IT WAS THE KIND OF QUESTION THAT Hippocrates, the father of medicine, never had to confront. A 29-year-old man, stricken suddenly by a brain aneurysm, lay dead in a Philadelphia hospital. No sooner had his distraught wife heard the news than she approached doctors with a desperate, and startling, request: She wanted them to remove sperm from his body and place it in a freezer, thereby keeping alive her dream of bearing her husband’s child. As the doctors knew—and as the woman had recently heard on a radio discussion—sperm can live in a dead body for at least 24 hours. But the doctors were less sure it would be ethical to create life from the body of a dead man. Rather than resolve the issue themselves, they called Art Caplan, the head of the bioethics department at the University of Pennsylvania.
Two hours later, Caplan was sitting at a table in a hospital conference room with eight doctors, the hospital’s attorney and the 27-year-old widow. At first, Caplan turned a dubious eye to her request; he felt that even a dead man should have the right to consent to fatherhood. What’s more, a woman still in the first hours of widowhood might not be thinking clearly enough to make such an important decision. But after hearing the woman out, Caplan reconsidered. For one thing, the couple had been trying to have a baby for months, which meant the man had consented to fatherhood. And the widow was willing to wait several months before making the final decision. “So we said go ahead,” Caplan says. “She passed all the hurdles.” (Four months later the woman is still deciding whether to use the frozen sperm.)
Caplan, 47, does not play God exactly, but sometimes he does a fair approximation. As perhaps the nation’s most prominent bioethicist he helps set the standards for an array of medical ethics issues, including how to distribute organs for transplants to critically ill patients, the use of experimental drugs on humans and the morality of doctor-assisted suicide. In the past such morally complex issues might have been addressed by a hospital’s most senior doctors, sometimes influenced by their religious beliefs. But technological breakthroughs, the high cost of care and, says Caplan, “religion’s fear of science,” have created a need for an unbiased outsider to help answer the Solomonic questions of modern medicine. “Most doctors want to do good,” he says. “But they’re humans, and humans tend to be flawed.”
So Caplan, a doctor of philosophy, serves as a conduit to wisdom. Sometimes he finds himself conducting a frantic emergency room conference to help referee a difficult case. More often, Caplan and his fellow bioethicists work at a more thoughtful pace, analyzing controversial practices and viewing the questions they raise against the fundamental ideals of social justice set by such philosophers as Plato, Aristotle and John Stuart Mill.
Though people have been debating medical ethics since the days of Hippocrates, the term bioethics wasn’t coined until the late ’60s, and the specialty is still viewed by some doctors with skepticism. Few of the estimated 2,000 bioethicists practicing in the U.S. have medical degrees, and none has any absolute authority over doctors, who are free to reject a bioethicist’s recommendations. Most, like Caplan, are academics paid by universities, medical schools or hospitals.
As the author or editor of 21 books, including Due Consideration: Controversy in an Age of Medical Miracles, which will be published in December, and hundreds of scholarly articles, Caplan has been a leader in the field almost from the time he broke into it 20 years ago. “Art’s the best in the world,” says Bill Kelley, dean of the University of Pennsylvania’s medical school. “He’s widely and highly regarded by all his colleagues.” And highly trained. While earning his Ph.D. in philosophy at Columbia University in the late ’70s, the burly, outgoing Caplan spent two years as a special student at Columbia’s medical school, eventually earning a master’s degree in the philosophy of science. And though he served on President Clinton’s health-care panel in 1993 and has spent the past two years on the Presidential Advisory Committee on Gulf War Veterans’ Illnesses, Caplan’s influence comes less from his academic résumé than his ability to communicate with nonacademics. “Art’s eclectic,” says Barbara Koenig, executive director of Stanford University’s Center for Biomedical Ethics. “He knows science and medicine from the inside, but he doesn’t hide in the ivory tower.”
Not that a bioethicist’s tower is sheltered. Once Caplan had to work out an ethical treatment for a man whose polydipsia—a compulsive need to drink water—threatened to kill him by washing all the nutrients from his body. (A crate of Gatorade kept him going until he could be committed to a psychiatric hospital.) Then there was the case of the diabetic whose transplanted kidney was giving out because the 55-year-old man had stopped taking his antirejection medicine. Though he would die without a second transplant, doctors judged him irresponsible. But before they struck him from the waiting list, they called Caplan. He first checked into similar case histories, then mulled 19th-century philosopher John Stuart Mill’s defense of individual liberty and self-determination. Finally, Caplan spoke to the patient and discovered a key point the man had hidden from his doctors: The high cost of the drugs was a hardship for his family. “Now,” says Caplan, “the framework shifts from ‘The guy’s a jerk’ to ‘The guy’s a hero.’ ” As a result, the man got financial advice as well as his new kidney.
