Spotlight on Dr. Michael Szego
Dr. Michael Szego
Director, Centre for Clinical Ethics (a joint venture between Providence Healthcare, St. Joseph’s Health Centre, and St. Michael’s Hospital)
Assistant Professor, Dalla Lana School of Public Health and the Department of Family and Community Medicine, Institute of Medical Science
By: Yena Lee
Dr. Szego was a bench scientist by training with plans to run his own lab until he learned of clinical bioethics as an alternative career path. While completing his PhD training in molecular genetics at the University of Toronto, Dr. Szego started volunteering with a clinical ethicist and eventually went on to complete a Master of Health Science in Bioethics and a Fellowship in Clinical Ethics at the Joint Centre for Bioethics at the University of Toronto. Now he’s the Director of the Centre for Clinical Ethics. As part of this faculty spotlight article, I interviewed Dr. Szego about what it means to be a clinical ethicist and his decision to pursue this field of work. The following are edited excerpts of our conversation.
What is clinical ethics and what do clinical ethicists do?
Clinical ethics is a practical discipline that provides a structured approach to assist healthcare providers, patients and their families to help identify, analyze and resolving ethical issues in medicine. Clinical ethicists help support healthcare organizations by conducting clinical consults, providing education to staff, through policy development and research. Clinical consults are usually requested by the clinical team when there is a conflict or moral uncertainty that has arisen over the course of delivering healthcare. Depending on the case, I will have a discussion with the clinical team or facilitate a conversation between the patient, family members, and healthcare providers. I think it is important to recognize that healthcare providers deal with ethical issues every day; however, sometimes there are difficult cases in which there is a disagreement about the right course of action. For example, I had a recent case involving a ventilated patient in the ICU. The clinical team determined that their interventions were merely prolonging the dying process and they proposed withdrawing life support. The family (since the patient was not capable of making treatment decisions) disagreed with the clinical team and wanted continued aggressive treatment. While I don’t have the space to unpack this case much further, I will end by saying the first step in cases like this is to try and determine what the patient would have wanted given the clinical scenario and use that information to guide the discussion.
What’s a typical day like for you?
There really is not a typical day, which is one of the reasons I like the role so much. I wear a pager and clinical consults always take precedent over any other plans for the day. When the pager is quiet, I work on healthcare policy development, sit on various hospital committees, and provide ethics education to healthcare providers. I also teach at U of T and have several ongoing bioethics research projects. One of my projects involves exploring patient and family perspectives on the return of whole genome sequencing results in children.
Can you tell me a little more about your research on ethical issues and genomics testing in children? How does the nature of your research in bioethics differ from that in the sciences, such as data collection or academic writing style?
For a child receiving conventional genetic testing, one ought to avoid tests pertaining to adult-onset disorders and wait until the child is old enough to make that choice for themselves. However, with clinical whole genome sequencing, the question is whether we should apply the same rules as for conventional genetic testing or should there be a different standard. If we performed clinical whole genome sequencing on a child, should we take the opportunity to screen for variants associated with preventable adult-onset disorders? And if we did identify a pathogenic BRCA1 mutation, for example, should we disclose the result to the parents? Such a result would have implications for the future health of the child and likely have immediate health implications for the child’s biological parents. My research focuses on using qualitative data, such as interviews, to describe the experiences of patients, families, and healthcare providers who have experience with whole genome sequencing. My goal is to use data to help inform the ethical debate.
How does your academic background differ from that of your colleagues in clinical bioethics? Do they generally have PhDs?
Bioethics is very interdisciplinary, so my colleagues all have different academic backgrounds, which makes collaboration a lot of fun. Most of my colleagues have either a Master’s or a Doctorate degree in philosophy, theology, or bioethics and many come from other disciplines such as medicine, social work, nursing, or allied health (e.g. speech pathology). While a Doctorate is not strictly required, it certainly helps as does the completion of a clinical ethics fellowship program.
What made you change careers paths?
When I started my PhD in molecular genetics my end goal was to run my own lab. I really enjoyed science and the work, but I got this nagging feeling, especially towards the middle to the end of my PhD, that a scientific career wasn’t entirely the right fit. I started going to seminars on alternate careers in the life sciences. At those seminars, I heard a bioethicist speak about his job and I remember being intrigued. One very appealing aspect of bioethics was the variety of activities that were associated with the job. He spoke about teaching, clinical consults, policy development, and research. It sounded like what I was missing—that kind of variety in any given day—so I put it in my back pocket as something interesting but at that point I needed to get back to my lab and focus on my thesis. But later, I coincidentally heard him speak a second time and this time I decided to talk to him after the seminar. I volunteered with him and shortly after decided to switch careers. I finished my PhD, then enrolled and completed a Master’s degree in bioethics and then completed a fellowship in clinical ethics.
What’s the most contentious case in the field right now?
There’s been a lot of discussion around medical aid in dying and conscientious objection. I am also seeing a lot of cases involving complicated transitions of care. Many patients in the hospital are what’s called, “alternate-level of care”. They don’t require acute care anymore, but there isn’t anywhere for them to go, so essentially they’re stuck in the hospital. For example, some families won’t agree to a discharge from hospital because they feel like their loved one is not ready or they want their loved one to go to a long-term care facility (nursing home).
Any advice for graduating students preparing for the next step in their careers?
This sounds trite, but follow your heart. You’re going to spend a lot of your life working so find something you like and are good at. If you are thinking about transitioning to another career path, talk to someone in that field and find out what path they took to get there. Volunteering is also a great way to get experience. If you want a hybrid career, it’s not a bad idea to get another degree. I know that sounds crazy at the end of a Master’s or a PhD, but having the credentials is important and you’ll also build a network which will help you in the future.