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The University of Chicago was founded in 1890 on the basis of values and beliefs that have guided the university to the present day. The visionary ideas were due in large part to the influence of its founding president, William Rainey Harper, and the unprecedented support of its founding benefactor, John D. Rockefeller [1]. If the University of Chicago no longer seems as radically innovative as it was at its inception , it is because its system of university structure and study implemented by Harper in 1890 has been so widely imitated across the United States [1]. Chicago was “built for a long future,” and its faculty and students are instilled with the commitment “to re-create that future for its successors” [1].

Those of us who have spent so much of our careers at the University of Chicago are well aware of the ongoing impact of the university’s longstanding cultural and intellectual ideals on students, residents, faculty, and deans. As described in John Boyer’s recently published history of the University of Chicago [1], the university’s cultural and intellectual milieu was powerfully shaped and conveyed in Harper’s original vision. One quality, namely his reverence for a “modern” scholarship that confronts facts courageously and thinks through complicated and controversial questions inductively, continues to be the gold standard by which our faculty and students measure themselves. As we consider Dr. Mark Siegler’s long and distinguished career on the campus of the University of Chicago and his impact on our school and our students, we are reminded of how aligned he is with the value system of the University of Chicago and how he himself has long served and continues to serve as one who has protected and sustained the University of Chicago’s “long future.” Over the 50-plus years that Mark has spent on the University of Chicago campus —as a medical student, internal medicine resident, chief resident, and faculty member—he has manifested the core values of this institution in his dedication to innovation and scholarship in clinical medical ethics, while also maintaining a deep commitment to teaching and to providing the highest quality of clinical care for his patients.

Shaped as he has been by the University of Chicago, Dr. Siegler has also served as an exemplar within the specific traditions and values that are fundamental to the history of medical education as it unfolded at this institution. The remarks made by Richard Richter, M.D., to the graduating class of 1967—Dr. Siegler’s class—and the alumni attending their reunion are very instructive in this regard. Dr. Richter, himself a 1925 graduate of the joint University of Chicago and Rush Medical School before the opening of Billings Hospital in 1927 allowed the medical school to consolidate both preclinical and clinical education on the University of Chicago campus [2], recounted the medical school’s history and its unique attributes. These include the geographic and intellectual integration of the basic and clinical sciences within the division of biological sciences, a completely full-time faculty relieved of “the relentless distractions and demands of private practice and free to devote their full energies to teaching or research, or both” [3], and the commitment that all patients seen at the clinics and hospitals of the university—not just charity hospitals—be part of the teaching and research enterprise. As Dr. Richter explained to the 1967 graduates, this clinical care and educational structure, which he described as a blend of the Johns Hopkins and Mayo Clinic models, offered unique advantages for the students and patients but, most importantly, shaped the faculty in profound ways. He stated, “To make it work successfully, the modern scientific clinician must lead a double life and function also as a skillful and humane doctor, able to attract and hold patients. He must even keep in mind that old bromide, the patient-physician relationship. For the patients come not to benefit medical science after all, but because they are sick and want to be helped” [3].

This review and description of the values and traditions which animated and shaped the university in general and medical education in specific provide a crucial context for Dr. Mark Siegler’s many contributions. As he has spent his entire career from medical school to the present at the University of Chicago, it is remarkable to appreciate the extent to which this university has molded and shaped Dr. Siegler as a teacher, physician, and scholar. In turn, it is no less true to say that Dr. Siegler’s impact and contribution to the institution’s “long future” has been no less formidable—as the “modern scientific clinician” whose work in establishing an academic clinical medical ethics program and consultation service and a clinical ethics fellowship program along with his commitment to the doctor-patient relationship has influenced the teaching and practice of clinical medicine on our campus and throughout the world.

