History

History

The Center for Health Humanities and Ethics continues UVA’s tradition, dating from the late 1960s, of exploring and teaching about the human complexities of illness, health, and health care, the interactions of medicine and society, and the values dimensions of biomedical research and policymaking. Our work, much of it collaborative and crossing professional lines, draws on methods and materials of humanities disciplines such as literature and language, history, law, philosophy, and religion—as well as the social sciences and the arts. Our center’s activities chart a longtime commitment to the productive integration of biomedical ethics and humanities and to forging new modes of interdisciplinary inquiry.

1960s and 1970s

UVA School of Medicine’s distinguished national reputation in biomedical ethics and medical humanities dates from the late 1960s. Even as medical education after the 1950s focused in on biomedical science and molecular medicine, former medical school dean Thomas H. Hunter MD and visiting medical ethicist Joseph F. Fletcher STD, author of Morals and Medicine (1954) and Situation Ethics (1966), wanted to ensure that UVA medical students—and their teachers—stayed conversant with big-picture issues of concern to both medicine and society. With a grant from the Commonwealth Fund, Dr. Hunter and Professor Fletcher established the Program in Human Biology and Society. They also created the Medical Center Hour, a public forum on medicine and society conceived as a variant of medicine’s traditional clinicopathologic case conference (TH Hunter and JF Fletcher, “Mutant CPCs,” The Pharos, 1972). By 1971 Medical Center Hour, under Dr. Hunter’s leadership, was a weekly event at which nationally known speakers debated topics from current headlines with an audience of students, faculty, clinicians, and community residents. Medical Center Hour has continued uninterrupted since, offering programs at midday on Wednesdays through the academic year. Professor Fletcher also occasionally taught a 500-level course in medical ethics in UVA’s religious studies department.

Biomedical ethics and health policy topics also prompted interdisciplinary and interprofessional inquiry around Grounds. From the early 1970s, the law school’s Center for the Study of Science, Technology, and Public Policy fostered scholarship in legal medicine and helped to bridge the medical and law schools, as did the Institute for Law, Psychiatry, and Public Policy, also established in those years. Several faculty—psychiatrist P. Browning Hoffman MD and legal scholars Walter Wadlington JD and Richard Bonnie LLB among them—held joint appointments in law and medicine. Beginning in the late 1970s, religious studies professor James F. Childress PhD, coauthor (with Tom Beauchamp) of Principles of Biomedical Ethics (1979-2019), taught biomedical ethics in Arts & Sciences, supervised religious studies graduate students working in bioethics, and participated regularly as a panelist in Medical Center Hour programs.

1980s

As biomedical ethics gained notice in clinical medicine, the medical school in 1981 invited E. Haavi Morreim PhD to be philosopher-in-residence in the clinical setting for a year. University of Chicago physician-ethicist Mark Siegler MD also visited as a fellow in religious studies and internal medicine for a year in the early 1980s. Former medical school dean and vice president for health sciences Kenneth Crispell MD studied the health crises of U.S. presidents, writing (with Carlos Gomez MD PhD, then a UVA student) Hidden Illness in the White House (1988). Well into the 1980s, Professor Childress and internal medicine professor Oscar A. Thorup MD co-taught “Ethics and Public Policy in Health Care,” a seminar for medical, law, nursing, and humanities graduate students; Dr. Crispell and others taught an undergraduate version of this course for several years. After Dr. Hunter retired, Dr. Thorup and Professor James Childress directed the Medical Center Hour.

In 1984, UVA Medical Center’s Ethics Committee was established, with internal medicine department head Edward W. Hook MD as chair.

In 1987, John C. Fletcher PhD joined UVA’s faculty after ten years as bioethics program chief at the National Institutes of Health’s Clinical Center. Professor Fletcher was appointed to the faculties of both religious studies and internal medicine, with the deans of Arts & Sciences and Medicine committing to an interdisciplinary, interschool, jointly funded appointment in biomedical ethics.

