Vital Signs

Ethics expert is inaugural incumbent of new chair

By Amos Esty

Over the course of his career as a neurologist, Dr. James Bernat has been widely recognized for his work in medical ethics. But even as he's traveled the world to share his expertise, he has remained committed to providing top-notch care to patients back at DHMC.

That commitment, together with his accomplishments in research and teaching, led to his recent appointment as the inaugural incumbent in the new Louis and Ruth Frank Professorship in Neuroscience. The chair was funded by Brigadier General Louis Frank and his family out of gratitude for the care provided by Bernat to Frank and his late wife, Ruth.

Question: "I am thrilled and honored and humbled to be named to this chair," Bernat says. He became interested in medical ethics as a resident at Dartmouth in the 1970s, when he began to question whether the cessation of brain function was the best means of determining death. The thinking, he recalls, was that "if you can show the irreversible cessation of the clinical functions of the brain, then you can declare the patient dead, despite the fact that their heart is still beating and they're on a ventilator. . . . I was a little skeptical initially about whether the person really was dead."

So Bernat began to study the issue in earnest, and in 1981 he and two Dartmouth colleagues published a groundbreaking paper that affirmed the use of brain death as the best way of determining death. "That was the first time there was a rigorous philosophical justification for why brain-dead patients are, in fact, dead," Bernat says.

Ethics: As his interest in medical ethics grew, Bernat became widely sought as a consultant; he's advised the Vatican and the World Health Organization, among other organizations. In April, he received the prestigious President's Award from the American Academy of Neurology (AAN); for 10 years he chaired the AAN ethics committee. Closer to home, he has chaired DHMC's ethics committee since 1994.

The field has become more rigorous since Bernat was a resident, but he feels the training that medical students receive could be improved. "It isn't really clear what the best way is to teach medical ethics," he says. With his appointment to the Frank Chair, he plans to pursue research on the teaching of the subject. He also plans to write a new edition of his book Ethical Issues in Neurology, first published in 1994.

Appointment: All of this, he notes, will be made possible by the appointment. "It's a wonderful time in my career," he says.