The Conceptual Foundations program takes a philosophical look at medicine

Caroline Webb (A&S ’23) planned to attend medical school until her senior year. Then she joined Pitt’s Conceptual Foundations of Medicine certificate program, and it changed her focus entirely. Learning about ethical questions surrounding clinical trials led her to shift her focus and pursue a career in clinical research instead.

“The program profoundly reshaped my perspective on medicine and health,” she said.

The ever-increasing rate of change of all things health-related doesn’t give most people the time to consider their own beliefs about health and how they were developed, or to engage with different perspectives and the people who hold them.

When people do get that opportunity, it can change their lives.

The core courses in the Conceptual Foundations of Medicine certificate program offer students that chance — and there’s no lack of interest, with the program’s enrollment growing from 300 to 900 in the past four years. Certificate students learn about medical ethics, the nature of explanation and evidence in the biomedical sciences and modern-day social problems.

The kind of examination Webb took part in is exactly what the program is intended to do, according to Jonathan Fuller, assistant professor of history and philosophy of science in the Kenneth P. Dietrich School of Arts and Sciences. “It’s about teaching people to challenge the way things are and think about the ways that they could be better.”

Webb accepted the challenge and ran with it. “The depth of understanding I had acquired from the program — especially regarding the interplay between mental health, socioeconomic structures and public awareness — has been instrumental in guiding my efforts,” she said. After graduating, she used that new understanding to start a small business focused on mental health advocacy.

The certificate program consists of two core classes, Mind and Medicine and Morality and Medicine. Both classes are open to all undergraduates, not just those pursuing a career in health, but to earn the certificate they also must take two elective courses and one biology class.

“Some of us become healthcare providers, but all of us are consumers, benefactors of the health system,” said Fuller, who has a medical degree. “It’s all of those people we’re trying to reach, too.”

Webb said she was able to explore a spectrum of ethical opinions thanks to the use of anonymous polling in the program, which made it easier for students to have candid discussions. She delved into what she describes as a diverse field filled with complex dilemmas and found conversations about end-of-life care especially transformative.

“What I had once perceived to be direct and rather uncomplicated was revealed to be a thick web of ethical considerations and logical arguments,” she said.

It’s fitting she pointed to end-of-life discussions to illustrate the program’s benefits — similar questions were at the fore in the late 1960s when Kenneth Schaffner, a professor emeritus of history and philosophy of science who founded the program, first proposed courses focusing on bioethics and the nascent philosophy of medicine.

“People were beginning to think, in a sense, outside the box about ethical issues in medicine,” said Schaffner, who is also the co-founder, with Alan Meisel, of the Center for Medical Ethics, now the Center for Bioethics and Health Law.

In fact, many of the topics Webb highlighted could have been on the syllabus in the program’s early days. Of clinical studies, Schaffner said, “There were emerging research questions about outrageous kinds of studies, like those done at Tuskegee.”  

Soon, Roe v. Wade brought questions of personhood into the public discourse, and Schaffner even considered the use of artificial intelligence in medicine. “Those were the days when we used telephone modems,” he said. Over time, he was able to watch as computing began to play a bigger role in healthcare, and watch as new ethical questions arose.

Half a century later, with the addition of the pandemic and social justice issues, there are plenty of questions to ask, problems to solve and opportunities to improve health, healthcare and health access. Given the opportunity to think deeply about these issues using the framework of philosophy, Fuller said, people can hopefully break free from their standard frame of reference to solve some of these problems.

“It’s ambitious,” he said, “but that’s what we hope to achieve by impacting the way our students think.”

Photography courtesy of Jonathan Fuller