The French connection
American exports to France are not always received favorably-McDonald's restaurants, Hollywood films, and the tentacled Americanisms that worm their way into other languages have found cool reception by those who fear a thinning French culture. But at least one American export, medical ethics, has been welcomed by the French government and medical community and may be poised to spread nationwide.

More precisely, medical ethics is a Chicago export, pioneered in the 1970s by Mark Siegler, MD'67, the Lindy Bergman distinguished service professor in medicine and director of the U of C's MacLean Center for Clinical Medical Ethics. After French Minister of Health Bernard Kouchner-a gastroenterologist who cofounded the humanitarian organization Doctors without Borders-invited Siegler to Paris in March 2001 to speak, the ministry decided that it was time for French hospitals to develop clinical ethics programs of their own.

"Ethics in France has largely been government controlled," says Siegler. "There are laws and regulations and national commissions that decide things, but there is surprisingly little of an institutional, day-to-day relationship of practice to ethics."

To bring practical ethical training to French hospitals, Kouchner sent Veronique Fournier, a physician and health-ministry advisor, to train at Chicago for a year beginning last July as a MacLean Center fellow. Since Siegler founded the center in 1984 with the notion of "taking mid-career physicians, providing training in clinical ethics, and sending them back to develop programs at their home institutions," 160 fellows have passed through its doors, sent by medical schools or hospitals "to return and become leaders in medical ethics," says Siegler. More than 50 former fellows now serve as directors or codirectors of clinical ethics programs in the U.S. and Canada.

Siegler first became interested in clinical ethics when he directed an intensive-care unit at Chicago in the mid-1970s, dealing daily with such issues as surrogate decision making, euthanasia, and bed rationing. The paucity of ethics instruction available to practicing physicians prompted him to seek guidance from ethics scholars in the Divinity School and the Committee on Social Thought.

"Medical ethics in the 1960s and 1970s was dominated by theologians, philosophers, and legal scholars who were writing about ethics as a theoretical matter," recalls Siegler. "But for doctors and nurses who were seeing patients, ethics was not a theoretical matter, it was a part of our everyday practice."

Although physicians could gain ethical training through Ph.D. programs, the process would keep them out of practice for so long that "by the time they finished they would generally have ended their clinical careers," says Siegler. For its first ten years, the MacLean Center was the only place in the country where physicians could train in clinical ethics and then continue as physicians.

Veronique Fournier's training at Chicago is similar to that of past fellows, but she is the first in the program to represent a nation rather than an individual institution. "I think that as the French government establishes a number of these clinical-ethics programs," says Siegler, "the MacLean Center will serve as an advisor to the programs and possibly to the Ministry of Health."

Fournier has returned to France several times over the past year and is spending April in Paris to prepare the country's first medical-ethics program at the Hôpital Cochin. Siegler will join her in France in mid-April to tour Cochin and visit the Ministry of Health.
-C.S.