Letter to a Young Bioethicist

By Daniel Sokol

It is now 18 years since I started my journey in bioethics.

In the summer of 2002, I sat in Brown’s Brasserie in Oxford with Tony Hope, Professor of Medical Ethics at Oxford University. At the time, I had completed an undergraduate degree in modern languages and was finishing a Master’s in Medical History. “I want to be a clinical ethicist”, I said. “I’m not sure there is such a thing in the UK”, he replied and recommended the MSc in Medical Ethics at Imperial College London.

Brown’s Brasserie in Oxford

Another Master’s and a Ph.D. later, I launched into an academic career. I enjoyed the teaching, research, and writing but loathed marking and meetings. In 2009, I trained as a barrister, and soon after started practising law. Despite the shift, I have never left the field of bioethics and continue to write and lecture on the subject. Although my achievements are modest, 18 years is probably enough to grant me the privilege of sharing a few thoughts with colleagues at an earlier stage of their career.

Be bold and innovative

It was my good fortune early on to meet Raanan Gillon, then Professor of Medical Ethics at Imperial College (now President of the British Medical Association). Of the many lessons he taught me the most valuable was the importance of fearless proactiveness and innovation, an attitude no doubt forged from his own trailblazing path into medical ethics. “Why don’t you produce something that could actually be useful to doctors?”, he said bluntly during one of our Ph.D. supervisions. This was the genesis of the ‘Deception Flowchart’ which appeared in the British Medical Journal in May 2007 and which, to this day, continues to generate debate in the area of truth-telling between doctors and patients. Since then, I moved away from more academic pursuits to producing work of practical value to the medical profession.

The Deception Flowchart

Create opportunities

There is a temptation when joining academia (as I did as a lecturer in 2006) to take the path of least resistance. You do what is expected of you and wait for your turn for opportunities to appear. Greater riches await, and faster, if you create the opportunities. Thus, after negotiating with my former Head of Department, I founded in 2007 the first UK course in Applied Clinical Ethics at Imperial College with sponsorship from the Medical Protection Society. It last ran in Hong Kong in December 2018. In line with my goal of helping doctors, I started favoring writing shorter pieces in high impact medical journals rather than long articles in little-read academic journals. This eventually led to the offer of a regular column in the BMJ, which continues to this day.

The first leaflet for the ACE course

Cultivate connections

I joined medical societies, like the Osler Club of London, and met senior doctors. They gave me ideas for projects and articles. It was at one of those clubs that a doctor whispered in my ear, over dinner, “it is doctors that will make your career, not philosophers.” If your area of bioethics involves clinicians, it is certainly a good idea to form contacts with practitioners. They hold the key to many doors.

To prove that I continue to heed the advice of proactiveness and innovation, in the last 2 years I published a bioethics book for the general public (which has proved more successful than all my other books combined, though frankly that is a low bar given the sales figures of those books) and, noting a ‘gap in the market’, created the Centre for Remedial Ethics to deliver bespoke ethics training to clinicians facing disciplinary proceedings.

The Centre for Remedial Ethics launched in 2019

Taking the path less traveled may create tensions with colleagues, particularly if it leads to success. Some will have slaved away for years with limited impact and may resent your unconventional approach. Such professional jealousy is unavoidable and should not cause you to lose heart.

Finally, your bold and innovative efforts will not always succeed. In the late 2000s, I tried to create a post of clinical ethicist in a major London hospital, tied with research funding from the Medical Research Council. The pitch was rejected. In fact, I have utterly failed in my goal, articulated in print in 2005, to introduce clinical ethicists in UK hospitals. It may never happen. However, to paraphrase the poet, it is better to have tried and failed than never to have tried at all.

My suggestion for introducing clinical ethicists in UK hospitals was not well received in 2005. The importance of resilience and a sunny disposition is for another letter!

You are entering a field that is endlessly fascinating and brimming with opportunities if you are perceptive enough to see them or brave enough to create them. More than mere intellectual fulfillment, a career in bioethics can make a real, positive difference to people’s lives.

Daniel Sokol is a medical ethicist and barrister at 12 King’s Bench Walk, London. On 7th June 2020, he suggested on Twitter that someone should write “Letters to a Young Bioethicist”, following in the footsteps of Rilke (“Letters to a Young Poet”) and Selzer (“Letters to a Young Doctor”). This is an example of what a letter might look like. @DanielSokol9"

Acknowledgments: thanks to the several bioethicists who responded to my Twitter call and generously volunteered their time and shared feedback to improve this article.



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Evi Tsokanaki

Evi Tsokanaki


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