Question: How do you balance bioethics, psychiatry, and writing?
Jacob Appel: Sure. I try to wake up every morning and get several hours of writing done before I go to the hospital, which can range between 5:00 in the morning and 7:00 in the morning. So, I could, in theory, be writing as early as 3:00. Do a few hours of writing; see my patients during the day. Intermittently during the day I do some phone interviews. If I'm on call at the hospital I can write a bioethics column and then I come home and do probably a couple of hours of bioethics work in the evening.
Question: What does your work as a psychiatrist and bioethicist entail?
Jacob Appel: Sure. Well, until recently, I was teaching bioethics at Brown University and NYU. So, there I would have my full class of either undergraduate or graduate students and I would do some consulting work on the hospital floors as well. Now, since I'm practicing medicine nearly full time at Mt. Sinai in psychiatry, I do occasional bioethics consultancy inside the hospital at Mt Sinai, but far more often, I'm consulting people outside, giving them advice on issues relating to the beginning of life, end of life.
Question: What is bioethics, and what is the role of a bioethicist within a hospital?
Jacob Appel: Absolutely. I think 30 years ago, there were no bioethicists. It is one of the new occupations of the technological age that we live in. And it takes traditional moral questions about when life begins when life ends, and sees them through the prism of modern technologies. And as we've developed, for example, ways of keeping life going beyond its natural parameters, the question arises; how far should we keep life going? And a bioethicist inside the consultant setting of the hospital doesn't offer people answers, it sets out parameters for people to think about answers. So that a family on their own can make decisions based upon different ways other people have handled these situations in the past.
Question: Should bioethicists perceive themselves as arbiters of right and wrong?
Jacob Appel: I think it's far better to think of bioethicists as guides. I think there is a cottage industry now of people who have made a living or a career out of criticizing bioethicists because they view bioethicists as these plutonic guardians on high who step into the fray and say, "this is how we will do things." I know no professional bioethicists who actually operate that way. Far more bioethicists show people the signposts, show people different alternatives and let them make their own decisions. And I think that's important. I think that in the same way you wouldn't want your medical or legal decisions made by someone else; you will want to be consulted on an expert and then make the decision on your own. A bioethicist is an expert who shows you different parameters and then let you make your own decision.
I should add, before the 1970's, philosophy as a field had branched far away from moral thought. It delved into questions of epistemology, the five-year olds age old question, when my parents leave the room do they still exist? And it's bioethics that in addition to working inside the hospital with families has also brought back morality back into the field of philosophy.
Recorded on March 1, 2010
Interviewed by Austin Allen