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The American Journal of Bioethics 2.4 (2002) 21-23



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Now That We Have the Data, What Was the Question?

Charles L. Bosk,
University of Pennsylvania

The editors have requested a commentary on The North American Bioethics and Medical Humanities Training Program Survey (American Society of Bioethics and Humanities (2001) that centers on three questions:

  1. What does the dramatic growth of graduate training programs in bioethics/medical humanities say about the current state of the field;
  2. What are the obligations of graduate bioethics medical humanities programs toward their students?
  3. What are some possible implications of the survey results for the future of the "field"?

Readers of my response to these questions should bear in mind that I regularly teach in a highly profitable bioethics master's program and that I find this teaching for an audience of largely "persons with professional or advanced degrees" to be extraordinarily challenging and stimulating, as well as an effective reminder of my own disciplinary blinders.

Despite the ongoing satisfying pedagogic experience and despite the past opportunity to discuss, reflect, and report on issues of education and practice with colleagues on the first ASBH Task Force on Guidelines and Standards for Clinical Ethics, I have conflicting responses to the questions that the editors pose. Unfortunately, the survey conducted by the ASBH's Status of the Field Committee does little to clarify my thinking. Now I have data, pages upon pages of graphs, charts, and factoids that appear capable of supporting whatever position I choose to take. I am beginning to feel that the sputtering incoherence of my efforts to reflect upon the future of bioethics is more an accurate reflection of the world that I am trying to describe than a defect in my cognitive abilities. As I read the report of the committee, the world of bioethics appears to be all trees and no forest; all hat, no cattle; all dots, no lines. The report does nothing so much as remind me of the punch line of the Steve Wright joke about the "photographer who went crazy trying to take a close-up of the horizon."

Dramatic Growth and the Current State of the Field

The ASBH Training Program Survey reports that 47 institutions offer a total of 108 programs: 63 M.A. programs, 19 Ph.D. programs, 13 fellowship programs, 11 certificate programs, and 2 labeled "Other." There was a 182% growth in bioethics training programs in the 1990s. Some of this explosive growth can be discounted as nothing more than a baseline phenomenon. When there are only a few programs initially, modest growth looks dramatic in percentage terms. Some of this growth can be understood as the natural organizational evolution of bioethics within academic institutions. First, interdisciplinary centers, institutes, or departments are formed; then those administrative units propose, develop, and offer degree programs. The motives for offering such programs can be multiple and mixed—there might be perceived local demand, students can be seen as a source of revenue, and mentorship is one of the real rewards of academic settings. Whatever the forces underlying the growth in graduate bioethics training, the implications from the expansion in the ranks of "academically legitimated and certified" specialists raises demographic, pedagogic, and political questions for the domain of bioethics.

In 1999-2000 there were 242 new graduates holding bioethics degrees of one sort or another. Since, in general, programs keep neither placement nor salary data, we have little idea of what these graduates are doing, for whom they are doing it, and for what level of compensation. The survey does tell us that, according to the best available data, 49 ethics positions were filled in the United States and that an additional 12 positions were closed/filled in Canada. Another way to look at the same data: four degree-holding bioethicists were produced in 1999-2000 for every posted job opening. If we extrapolate these figures over a ten-year period, close to 2500 bioethicists will be chasing 600 jobs. This would constitute an extreme case of a buyer's market. These...

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