center’s ethics certification program for residents and fellows.
“There has been greater recognition of the role ethics can play in the clinical arena,” explains Joel Frader, MD, head of the Division of Palliative Care at Lurie Children’s and a mentor of Michelson’s. “There is wider understanding that this needs to be a greater part of clinical education and training.”
The center will also be a resource for scientists at Northwestern. For instance, Michelson is working with Northwestern’s Tamara Isakova, MD, MMSc, director of the Center for Translational Metabolism and Health, on a grant application to the National Institutes of Health (NIH) for a project that would provide resources to safely and ethically translate discoveries to patients with kidney disease. Michelson says discussing ethical implications helps investigators refine their research questions and address potential ethical concerns related to the conduct of their work as well as the innovations that result from their findings.
“There’s a lot of interplay between research and ethics that I’m hoping to support,” she says.
To broaden the center’s reach, Michelson would like to regularly connect the clinical bioethics teams at Northwestern Memorial Hospital, the Rehabilitation Institute of Chicago and Lurie Children’s Hospital to share experiences and support one another.
Bringing ethics into day-to-day practice at the hospitals is essential, Harris says. She says clinicians increasingly must grapple with ethics in their clinical decision-making as medicine advances.
“Sometimes it is no longer a question of can we intervene, but should we,” Harris says. “The new imperative will be for clinicians not only to be clinically excellent, but also ethical and humane.”
The public also has a stake in the bioethical questions facing clinicians and investigators, Michelson notes.
“I’m hoping the center will extend beyond Northwestern and engage the community in these conversations and decisions about how we deliver and advance healthcare,” Michelson says. “These affect everyone.”
A TENACIOUS LEADER
Carrying out this ambitious agenda will require securing sufficient resources for bioethical research and programs across departments that may be siloed, says Frader. But Michelson’s research background and tenacity will be assets as she faces these challenges.
During his 15-year collaboration with Michelson, which began during her fellowship, Frader has seen her repeatedly win over skeptics with her hard work. For example, she won a very coveted early career development grant from the NIH, beating out many applicants with more traditional biomedical research backgrounds. Michelson has embraced qualitative research, a departure from the more quantitative epidemiological research she learned while earning her masters in public health at the University of North Carolina-Chapel Hill in 1996 and her medical degree at Duke University in 1997.
When Michelson began her research, hospitals and clinicians weren’t focused on patient-centered outcomes like they are today, explains Harris. Michelson really had to chart her own course guided by her values and commitment to understanding families and patients.
“She’ll be able to bring that same moral courage and fortitude to teaching a whole community how to apply ethics to what we do day in and day out,” Harris says.
Her skill bringing together clinical staff during end-of-life care discussions will also be an asset in her new role.
“She is the consummate listener,” Harris says. “She recognizes we are not all going to agree. She makes people feel comfortable disagreeing and voicing opinions.”
Frader agreed that Michelson’s skill as a communicator and problem-solver will be critical.
“Kelly is persistent and creative, and she wants to be able to bring the voices of patients and families to the table when making choices about the care of sick children,” Frader says. “I think she can bring that sense of how to invite and include many different people and solve problems collaboratively to the center.”