Advancing the Science

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January 24, 2020

The Compass offers direction on biomedical issues

By Advancing the Science contributor
antique map of the world with brass compass and built-in sundial laying on the map
Image by schaeffler from Pixabay

By Jay Furst

A compass, whether the old-fashioned kind in a brass case or the hands-free version on your dashboard, provides direction and helps you to find your way. The word's Latin origin, though, is about more than navigation. It's the root of the word "compassion," which implies feeling, connectedness and presence.

It's that deeper meaning that the editors of The Compass, a new feature in Mayo Clinic Proceedings, are most interested in: the notion of joining with readers to explore ethical and humanistic issues at the heart of medicine, at a time when health care is changing at blinding speed.

The Compass was launched in the May issue and aims to promote discussion and analysis of bioethics issues, "questions of moral and clinical decision-making," as the introductory essay says. One Compass article focused on the tensions between clinical productivity and the culture of medicine, which pledges to treat colleagues like family, embrace beneficence toward patients, and do no harm. Another looked at moral arguments for a physician's reluctance to treat a patient who doesn't want treatment but lacks decision-making capacity.

A study that appeared in December examined how patients view physicians' financial conflict of interest disclosures, and how their reactions were different depending on the doctor's clinical specialty. (The upshot: All conflicts of interest are considered important by patients, regardless of specialty.)

Richard Sharp, Ph.D.
Richard Sharp, Ph.D., director of the Mayo Clinic Biomedical Ethics Research Program

All the articles would have appeared in Mayo Clinic Proceedings prior to The Compass, but the goal is to call attention to research and commentary that gets at the ethical and moral underpinnings of health care, and to generate new content for the journal as well.

"We're attempting to fill an unmet need within the medical literature, where these ethical and humanistic issues can be discussed," says Richard Sharp, Ph.D., who directs the Mayo Clinic Biomedical Ethics Research Program. "There are few journals that publish this type of content about emerging issues and under-examined topics, especially topics that have broad societal impact or the potential to transform medicine."

Job burnout, for example, can be considered an ethical issue that affects not only health care providers but their patients. So are the demands for increased physician productivity, the impact of artificial intelligence on research jobs, and digitally driven value-based care.

"We want to bring scholarly approaches to cutting edge issues in bioethics and the humanities in medicine to our readership in an accessible ways," says Daniel Hall-Flavin, M.D., medical director of the Mayo Clinic Dolores Jean Lavins Center for Humanities in Medicine, who worked with Dr. Sharp to start the feature. "We also want to clearly articulate the value of bioethics and the health humanities." With health care being transformed by technology, from genomic research to AI, those values have never been more in need of articulation, he says, and there are few places, in print, online or in person, where it's happening.

Dr. Hall Flavin stands speaking at a microphone
Daniel Hall-Flavin, M.D., speaks at the 2019 Mayo Clinic Festival of Cultures

Drs. Hall-Flavin and Sharp went to the editors of Mayo Clinic's 94-year-old journal and proposed the new feature last year. After discussions with Karl Nath, M.D., the Proceedings editor-in-chief, it took off in May. By design, it isn't a defined section in the journal's print edition, it's an eclectic range of articles that are identified by an icon. "We wanted articles to be sprinkled throughout the edition, rather than in a stand-alone section, so that readers will stop, maybe be surprised by the content and think about it," Dr. Sharp says.

While he and Dr. Hall-Flavin don't edit copy, they're involved in identifying Compass articles, and as the word gets out, they'll initiate articles on topics that fit the bill. "I've been most impressed with the professionalism of Dr. Nath and his staff and how supportive they've been about the feature," Dr. Sharp says. "They've been a dream to work with."

The Compass is a natural next step for both programs, which promote the humanistic values of medicine. The Biomedical Ethics Research Program was created eight years ago "to align the care that we provide with what patients are most interested in receiving, and to identify what it is that patients and providers regard as ethical constraints in health care," Dr. Sharp says. Program leaders conduct research, teach ethics courses and organize policy discussions about ethical issues. Building on programming starting in 1981, the Lavins Center for Humanities in Medicine was established six years ago. It brings together healing arts and humanities programs for patients, staff and community members, as well as offering formal coursework for medical students .

Dr. Sharp also leads the Mayo Clinic Center for Individualized Medicine Bioethics Program and the Clinical and Translational Research Ethics Program, which promotes ethical conduct in research and works with scientists and physician investigators to find solutions to ethical challenges.

"The material that we'll be covering in the Compass are issues that medical students and clinicians will be facing in the future very directly," such as ways in which digital and information technology are transforming health care, says Dr. Hall-Flavin. "We have in the pipeline several outstanding articles authored by senior ethics scholars for example, that will likely provoke much discussion."

That enlightened discussion is what they're after, and they'll know they're on the right track when they hear from colleagues that they noticed the latest Compass piece on an emerging bioethics issue.

Jan 2020 cover of Mayo Clinic Proceedings

"It's been a great collaboration that encourages us to stretch and think about different kinds of contributions to the academic literature," says Dr. Sharp. "It also provides a nice outlet for all the work that we're doing."

He and Dr. Hall-Flavin connect this project to the legacy of the Mayo family and the Franciscan Sisters, who consistently championed humanistic and moral values in the founding of Mayo Clinic and hospitals. As they wrote in the introductory essay, "The legacy left by the Franciscan sisters and the Mayo family is very much alive and is itself a compass for making our way in these challenging times ... it is our hope that The Compass will give voice to the many humanistic attributes of medicine including not only ambiguity and failure but also hope, joy and the striving for excellence within an increasingly technological world."

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Tags: About, biomedical ethics, Center for Clinical and Translational Science, Center for Individualized Medicine, Daniel Hall-Flavin, health humanities, Mayo Clinic Proceedings, News, research, Richard Sharp

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