Despite such successes, some critics worry that bioethicists might be used by budget-conscious health-care providers to bully patients into accepting lower standards of treatment. “There can be conflicts of interest,” says Stanford’s Koenig of the bioethicists who (unlike Caplan) are paid by hospitals or insurance companies. “Patients need to be aware of the power dynamics at work.”
Caplan, a staunch supporter of universal health care, nonprofit hospitals and patients’ rights, escapes that particular criticism. Yet he has drawn fire for his love of the spotlight. “[Other bioethicists] grumble because they think he’s on TV too much,” says Caplan’s wife, Jane. Caplan says focusing public attention on bioethics—as when he makes one of his many appearances on ABC’s Nightline or supplies quotes for yet another article in The New York Times—is a key part of his job. “There’s no reason to keep this stuff locked in academic journals,” he says. Still, Jane admits, “He loves getting in front of a crowd.”
It shows. A man who talks as fast as he thinks, Caplan laces med school lectures on such topics as informed consent with wisecracks and karate-chop hand gestures. Facing down a camera or a newspaper reporter, he practically glows. “He always wanted to help mankind,” Caplan’s mother, Natalie, recalls. “And he [also] wanted to be famous.”
The eldest of three children born to Natalie, a homemaker, and Sidney, a pharmacist, Caplan grew up in suburban Framingham, Mass. One morning when he was 6, Caplan suddenly came down with a high fever and weakness in his limbs. Diagnosed with polio, he was sent to Children’s Hospital in Boston—a terrifying place in the midst of a polio epidemic. “Kids in his room would vanish,” his mother recalls. “And he’d ask, ‘Where did they go?’ ” The doctors tried to cover up the truth. “They’d say, ‘Oh, Johnny went home,’ ” Caplan says. “But you’d know Johnny was dead.”
Caplan was luckier. His paralysis ebbed after two months, and he resumed a normal life, eventually growing strong enough to play lineman on the Framingham North High School football team. Caplan also made the National Honor Society before heading in 1967 to Brandeis University—where he was not exactly voted most likely to be a bioethicist. “Art was very smart,” says Jane, who met her future husband, a sophomore, during her freshman year. “But he was a jock who liked knocking people over. He was known for throwing beer cans at security guys.”
Caplan also threw himself into philosophy, he says, because it combined elements of sports and academics. “It was like intellectual wrestling,” he explains. “The people in it were very sharp, and I wanted to go at it with them.” After graduating in 1971 (and marrying Jane, now a psychologist, the same year; their son Zach was born in 1984), Caplan headed for Columbia, where in 1975 he learned that the medical school needed a grad student to teach a medical ethics class. Taking the job for its $1,000 salary, Caplan—who knew how it felt to face a potentially deadly disease—found himself enthralled by questions involving test-tube babies and organ-transplant candidates. “Med school was like a giant philosophy lab,” he says. “It was full of drama and ethical questions.”
By 1980, Caplan was dividing his time between teaching at Columbia and a research job at a bioethics think tank in Hastings, N.Y., called the Hastings Center, where he helped promote federal legislation to create living wills and encourage organ donation. After founding a bioethics program at the University of Minnesota in 1987, Caplan started writing a weekly bioethics column for the St. Paul Pioneer Press that became nationally syndicated. Three years ago, he was lured to Penn by a $200,000 salary, an interest-free loan for the historic stone house he bought for his family in the Philadelphia suburbs and a promise by the school to build the nation’s best bioethics center.
As he sits in his sparsely decorated office—just across the hall from the expanding center of bioethics, where construction workers are making space to enlarge the staff to 20 full-and part-time professors—Caplan sees a future full of bioethics. “People haven’t really fathomed how big this is going to be in our lives,” he says. “With gene mapping we’re going to be able to design our own children, literally. And with realtime brain scanning, you can figure out someone’s sexuality, their psychological balance, and more. But what do you do with that information?” The possibilities—and questions—are endless. “When it comes to ethical thinking,” Caplan says, “the future is bright.”