Ethicist aids public in good decision making

by Michele Skalicky

SBJ Contributing Writer

There are only a handful of ethicists on staff at hospitals across the country, and Tobias Meeker is one of them. After serving as a chaplain in the health care setting for six years, working primarily with those suffering from life-threatening illnesses, the 53-year-old was hired as a full-time ethicist at Springfield's St. John's Regional Health Center in 1987.

Meeker describes himself as a "coach" or "midwife. I'm not the answer man," he said. Each year he helps hundreds of people make ethical decisions regarding clinical, professional, management or personal issues.

He never makes decisions for others. Instead, Meeker helps clarify issues, facilitating the process through which people make decisions for themselves about the moral and ethical courses they wish to pursue.

"Most people in the service profession in general make ethically good decisions rather consistently," he said. "They get thrown for a loop when something comes up outside their experience and they don't know the elements that go into making a good decision."

The ethicist's job, Meeker said, is knowing what goes into making good decisions.

People who consult with Meeker or his colleague at St. John's aren't given a lecture on ethics and all the subtleties and intricacies surrounding it.

"It comes across in conversation and drawing people out and asking questions," he said.

Meeker's job description labels his position as a public service, and he gets his share of people seeking help from outside the hospital. In fact, about one-third of those who go to Meeker for help in making ethical decisions don't work at St. John's.

There is no charge for his services.

While it is still very uncommon for a medical institution, or an institution of any kind, to have an ethicist on staff, Meeker said it's important to focus on ethical decision making.

"In order to be effective in providing health care, people have to trust you," he said. "The most important asset you have is trust. If you don't have that therapeutic relationship, the whole endeavor you're about doesn't happen."

St. John's, which is a religious sponsored organization, realized that in 1984 and decided to begin recruiting for a full-time staff ethicist. "They believed that this person would be of assistance to the institution," Meeker said, "to help it be true to what it said it was."

That was Meeker's chance to follow up on a long-time dream. He was a teenager during the period when renal dialysis machines were first invented. The machines were costly and limited, and many people who were eligible for treatment didn't get it. Groups were formed in places that had the machines that came to be known in the press as "God committees," Meeker said, because they ultimately decided who lived and who died.

He became fascinated with the subject of medical ethics and read about it as much as he could. He took the only course available on the subject while he was a student, studying Christian theological ethics at Yale.

After completing undergraduate work at Harvard University, Meeker went on to graduate from the Divinity School of Yale University. He received his formal education in medical ethics at the Kennedy Institute of Ethics at Georgetown University.

Once he began the ethicist job at St. John's, he made it up as he went along. "There were no models for this," he said. "The field didn't exist then."

He serves on the Institute Review Committee for St. John's, which decides what types of research can or cannot be done at the hospital. The committee has decided phase I research in which people with no other hope are given experimental treatment until their bodies crash (which determines tolerance level) will not be done at St. John's.

The hospital does, however, conduct phase II research, which is done with experimental treatments already tested in phase I, and it conducts phase III research, with experimental treatments that have proven highly effective in other phases.

Meeker keeps up with the latest technology. He reviews hundreds of articles each year, and said he has some concerns about the United States' fascination with medical technology. Prescription drugs are so expensive, he said, because they cost a lot to develop. The overall cost of drugs continues to rise, he said, even though there are more generic drugs on the market than ever before.

He believes technology impacts access to health care in many ways. "Public policy is influenced to a large degree because people fear expanding access because of the expense," he said. "The overall economics of health care, whether it means access in a public policy sense or access to treatment, is certainly affected by technology."

According to Meeker, a "logical fallacy" is pervasive in our society today that "if you can do something, you must." For example, he believes X-rays, which are much cheaper than other procedures such as MRIs, are just as effective in some cases, yet people want the MRIs because they believe anything less to be substandard care.

Meeker said the public is slowly moving away from the feeling that "death is optional," which he believes needs to happen. "Post technology, if death happened, it was in spite of everything else. It was looked at as a defeat. There are sometimes grotesque attempts to revive someone."

But Meeker is optimistic that that is changing.

Springfield has formed a community task force to work on building community awareness of end-of-life issues, and the Springfield-Greene County Library is helping to put together information on the subject, that will be available to the general public.

Meeker said he'll continue to work as an ethicist as long is he is able.

"That is what my whole life is about."

PHOTO CAPTION:

St. John's ethicist Tobias Meeker is one of only a handful of staff ethicists nationwide.

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Meeker believes technology impacts access to health care in many ways.[[In-content Ad]]