Mark Siegler arrived in Chicago in 1963 as a young graduate of Princeton University. He joined the University of Chicago medical school class just days after meeting his future wife, Anna, on the University of Chicago’s campus, thus beginning two lifelong relationships formed in Hyde Park. Dr. Siegler is proud to affirm that during his 50-plus years at the University of Chicago, he has personally known all but 3 of the 19 deans of the biological sciences division and the Pritzker School of Medicine, including our medical school’s founding dean, Dr. Franklin McLean , whom Mark cared for as an internal medicine resident during Dr. McLean’s hospital admissions. Mark has always honored the traditions and histories of the University of Chicago as well as its thought leaders, even going so far as to find time to pay his respects to Lowell Coggeshall, the former dean of the biological sciences division from 1947 to 1960, during his 1967 honeymoon! Amusing as an anecdote, it nonetheless says something notable about Mark and his loyalty and admiration for the history and traditions of the University of Chicago.

Following the completion of his internal medicine residency and his chief residency year, Dr. Siegler left the university for the one and only time in his career to complete training at the Hammersmith Hospital in London, England. Returning to campus as an assistant professor, Dr. Siegler met with the chairman of medicine, Alvin Tarlov, and as he is very fond of relating, took on the four jobs that comprised his first faculty role in the department of medicine. One of Dr. Tarlov’s early goals as chairman of medicine was to create a strong academic section of general internal medicine to complement the strong subspecialty orientation of the department. From its inception in 1927, the department had been divided into different sections that encompassed all components of internal medicine. As explained by Dr. Franklin McLean and Ilza Veith in their history of the first 25 years of medicine at the University of Chicago [2], such a structure would leverage the benefits derived from the intense focus of specialization while limiting the dangers of limited experience by having the specialists function as generalists, practicing together in the provision of clinical care, making a separate section of general internal medicine unnecessary. However, under the leadership of the department chair George Dick, from 1933 to 1945, an “undifferentiated” clinical service grew in size such that it occupied one-third of the beds overseen by the department of medicine [4]. Following his departure, the concept of a general medicine service disappeared, until resurrected by Dr. Tarlov in 1970.

In 1973, the section of general internal medicine was formed, and Dr. Siegler became one of the first faculty members [4]. This newly constituted section was responsible for its own inpatient and outpatient services as well as a consultation service and commenced its own program of research and investigation. Mark was one of the backbones of this section as it grew—serving as inpatient director of one of the inpatient general medicine services for 8 months of the year as well as providing oversight of all medical student programs sponsored by the department of medicine, including the third year internal medicine clerkship and the fourth year electives in medicine. In addition to these two important jobs, Mark also served as the leader of the newly created general medicine consultation service to provide consultations to other departments such as surgery and obstetrics-gynecology. During this same year, Dr. Tarlov conceived of something else that was new—a medical intensive care unit . In 1972, the specialty of critical care medicine did not yet exist, but Dr. Tarlov understood that there needed to be a unit where care for the sickest patients could be monitored most closely. Dr. Siegler was to attend on the medical intensive care unit 12 months of the year!

Mark with his “four jobs” served as one of the leaders in forming this section of general internal medicine, but even more importantly, these opportunities provided an intensive “think tank” or laboratory wherein Mark found his focus and his professional direction. During the 5 years when he directed the medical intensive care unit (1972–1976) multiple important ethical issues related to medicine emerged—from end-of-life care to informed consent to surrogate decision-making to confidentiality. Mark saw students, faculty, and residents confronting ethical issues in clinical care on a daily basis without a frame of reference or background of scholarship to rely on for guidance and support. From this experience came Mark’s sense of purpose for his future career and the birth of a clinical medical ethics consultation service , where the practical and difficult ethical questions arising in the care of patients could be answered with an integrated ethical analysis. This service produced two very positive outcomes: patient and family engagement increased and the confidence of clinicians in complicated ethical decision-making grew. In Mark’s words, “Clinical ethics focuses on the doctor-patient relationship and helps patients, families, and physicians reach good clinical decisions , taking account of both the medical facts of the situation, as well as the patient’s preferences and values” [5].

