Jacob Appel is a busy man: A bioethicist, fiction writer, advocate and teacher, he has amassed numerous degrees, awards and accolades. His academic achievements include a B.A. and M.A. from Brown, an M.A. and M.Phil from Columbia, an M.D. from Columbia’s College of Physicians and Surgeons, a J.D. from Harvard Law, and an M.F.A. from NYU. He is a member of the bar in New York and Rhode Island. Appel has published over 100 short stories in literary journals, with several receiving prestigious awards, and has seen 10 of his plays performed in small theaters across the country. Currently, as a third year resident in psychiatry at Mt. Sinai School of Medicine, he teaches medical ethics and medical law.
Other teaching stints have included New York’s Gotham Writers Workshop and Brown University. At Brown, where he won the Undergraduate Council of Students Award for Excellence in Teaching in 2003, he co-taught and then taught legendary Professor Edward Beiser’s popular course, “Hard Choices,” an examination of the confluence of ethics and law. He also taught “Medicine, Law, and Morality” at the college. Appel is a libertarian in matters concerning the human body and personal behavior and advocates his views in academic and professional journals as well as in the press.
Half jokingly, Appel explains that his unusually broad academic and career training allows him to do poorly in one area while finding success in another. Professor Beiser, who was a great influence, taught that if you do many things, you perform well in some endeavors and poorly in others, and can get away with the poor performances because of the “confusion you have caused.” In truth, Appel explains, he is largely focused on bioethics, a field that both his medical and legal training inform. Even his fiction writing often addresses questions of ethics.
Bioethics embraces two distinct careers. One involves advocacy in the public sphere through writing and speaking to try to shift the values of others. The other is as ethics consultant in a hospital, discussing options with patients and families. Appel explains that an ethicist can provide general guidelines in public comments but must respect patient ideas and sensibilities in private contacts. In working with patients, it is important to distinguish between science and values, he advises.
“We should all be able to agree on science, but values vary,” he says. Cultural differences in our society must be recognized and understood by the bioethicist. He teaches students to respect patient views, and not think of them as incompetent if their beliefs differ. Accommodations must be made. For example, Jehovah’s Witnesses embrace most modern medical practices but, because of a biblical command, will not accept blood transfusions. Alternate medical and surgical techniques can be employed.
Ethicists are most effective and gain trust if they do not tell people what to do, but present options and make decision making comfortable. The professional field of bioethics is relatively new and evolving. Ethicists can be full time (one per hospital) or part time, performing the role together with other duties. The first ethicists were church related and concerned with practical everyday matters. More recently, legal aspects were emphasized.
Only in the past decade have programs to train ethicists been established. Programs are few, but Appel sees opportunities for advances in the new discipline.
“Five years is an eternity in bioethics. I have no idea what the future will look like,” he muses. While ethicists may have an impact in difficult situations, “they are not remembered,” Appel explains. “Their role is to do good in the world but not leave an imprint. #