August 05, 2008

Contact:   Bill Giduz

In recognition of professional achievements, an impressive record of publications, and outstanding leadership of the medical humanities program, Lance K. Stell has been named as Davidson College’s Samuel E. and Mary West Thatcher Professor of Philosophy and Medical Humanities.

Lance Stell

Clark Ross, Vice President for Academic Affairs and Dean of the Faculty, said Stell richly deserves the honor. “Our medical humanities program is frequently cited as an undergraduate model, and Lance deserves much credit. He set the foundation 20 years ago with a faculty summer seminar, helped develop it from an idea to a new program, and has been a major contributor since its inception.”

The Thatcher Professorship was last held by Professor of Religion and President Emeritus John W. Kuykendall ’59, and its inaugural holder was Rosemarie Tong, the first director of medical humanities at Davidson.

Stell has taught at Davidson since 1976. In 1988 he was invited to serve on the Ethics Committee at Carolinas Medical Center (CMC), and became fascinated with the daunting issues raised in the hospital setting, such as the importance of respecting religious beliefs in providing care to Jehovah’s Witnesses, whether or not to withdraw treatment from severely impaired newborns, and who should make medical care decisions for incompetent patients.

With the help of Dr. Bill Williams ’69, then director of Graduate Medical Education at CMC, Stell arranged to spend his 1989-90 sabbatical working there. He studied CMC’s educational curriculum and the role professional ethics played in clinical teaching, shadowed physicians on rounds, observed surgery, talked with patients and their families, and attended daily teaching conferences.

He has become steadily more involved with the hospital since that time, and now has an office there and holds the title of Clinical Professor and Medical Ethicist. He regularly teaches ethics to CMC residents, and directs CMC’s Ethics Consultation Service. The latter responsibility requires that he carry a beeper so that he can be reached at any time of day to help resolve ethical concerns that arise in patient care. He said, “Some of the cases are so complicated, and the circumstances so tragic, that you never forget them.”
 
At the same time, Stell has created opportunities for Davidson students to study medical issues in that real-life setting through a seminar in “Healthcare Ethics.” For the 18th year again this fall, enrolled students will receive a hospital identification card and a white coat, and work under a physician mentor. They will attend events such as grand rounds, transplant meetings, and morbidity and mortality conferences.  “There’s no replacement for being there,” Stell said. “Human medical care becomes more fascinating and difficult when you’re there as it’s unfolding. That’s where you get all the details, which makes all the difference.”

After completing a formal orientation to acquaint them with hospital policies and standard of conduct, students may spend as much time at the hospital as possible. They also meet as a group once a week with Stell and guest speakers to discuss subjects such as determining when someone is disabled, when someone lacks sufficient capacity to make his or her own medical decisions, disclosing errors, the problem of medicalizing human distress, and the relationship between law and medicine. Students maintain a journal about their experiences, and write a term paper on an issue that piques their interest. The course is valuable not just for students who aspire to careers in the field, Stell said, noting, “Not everybody becomes a physician, but almost everyone does become a patient.”

Stell’s current primary interests in the field concern the ethics of transplantation. Among its controversies are whether a person’s behavior and moral character should affect eligibility for a donated organ. Stell explained, “What if someone’s a smoker, or is morbidly obese, or doesn’t follow a doctor’s orders about taking medication? It’s troubling to think that issues like those could affect a person’s qualification for a potentially lifesaving operation, but how can you not consider them?”

Another troubling issue is compensation for organ donors. It is currently illegal in almost all countries to pay someone who offers an organ for transplantation. But the American Medical Association has recently urged that the restrictions be relaxed in hopes of increasing the supply of organs for an ever-growing list of waiting patients. Stell has frequent opportunity to consider those issues in his work at the hospital, since CMC performs about 160 kidney transplants per year, and about 40 liver transplants.

One of Stell’s primary involvements outside the hospital is the North Carolina Medical Society. He served on its ethical and judicial affairs committee, and was instrumental in drafting the society’s statement on the use of long-term feeding tubes. The document provides succinct and clear guidelines for physicians to consider when counseling patients and families about the benefits and risks of long-term feeding tubes in cases of advanced dementia. The society in 2005 awarded Stell its top honor, the John Huske Anderson Award for “contributions that have had a positive impact on the medical profession and the public health.”

Stell also serves on the Mecklenburg County Bar Association Grievance Committee, which investigates complaints of unethical conduct by lawyers and determines whether the rules of professional conduct have been violated. The committee’s determination is referred to the State Bar for final disposition. Stell also consults as an expert witness in litigation involving professional discipline and breaches of medical ethics.

Stell noted that the experience of teaching residents at CMC and undergraduates at Davidson is quite different. In his medical consultations, the need for a decision is usually time sensitive. “Doctors don’t usually have time for needless theorizing or thinking about ‘what-if’ scenarios,” Stell said.
 
In the Davidson classroom, however, he enjoys the luxury of helping students engage their imaginations and wrestle with theoretical issues and classic real-life law cases, such as whether it’s ever justified to kill an innocent person for purposes of survival cannibalism. ”It’s a privilege to pose such dramatic questions to students and help them think about alternative approaches to a resolution,” Stell said. “The cases are inherently fascinating, and students get excited talking about them. Decided cases of law provide plenty think about. Understanding the various sides that can be taken is the real value in the exercise.”

In addition to his involvement with medical ethics, Stell teaches philosophy department courses at Davidson on ethics, political philosophy, and the philosophy of law. He has published widely on a variety of philosophical topics, and is currently working on a paper about the conflicts of interest between medicine and the pharmaceutical industry, and another paper on physicians’ right to refuse to provide care in some cases because of their conscientious objections.

Davidson’s Medical Humanities Program, which is offered as a curricular concentration, provides students an interdisciplinary appreciation for strengths and limits of the natural sciences, social sciences, and humanities as they try to achieve control over disease, illness, and suffering. Anywhere from 6-12 students graduate each year with medical humanities concentrations.

Until now, Stell has been the program’s sole faculty member. This fall, however, the faculty will double in size with the addition of Associate Professor Kristie Foley, who will serve as its associate program director. Formerly a professor at Wake Forest University School of Medicine, Foley brings to Davidson her expertise in research ethics, epidemiology, and public health.

Davidson is a highly selective independent liberal arts college for 1,700 students located 20 miles north of Charlotte in Davidson, N.C. Since its establishment in 1837 by Presbyterians, the college has graduate 23 Rhodes Scholars and is consistently regarded as one of the top liberal arts colleges in the country. Through The Davidson Trust, the college became the first liberal arts institution in the nation to replace loans with grants in all financial aid packages, giving all students the opportunity to graduate debt-free. Davidson competes in NCAA athletics at the Division I level, and a longstanding Honor Code is central to student life.

#   #   #

Posted By: Bill Giduz