With the early support of his next department chair, Dr. Arthur Rubenstein, the Mellon Foundation, and later with the generous naming gift from the MacLean Family, Dr. Siegler founded the first Center for Clinical Medical Ethics in the department of medicine in 1984.

In 2013, in recognition of the international significance and fundamental impact of the work conducted by the MacLean Center, it became only the fourth institution (joining the Hastings Center, Kennedy Institute of Ethics at Georgetown, and the Institute for Medical Humanities at the University of Texas) to receive the Cornerstone Award from the American Society of Bioethics and Humanities for “outstanding contributions from an institution that has helped shape the direction of the field of bioethics” [6].

The MacLean Center has too many achievements and contributions to be described comprehensively, but we wish to highlight two of its most notable activities. The first is the signature program of the MacLean Center, the clinical ethics fellowship , which began in 1981. The first of its kind, this program has provided training for over 440 fellows, including more than 275 physicians. More than 40 of the fellows trained at the MacLean Center have gone on to direct university ethics programs, and more than 25 fellows now hold endowed professorships in ethics. The fellowship’s impact is not only national but global—with fellows joining our campus from Argentina, Brazil, Canada, China, France, Kuwait, Russia, Spain, and Switzerland, among other countries. These individuals have published many thousands of peer-reviewed journal articles and more than 150 books advancing the field of clinical medical ethics.

A second notable achievement of the center is the creation of a unique clinical ethics consultation service in 1986 [7]. Over the prior decade, an increasing number of ethicists began focusing on issues in medicine. However, trained in the humanities and focused on theory, these scholars were not able to provide guidance on the plethora of day-to-day dilemmas encountered by the practicing physician [8]. The field of biomedical ethics’ “language of theory was not helpful in resolving the dilemmas of practice” [9]. The University of Chicago’s clinical ethics consultation service was, in contrast, one of the first of its kind in the United States to utilize physicians as trained ethics consultants, thereby providing, over the past 30 years, a truly unique resource for our institution’s clinicians, who can rely on the body of scholarship and inductive reasoning skills of the center’s faculty and fellows to help manage complex and ethically challenging clinical patient scenarios [8]. In a 1978 paper [10] reprinted in this volume on page 220, Mark was the first to use the term clinical ethics [8] and identify where it needed to be taught—in true Oslerian fashion—at the bedside [10]. Since the service’s inception, the center’s faculty and fellows have consulted on over 2500 cases at the University of Chicago. One of the papers reprinted in this collection, on page 40, assesses the preliminary impact of this ethics consultation service through a prospective study conducted in its first 2 years of operation. Even in this short time, it was eminently clear that such a consultation service had enormous value in helping physicians identify, analyze, and resolve ethical issues in patient care [7].

We have spoken of how the University of Chicago and its core values shaped Mark’s work; it is equally important to note the unique opportunities that Mark found at our university as he implemented and developed the MacLean Center’s programs . William Rainey Harper’s original vision of the University of Chicago included a commitment to aggressive programs of original research [1], and the University of Chicago, with 89 faculty and alumni Nobel laureates, one of the highest numbers of any U.S. institution [11], is justifiably regarded as a major contributor to knowledge in multiple disciplines. Further, from its inception in 1890 the university has emphasized and encouraged interdisciplinary fields of study and cross-disciplinary collaboration [1].

