Fredy Abboud (Biology, ’25)
After serving as an undergraduate research fellow at the Institute of Clinical Bioethics (ICB) for almost two-and-a-half years, I thought my path and the ICB’s would diverge after my graduation in December. However, an unexpected offer had been enough to remind me that I still had much to learn in medical ethics. This past January, I accepted a position as a medical ethics intern at the ICB. After holding a similar position in the summer of 2024, I expected this experience to be similar, but I couldn’t have been more mistaken, as the internship has thus far been far more eye-opening and demanding (in a positive way!).
As an intern, I have been blessed to join the ICB’s director, Fr. Peter A. Clark, on ethics teaching rounds, bedside ethics consultations, and ethics committee meetings, most of which have been centered on end-of-life care. During my earlier research fellowship and ethics internship at the ICB, I learned about DNR/AND orders, advanced care planning, and the intersection of medicine, law and ethics, yet, throughout the past few months, I have been struck by the severity of some of the cases and the complexity of the decision-making processes.
Day in and day out, one case followed another; some dealt with physician abandonment, whereas others centered on informed consent and withdrawal of care. Those ethics cases have helped me envision what I may encounter in my medical education and training in years to come. Indeed, medical students are taught about increasingly prevalent illnesses and associated risk factors, but is there comparable emphasis on the silent epidemics plaguing our societies? The mental health crisis and rising rates of suicide attempts are among these ethically charged epidemics, leaving physicians to walk a fine line between beneficence and patient autonomy. How can one ensure that a potentially suicidal patient isn’t discharged too early? What if the patient is concealing their actual mental condition? These are just a few of the many questions physicians and ethicists frequently contend with and which I have been fortunate to encounter and reflect upon as an intern.
Although the cases differed in content, they all shared a common denominator: ethics committees are a refuge for both patients/proxies and physicians. When proxies request an ethics committee meeting, they’re actively seeking what they perceive as the lifeline amid turbulent times, and when physicians request the committee’s recommendation, they’re looking to find solace in their decisions. However, at the center of this spectrum is the patient’s best interest, the foundation upon which ethics committees have been established and around which their mission revolves. After arriving at this realization, I began to recognize the significance of ethical guidance for young physicians and its contribution to a more comprehensive patient-centered medical care.
If my experience had been limited to encountering the reassurance different parties seek from ethics committees’ recommendations, I would have been satisfied, but there was much more in store for me! As an incoming medical student, gaining early exposure to ethics teaching rounds was an invaluable experience, as I learned what medical residents may grapple with on personal levels, namely guilt and uncertainty, and how they must manage them. My previous internship had introduced me to such scenarios, but this internship solidified the notion that great patient care begins with physician prioritization of self-care.
Beyond the clinical lessons that are worth their weight in gold, I was privileged to develop professional and public speaking skills by leading ethics case discussions during teaching rounds and even presenting the ICB’s wound care initiatives in Kensington, Philadelphia to medical students, residents, and attending physicians. Additionally, I was delighted to assume the role of mentor for many undergraduate research fellows interested in pursuing an ethics-oriented medical career. I not only had the chance to guide them through bioethics-focused research projects but also was privileged to celebrate their successes and achievements over the past four months. As a student, one may take the mentorship and guidance they’re receiving for granted; however, when that student switches from recipient to donor, they can’t possibly overlook the extent to which their own mentors may have gone for them.
In brief, as I reflect on my months of experience as a medical ethics intern, it would have been easy to write solely and endlessly on the intricacies of the cases I faced, but that wouldn’t fulfill my desire to share the enduring lessons I learned only a few months away from starting my medical education. Through my exposure to medical ethics, I have learned that the patient-physician relationship shouldn’t be merely transactional but rather understood as mutually constructive. At first, I believed my lesson was that healing cannot always be promised; however, I know now that physicians can offer at least one type of healing with greater certitude, a healing of spirit and humanity.