Close-up with Dr. Martin McKneally
By Chelsea Lowther
Photograph courtesy of Matthew Wu
Always do the right thing. It will please some people and astonish the rest. –Mark Twain
This past summer I sat down with the 2014 Institute of Medical Science (IMS) Course Director Award recipient Dr. Martin McKneally to find out more about his two highly regarded IMS courses—Practical Bioethics (MSC1052H) and Foundations 2: Teaching Bioethics (MSC3002Y). It came as no surprise that Dr. McKneally had a wealth of experience to draw on when designing these two courses. He completed both his cardiothoracic surgical training and PhD at the University of Minnesota and was thereafter appointed Professor of Surgery and Chief of the Division of Cardiothoracic Surgery at the Albany Medical Center in Albany, New York. In 1990, the University of Toronto was fortunate to gain Dr. McKneally as a faculty member and today he is Professor Emeritus of Surgery at the IMS, the Joint Centre for Bioethics, and the Toronto General Hospital.
Dr. McKneally’s move from the United States to Canada came with a shift in his research focus from applied immunology in surgery to surgical ethics, specifically the area of informed consent during what he calls the “surgical transaction.” This has included qualitative investigations of patients’ views of informed consent, and more recently an exploration of how surgeons and patients preoperatively discuss life-sustaining treatments when patients are undergoing moderate to high risk operations. In collaboration with surgeons at Harvard and the University of Wisconsin, cardiothoracic surgeons at the University of Toronto have played a significant role in this project. Dr. McKneally asserts that “as surgeons push the boundaries, operating on older and sicker patients, intensive care units fill up in North America and it becomes important that we have explicit conversations with our patients about potential adverse outcomes.
Dr. McKneally has been a member of the Joint Centre for Bioethics at the University of Toronto since its founding, and in 1999 he helped create the Masters of Health Science (MHSc) program in bioethics. According to Dr. McKneally’s colleagues, several of whom nominated him for the 2014 IMS Course Director Award, his continuing commitment to the MHSc program has been “an instrumental contribution” to the program’s success. Several of his previous students wrote letters of support detailing his unmatched commitment to their individual learning and his ability to integrate philosophical theories with modern day clinical practice. After spending just an afternoon with Dr. McKneally discussing several hot button ethical issues, including whether it is ethically sound to give experimental drugs to patients with Ebola, I can certainly echo this sentiment.
Faint memories of my own experience as a student in an undergraduate bioethics class remind me that ethics are, as Dr. McKneally teaches, “sets of values, principles, beliefs, and standards of conduct that guide the behavior of specified groups, such as doctors, lawyers, journalists, Mafiosi, and pirates,” and that bioethics is the field of study concerned with the ethical and philosophical implications of certain medical procedures, technologies, treatments, and research. I asked Dr. McKneally how he conceptualizes the teaching of bioethics. “It’s like teaching surgical judgement. The judgements you make are not based on authority. Instead, it is a process of determining a well-reasoned, thoughtful, and reflective argument to support a decision or a plan of action.” I momentarily imagined how challenging it must be to teach this process to students.
When asked about the popularity of the Practical Bioethics course (also known as the “Capstone Course”), Dr. McKneally attributes its reputation to the students. “I really believe that the discussion is what makes the experience intellectually stimulating and the discussion really depends on the students.” One of Dr. McKneally’s teaching strategies is to set up class debates—assigning students to positions that they may not personally agree with. “The goal is to teach them how to develop a reasonable way to think about a problem and not focus on finding the single right answer to a multiple choice question. I try to put emphasis on clarity of presentation and proper use of persuasive argument, very important skills for the bioethicist.” By the time students finish the course they have completed a term-long project intended to prepare them to serve as entry level professionals in the field of bioethics. “A lot of coaching goes on during the course. I am fortunate to be teaching it with my talented co-director, nurse-psychotherapist and bioethicist Sue MacRae,” says Dr. McKneally.
The Foundations 2: Teaching Bioethics course Dr. McKneally teaches is equally as hands on; students are required to design their own bioethics teaching curriculum. “The ability to apply bioethical theory and reasoning to a wide array of real-life situations is a critical skill for bioethicists to learn.” Dr. McKneally argues that you can’t arrive at a situation and say “that’s not my area of interest; you need to be able to at least apply a framework when trying to help solve a problem.” A true testament to Dr. McKneally’s famed teaching style is the broad range of students attracted to his classes, varying from physicians and midwives to lawyers and administrators, each bringing a collection of rich personal experience. “One of the advantages of teaching at the University of Toronto is the wide array of international students. They add yet another perspective to each class that enriches discussion.”
I laugh knowingly when I ask Dr. McKneally to describe his teaching style and he replies “a lot of coaching goes on, I put emphasis on writing because writing is thinking—you must think clearly in order to write clearly.” In the realm of science, filled with manuscripts and grant proposals, no truer words have ever been spoken. If anything has come across during my meeting with Dr. McKneally it is just how important sound training in bioethics is to essentially every realm of science, whether it be clinical, research, or administrative domains. I’ve quickly grown accustomed to Dr. McKneally’s humbleness and am not surprised when he says that learning from the students has been the best part of his teaching career. Clearly, the students have not forgotten him either. Congratulations on your award, Dr. McKneally.