The Center for Biomedical Ethics was organized in 1988 as a division of the Department of Internal Medicine, with Professor John Fletcher as director. In 1989, a required course in clinical ethics was developed for first-year medical students.

1990-1996

In 1990, the Center for Biomedical Ethics, led by Professor John Fletcher, became a program of the medical school dean’s office. Together with the religious studies department, the center developed an MA program and graduate-level courses in bioethics. The center helped to establish and staff the UVA Medical Center’s interdisciplinary clinical ethics consultation service and began outreach education for Virginia hospitals developing their own ethics committees.

In 1991, Dean Robert Carey established the Program of Humanities in Medicine as a program in the dean’s office, with Dr. Hook, now chair emeritus of internal medicine, as founding director. Humanities in Medicine offered medical school elective courses in humanities disciplines such as history, literature, and religious studies (with Arts & Sciences faculty teaching some courses), developed humanities-based continuing education for practicing physicians, and published medical students’ creative writing (Veritas). Humanities in Medicine also assumed responsibility for the Medical Center Hour.

The biomedical ethics and medical humanities programs occupied adjacent office clusters in the Barringer (now Collins) building. In 2000, this space was renovated into a single suite of offices with shared teaching, resource, and administrative support space.

In 1995, Arts & Sciences’ Undergraduate Program in Bioethics was created, with philosopher-ethicist John Arras PhD (Ethical Issues in Modern Medicine, with Bonnie Steinbock, 2002) recruited to the Porterfield Chair in Biomedical Ethics. UVA undergraduates could minor in bioethics.

1996-2004

In 1996, literature scholar Marcia Day Childress PhD and internal medicine professor Julia E. Connelly MD became co-directors of the Program of Humanities in Medicine, succeeding Dr. Hook. (Dr. Hook died unexpectedly in 1998.) In 1998, when Professor Fletcher retired, philosopher-ethicist Jonathan Moreno PhD (Deciding Together: Bioethics and Moral Consensus, 1995) was appointed Kornfeld Professor in Biomedical Ethics and director of the Center for Biomedical Ethics. Education initiatives for medical students, UVA undergraduate and graduate students, and practicing clinicians continued to develop in both programs, with increasing overlap of faculty research, teaching, and service interests. New core faculty included rehabilitation physician and ethicist Walt Davis MD; lawyer-historian Paul Lombardo JD PhD (Three Generations, No Imbeciles: Eugenics, the Supreme Court and Buck v. Bell, 2008); pediatrician and religious ethics scholar Margaret Mohrmann MD PhD (Medicine as Ministry, 1995; and Attending Children: A Doctor’s Education, 2005); and medical humanities scholar David Morris PhD (The Culture of Pain, 1991; and Illness and Culture in the Post-Modern Age, 1998).

In 2000, capitalizing on institutional strength in ethics scholarship and teaching, UVA established the Institute for Practical Ethics and Public Life (IPE), a university-wide program to foster interdisciplinary exploration of ethical dimensions of individual and social choices in professional life and public policy. The institute’s founding director was James Childress PhD, University Professor and Hollingsworth Professor of Ethics; IPE is now led by Professor Ruth Gaare Bernheim JD MPH, who also chairs the Department of Public Health Sciences. The institute sponsors faculty fellowships for ethics teaching, undergraduate student internships focused on practical ethics, and an annual undergraduate essay prize.

2005-2007

In 2005, Dean Tim Garson reorganized the Program of Humanities in Medicine into the Center for Humanism in Medicine to build on the medical humanities program’s work, foster professionalism and renewal in students and faculty, and create faculty development opportunities. Internal medicine professor Daniel Becker MD MPH MFA was appointed center director.

In 2005, the Program in Ethics and Policy in Health Care, with Patricia Tereskerz JD PhD and Ann Mills Msc (Econ) MBA, was established within the Center for Biomedical Ethics to promote scholarly work on ethical issues in health care organizations, biotechnology, and health policy.

