Thinking out loud — Stuart Finder relates the ethics of medicine

Thinking out loud — Stuart Finder relates the ethics of medicine

There’s Stuart Finder, 5 years old, a firm grip on his grandfather’s hand, a curious eye on the passing trees, homes, cars, people they pass as the streetcar rocks and clangs through suburban Pittsburgh. It’s the mid 1960s, the country is in the middle of its most explosive decade, and the boy is on the brink of a major discovery.

“He taught me the word ‘contemplation,’” Finder says. Thirty-five years later, you can still see the boy under the bushy beard of the man who now is director of the Center for Clinical and Research Ethics. You can see his head tilt to the left to let his grandfather’s words fall into his ear.

“On the way there and on the way back, he kept teaching about it,” Finder says. One word, one lesson, and little Stuart was enthralled. “It was a big word. He taught me how to say it. Then, what it means – to think really hard about stuff.”

He wasn’t discovering the concept. He was learning what he’d been doing with his time; that “there was a name for that,” he says, still in amazement.

Contemplation: consider, meditate, ponder. It’s what Stuart Finder does for a living from his third floor disheveled Oxford House office and from ICU bedsides or quiet one-on-one consults with nurses, physicians, and patient families.

“If there’s a patient issue (concerning ethics) that needs immediate attention, he’s the consultant who calls the meeting,” says associate general counsel Julia Morris, who works with Finder on several committees. “Stuart might get called because nursing staff may be concerned about a particular issue. He might get called to facilitate a discussion.” And when you ask him a question, Morris says, “you get a tug of the beard, a tilt of the head and a squint of the eye. It’s thoughtful, measured, quiet.” Contemplative. Just as he’s always been.

At Vanderbilt, Finder takes contemplation in his palm like a big-league pitcher, rubs it, fingers the seams just so, and tosses it like a high curve ball into heavy-hitting issues – physician fallibility, genetic testing, the struggle of removing a patient from life support. His goal isn’t a strikeout, but he wants people swinging their ideas, morals and internal struggles. And when they connect, it’s after careful study, with a new appreciation for the issue, and it’s solid.

Finder “looks at things differently,” says Dr. Keith Wrenn, professor and vice chair of Emergency Medicine. He sits with Finder and Morris on the VUMC ethics committee. “He broadens how you look at things ethically.”

Decisions made following a Finder consult are better informed, says Jean Gauld-Yeager, director of Patient Affairs. “He will not let people slide over issues that are troublesome or hard to deal with or have an easy answer. Those issues have to be addressed.”

Medical ethics is as old as Hippocrates. But as a field complimentary to medicine, where non-medical people are trained to examine medical ethical issues and inject consideration, it’s relatively new. Richard Zaner started Vanderbilt’s Center for Clinical and Research Ethics in 1982, one year after arriving here as the inaugural holder of the Ann Geddes Stahlman Chair in Medical Ethics, which was established by a gift from James Stahlman. In the 1950s and 1960s, medical ethics started taking root, Zaner says, as ventilation and organ transplantation were beginning. In 1968, when Finder was a knobby-kneed kid playing in the Allegheny mountains, the term “brain death” surfaced. Now, with the Human Genome Project and proteomics – the study of how proteins work – in the forefront of science, medical ethics might be reaching its heyday. Last June, Finder was named director of the center Zaner founded. Lots of fodder for contemplation.

More than thought

Finder caught fire for medical ethics while at the University of Utah Health Sciences Center, where he received his doctoral degree in 1991. He had an undergraduate degree in “environmental studies mixed with religion and philosophy,” he says, and two master’s degrees, which, undoubtedly, required a lot of contemplation.

But in Salt Lake City, he spent six hours a day in intensive care settings. “All the pediatric residents rotated through there and they hated it because they were caring for patients who, to a large degree, wouldn’t survive,” Finder says. “They were faced with disbelief (in medicine), fears. That’s when I got it.”

What he got, he says, is that contemplation, medical ethics, health care policies – like Vanderbilt’s current DNR policy, which many people credit Finder with creating and seeing it through to fruition – have one thing in common.

“Medical ethics is not grand theories,” Finder says. “It’s about people’s experiences. We don’t just sit in board rooms and offices and think up questions,” Finder says of himself, Zaner and Mark Bliton, Ph.D., chief of the Clinical Ethics Consultation Service. “We have to maintain the core of clinical care. All the other stuff (the contemplation) only makes sense if we maintain a clinical element.”

