Douglas Brown, PhD, celebrates 20 years advancing medical and surgical ethics

Douglas Brown, PhD, came to WashU Medicine and Barnes-Jewish Hospital in January 2007, bringing with him an uncommon perspective grounded in years of work in clinical settings and a concentration on the questions that come into focus when medicine reaches its limits. Over the past 2 decades, exposure to this perspective has helped medical students, residents, and faculty members navigate the ethical challenges that accompany patient care.

Now in his 20th year with WashU Medicine and approaching 15 years with the Department of Surgery, Brown’s influence is present across educational programs, ethics initiatives, and mentoring relationships that have helped shape the culture of surgical training.

Emerging ethicist

Brown’s journey into bioethics education began unexpectedly. Originally trained as a historian, his perspective was profoundly shaped by caring for his first wife (d. 1987) during her 14-year battle with multiple sclerosis, prompting deeper questions about illness, suffering, and compassionate care.

“The illness put us in an unanticipated existential crucible,” said Brown. “For a decade, I was a graduate student examining the history of ideas against the backdrop of a chronic illness that demanded a verdict every day concerning what makes a life meaningful. I was struck by the discovery that there were physicians and nurses caring for patients such as my wife when they had no interventions to control, much less to defeat, their illnesses. Why?”

As bioethics emerged as a growing field in the late 1970s, Brown connected with physicians who saw a role for the humanities in medicine.

“By the time I finished graduate school and was moving into a career as a history professor,” Brown said, “I had met academic physicians who were looking ahead, recognizing the need for the humanities to have a place both in medical education and in clinical practice.”

Brown’s collaborations in obstetrics, gynecology, and neonatology brought him into hospitals and clinics, where a research interest evolved into a career working alongside clinicians to address complex ethical challenges in patient care. Throughout his career, Brown remained closely connected to the realities of bedside medicine, engaging ethical questions directly in clinical settings. His commitment to staying closely connected to patient care has guided his career. Rather than looking at ethical issues from a distance, he has addressed ethical questions firsthand in clinical settings.

Building ethical practice in surgery

Brown came to WashU Medicine in January 2007, initially working with hospital ethics committee leaders and spending most of his time in ICUs, emergency departments, and other frontline settings. These experiences established a foundation for blending scholarship, ethics, and clinical practice. Brown sought opportunities to engage directly with the caregivers and patients confronting difficult medical decisions every day.

His contributions also extended to facilitating ethics education for clinical support staff, such as nurses and chaplains, serving on a WashU Institutional Review Board review committee, and contributing to research initiatives examining inequities in health care participation. In one notable project, he served as lead field researcher and data analyst for a 2-year study investigating why older African American St. Louis residents living near WashU Medicine and Barnes-Jewish Hospital were underrepresented in research studies addressing health disparities.

Early in the 2011-12 academic year, Mary Klingensmith, MD, then vice-chair for education in the Department of Surgery, brought Brown into the department to handle the day-to-day management of the third-year medical student surgery clerkship. As a member of the department, he was better able to help faculty and residents develop educational programs for medical students and residents. Among his contributions were creating a structured ethics curriculum within the surgery clerkship (making the surgery clerkship one of the first required clerkships at WashU Medicine to integrate ethics education with clinical education); and assisting Ira Kodner, MD, in implementing a unique ‘Ethical Challenges’ elective for fourth-year medical students.

Advancing surgical ethics leaders

Among Brown’s most significant contributions has been his role in the formation of the Center for Humanism and Ethics in Surgical Specialties (CHESS) created by former faculty member and trauma surgeon Piroska Kopar, MD, MBA. This fellowship, which has helped position the Department of Surgery as a national leader in surgical ethics education and scholarship, offers structured training for faculty and educators seeking to advance ethics instruction in surgery and serves as a model for similar programs nationwide. Brown continues to assist with the transition of the fellowship into the Ethics of Surgery Fellowship recently adopted and endorsed by the Association for Surgical Education (ASE), having been recognized by the ASE with the Clerkship Coordinator Recognition Award and the Clerkship Administrator of the Year award in 2019. The evolution of the program represents an important milestone for CHESS and highlights the national reach of work that originated at WashU Medicine.

Brown remains engaged in several ongoing projects, including development of a practical medical and surgical ethics handbook designed to help clinicians address ethical concerns in real time. Another initiative explores lessons learned from the COVID-19 pandemic through a humanities-based symposium that allows frontline responders to reflect on the challenges and consequences of one of the most extraordinary periods in modern health care.

Reverberating impact

Brown credits much of the department’s contributions to the surgical ethics field to visionary leaders who championed the field more than two decades ago and whose impact transcends the school of medicine. He points to the continued leadership of associate professor of surgery Kathryn Rowland, MD, MPHS, and adjunct instructor of surgery Marguerite Spruce, MD, who are guiding the next phase of growth in ethics education and research at CHESS.

As the department looks to the future, Brown is encouraged by the growing community of faculty, fellows and residents committed to strengthening surgical ethics both at WashU Medicine and across the country.

Brown has focused on creating opportunities for students, residents, fellows, and faculty members to think more intentionally about the ethical dimension of medicine. His influence is evident in the trainees he has mentored, the educational programs he has helped establish, and the culture of ethical inquiry that has become a hallmark of the Department of Surgery.

Despite his many contributions, Brown remains modest about his role.

“I’m a mudder,” said Brown, invoking the interior construction worker who patiently smooths walls before the wallpaper or paint is applied. “Or an irrigation ditch, even a drainage ditch at times! These metaphors point to the aim to be an encourager.”

Yet after 20 years of service, his impact is clear. He has helped ensure that future surgeons trained at WashU Medicine are prepared not only to care for patients skillfully, but also to care for them thoughtfully and compassionately with respect, wisdom, and gratitude.

Brown keeps a coffee mug beside his work station laptop that is inscribed with a quotation from Ralph Waldo Emerson to make sure he remembers what really matters in a life:

Douglas Brown, PhD, remains active in departmental surgical ethics initiatives. He and his wife live in the Central West End. They have three daughters and four granddaughters.