2007-2018

Establishment of the Center for Biomedical Ethics and Humanities in 2007 united the medical school’s biomedical ethics, medical humanities, and medical law programs; the center remained a program of the dean’s office, with Dr. Daniel Becker as director. Dr. Becker was also founding editor of Hospital Drive, the medical school’s online literary/arts magazine, based in the center. Upon Professor Moreno’s departure in 2009, Dr. Margaret Mohrmann became Kornfeld Professor of Biomedical Ethics and director of the center’s biomedical ethics programs. She was succeeded in both roles in 2012 when Mary Faith Marshall PhD RN joined the UVA faculty from the University of Minnesota. Professor Marcia Day Childress leads medical student elective courses and directs the Medical Center Hour, which, since 2009 has included programs produced together with the Health Sciences Library’s History of the Health Sciences Lecture Series. In 2008, lawyer-bioethicist Lois Shepherd JD (If That Ever Happens to Me: Making Life and Death Decisions after Terri Schiavo, 2009) was recruited from Florida State University to join the core faculty. UVA psychiatrist-ethicist Donna Chen MD MPH joined the core faculty that same year. In 2013, Porterfield Professor of Biomedical Ethics John Arras was appointed to the core faculty.

UVA’s MA degree in bioethics was dropped in 2011 because of lack of degree productivity.

Over the years, the center’s roster of core faculty has changed. Dr. Julia Connelly and Professor David Morris retired in 2012. Dr. Margaret Mohrmann retired in 2015. Dr. Walt Davis left UVA to enter private practice. Professor John Arras died unexpectedly in 2015. Dr. Becker retired in 2018.

Nurse-ethicist Elizabeth Epstein PhD RN and pediatrician-ethicist Julia Taylor MD have joined the core faculty, as have emeritus professor of pediatrics Robert Boyle MD and University professor emeritus James Childress PhD. Assistant professors David Lapides MD (Neurology) and Justin Mutter MD MA (Medicine) are the newest members of the center’s faculty. Scholars, teachers, and practitioners from across UVA, the local community, and other academic centers make up the center’s robust cohort of Affiliates.

Professor Mary Faith Marshall became center director in 2019. That same year, in recognition both of burgeoning international prominence of so-called “health humanities” (including ethics) and of our own interprofessional makeup, the center changed its name to Center for Health Humanities and Ethics.

2019 and beyond

The Center for Health Humanities and Ethics brings theories, techniques, and tools of humanities disciplines, including ethics, to the study and practice of medicine and other health professions, to the care of patients, performance of research, and development of health care policy. Center faculty collaborate with peers and programs in other UVA schools—notably, Arts & Sciences, Law, Nursing, and Architecture—and, within Medicine, in public health, geriatrics, palliative care, physician wellness, medical education, faculty development, chaplaincy services, several clinical specialties, and Historical Collections of the Claude Moore Health Sciences Library.

The center continues to produce Medical Center Hour, which will mark its fiftieth season in 2020-2021.

The center is home to the Edward W. Hook Scholars Program in Humanities and Ethics for selected medical students—usually, three or four per class year—who seek to make the humanities, arts, or ethics an integral part of their medical education and professional life. The first Hook Scholars cohort graduated in 2016. Each summer, the center hosts bioethics interns, usually undergraduate students or recent graduates, from UVA and other colleges and universities.

Since 2013, the center has partnered with UVA’s Fralin Museum of Art on Clinician’s Eye, a visual observation workshop for apprentice clinicians.

New program development within the center includes Studies in Reproductive Ethics and Justice, with a dual focus on scholarship and service. The center is a key player in a novel interdisciplinary/interprofessional clinical program, Virginia at Home, for comprehensive elder care. Looking forward, at the heart of the center’s work is the Fusion Lab, which fosters education, research, and service initiatives that fundamentally integrate health humanities and ethics.