It’s Finder’s experience in applying ethical ideologies to clinical practice that made Finder right for the directorship, Zaner says. Dr. Frank Boehm, chair of the ethics committee and professor of Obstetrics and Gynecology, says Finder embodies the philosophy of medical ethics.

“He brings to the bedside a sense of completeness of medical care. When Stuart is included in patient care, we’re not just dispensing medication. He reminds us how we relate to patients as human beings. Ethicists like Stuart keep that light burning for everyone to see,” Boehm says.

Finder sees himself as a facilitator. Zaner says he’s good because he can be an enabler, someone who can lob in a question and get out of the way of the answers.

But just because he’s a thinker doesn’t make him void of answers.

“One of the things ethicists get accused of is never having any answers,” Gauld-Yeager says. People say, ‘All I wanted was a simple yes or no, so give it to me.’

“A lot of people expect them to make decisions for them, but they won’t do it.”

Calvin and Jerry Garcia

Growing up, Finder was a nerdy kid by his account. In high school, he says, “I was weird looking. I had a full beard” because he wondered why he’d want to scrape a razor over his face every day. He contemplated the idea, and made a decision. The process is a theme for Finder.

When his older brother went to Allegheny College, Finder got to know one of his brother’s roommates, who now is his best friend and closest co-worker, Mark Bliton. Finder later enrolled at Allegheny and the friendship with Bliton blossomed.

“Over the years, we’ve developed a sense of freedom of inquiry. We could talk to each other about a lot of different things. And there’s been trust. I have always been able to rely on Stu for a clear and straight answer,” Bliton says. At work, he says, Finder “has a persistent requirement, an insistence for clarity.”

During those college days, Finder also met another of his brothers’ friends, a tall brunette named Cindy, whom he later married.

Cindy and Stuart have three kids – twins Sam and Sarah, 10, and Nathan, 9. There’s a strict rule against his work interfering with family time, and the troupe regularly packs up the family mobile for hiking forays.

In the family home is a collection of more than 160 Grateful Dead cassette tapes and CDs. More than a few are bootlegged. How ethical is that? “Yeah, well,” he says, and rips into a Dead dissertation of the band’s jazz-like quality, their dynamic improvisation. There’s a lesson here. “ You have to enact to discover,” he says. “You have to listen to what the other guy’s playing to see if it fits what you’re playing.”

In another conversation, Finder explains the insight of another cultish favorite, the retired comic strip “Calvin and Hobbes.”

“Calvin, through Hobbes, gets to play both sides of himself,” Finder says. “It’s the interplay between fantasy and reality, and those lines blur at times. The whole fantasy of Hobbes really is Calvin’s creation. And yet, when Hobbes attacks Calvin with a snowball or takes over the tree fort, Hobbes won’t follow orders – it’s something Calvin has no control over.”

So, what does that mean?

“Exactly,” Finder says, his head tilting, the brow narrowing. “It reaffirms and clarifies the question: ‘What does life mean?’ Calvin deals with it every day: What does it mean to be alive, going through a world in which I have no control over, yet which sometimes I think I do?,” he says, and strokes the beard.

Familial perspective

Finder says he’s still probably a nerd because, he says, “I’m not real social.”

He shrugs off the irony that his work has huge social implications. “I’m good in one-on-one situations, or with small groups,” he says.

That clear memory of the day with his grandfather has another layer. It’s the tie between Finder today and the Finders of his Jewish lineage. He claims the Holocaust, in which most of his father’s family died, as one of the more influential events in his life. Millions of people would say the same. But, he says, it’s influenced him because it hit close to home. “That’s why family is so important,” he says. “Because there are so few of us.”

The Holocaust, Finder says, “is significant to who I am.” He remembers as a small boy knowing survivors, with concentration camp tattoos on their arms, thick accents, stories and backgrounds that were both horrifying and compelling. It adds perspective and appreciation for his life. “No matter how bad things get, nobody’s rounding up my family, shoving us into a cattle car and carrying us away. Nobody’s lining us up and shooting us. Things aren’t that bad,” he says.

So, this is Stuart Finder, a guy who can discuss the holocaust and Calvin and Hobbes in the same conversation, all grown up yet still riding that streetcar, contemplating contemplation. Only today, he’s the one delivering the message to the doctors and patients.