In this environment, Mark Siegler enthusiastically sought out and masterfully utilized the resources and advantages of the University of Chicago, drawing on its world-renowned faculty from law, public policy, divinity, business, philosophy, and economics to contribute to the center and its work. That so many leading scholars would choose to affiliate with the MacLean Center is in fact one of the defining characteristics of the center and of its work. In 1981, Mark Siegler and Richard Epstein, then the James Parker Hall Distinguished Service Professor of Law, organized what has now become an annually offered interdisciplinary faculty seminar series, bringing together leading thinkers from across campus and throughout the world to conduct an in-depth ethical analysis of one key health issue through multiple hour-long seminars held every few weeks. This seminar series, constructed in the prototype of the university’s vaunted workshop model, which was introduced in the economics department in the 1940s and has expanded across the university in the ensuing years [1], brings together faculty and students to explore multiple perspectives on complex issues affecting science and medicine. Topics have included organ transplantation, pediatric ethics, end-of-life care, global health, health care disparities, medical professionalism, confidentiality, pharmaceutical innovation and regulation, neuroethics, and reproductive ethics [12].

Mark’s impact as a scholar has been felt around the world, but on our campus he is also deeply respected as a teacher and as a clinician. In 1898, William Rainey Harper stated, “I cannot conceive that a man worthy to hold the place of Dean would accept the position without the privilege of giving instruction. A man who was a Dean and who gave no instruction would merely be a clerk….So strongly do I feel this principle myself that I do the work of a professor, and shall continue to do so as long as I am President” [1]. Throughout Mark Siegler’s career, while providing care to patients, developing scholarly contributions in developing a new consult service and fellowship program, creating and leading a world-renowned center, and receiving multiple honors and awards, he has followed President Harper’s stricture—he has done “the work of a professor.” Nor were these minimal contributions to the teaching mission. Two commitments stand out from multiple others: he was for 10 years the director of the medical school’s required Physical Diagnosis course, and he has been for the last 16 years the director of the medical school course on the Doctor-Patient Relationship in Clinical Practice , required for all first-year students.

As quoted previously, Dr. Richter stated at Mark’s 1967 medical school graduation that the modern scientific clinician must lead a double life and function also as a skillful and humane doctor. Mark Siegler has given an unwavering enthusiasm and commitment over 50 years to his role as clinician. He has cared for trustees and politicians and the most vulnerable patients from our South Side community with devotion and commitment. He is, for all his patients and not only for those who can afford such a privilege, a “concierge” clinician by temperament and practice. He meets his patients in the emergency department and accompanies them to the operating room. He is a role model for providing compassionate care.

It was his outstanding clinical care that served as the model on which the Bucksbaum Institute for Clinical Excellence was established in 2011, with a most generous donation by a grateful patient who admired and appreciated his collaborative relationship with patients and felt that such care should serve as an exemplar for all physicians. The central mission of the Bucksbaum Institute is to elevate the doctor-patient relationship and to make optimizing our relationship with patients a core guiding value for all our clinicians [13]. As part of the Bucksbaum Institute’s support, Mark is currently co-teaching a senior medical student seminar on the doctor-patient relationship with one of us (HJH). One of his favorite teaching articles for the class is included in this book, on page 92. This paper, presented as part of a 1980 conference and published the following year, explores the tensions between the traditional paternalistic model of the doctor-patient relationship and the patient-centered , potentially consumerist model that emerged in the latter part of the twentieth century and has grown even stronger with the advent of the internet [14]. Mark’s prescience in identifying this tension and his creativity in seeking a third way, which he terms “physician-patient accommodation” and which transcends the biases inherent in the competing models, is every bit as relevant today as it was 35 years ago. Dr. Mark Siegler’s thoughtful consideration of the human and ethical aspects of science and medicine has made him a reference point for countless individuals. He has contributed to the intellectual life through not only the generation of new ideas but also his mentorship of students and physicians. In his history of the University of Chicago, John Boyer writes that the first faculty and leaders of the University of Chicago marveled at how our institution was created “de novo out of ambition, openness, a penchant for risk taking, and seriousness” [1]. These words and this legacy could aptly and accurately be used to describe Dr. Mark Siegler and his life’s work as a physician, a teacher, and a thought leader. The essence of the University of Chicago is its faculty, and Mark’s contribution to the fabric of this intellectual community enjoys a place of prominence over the many years of our institution’s history.