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Busy young lawyers in search of the next big thing would do well to consider Tristan McCann’s concern about the ethics of the U.S. health care system — and what she is doing about it personally. McCann, 37, is a former corporate associate at Clifford Chance. She now lives in upstate Niskayuna, N.Y., with a traveling husband, two babies and a home computer that allows her to pursue a master’s degree in bioethics. The courses are offered through a unique online program created in 2001 for practicing lawyers and health professionals by professors Wayne Shelton of Albany Medical College and Robert Baker of The Graduate College of Union University in Schnectady. While classes are conducted online, students must be physically present at Albany Medical College for two-week seminars during each of their three years of study, including intensive clinical exposure and training during the second year. Last week, the faculty of Albany Law School voted to become an additional element of the program: The incoming law class may now earn a juris doctorate and master’s degree in bioethics in four years. What does an attorney do with a bioethics degree? After reciting a laundry list of hypocrisies she sees in terms of who gets what level of medical attention in this country, and what she considers undue influence of the pharmaceutical and insurance industries on national policies, McCann staked out her own first order of business. “We have a system that is eventually going to implode,” said the New York University School of Law graduate. “There is a great need for lawyers who understand the legislative process and corporate needs — and what is right, what is ethical. “They’re going to be the people to change our system,” she said. “It can’t stay the same.” McCann’s zeal for policy change represents the highest hope of Alicia R. Ouellette, associate lawyering professor at Albany Law and liaison to the bioethics program. “A great use of this program would be for a lawyer coming out of it and going on to change bad law,” said Ouellette, who formerly worked in the Albany Appeals Bureau of the state Attorney General’s Office. With reference to the decision in Blouin v. Spitzer, 02-7997, in which the U.S. District Court for the Northern District determined that despite family wishes New York state law permitted the mechanical prolonging of life in the case of a terminally ill adult who had been mentally incapacitated since childhood, Ouellette added, “People came forward to say the law on this stinks.” MEDIATION ROLE Shelton sees the process of making a bioethical decision as a natural augmentation of a lawyer’s role as mediator. “There should be some manner of consensus, and not every situation has a single right answer,” said Shelton, who holds a doctorate in philosophy from the University of Tennessee and a master’s in social service administration from the University of Chicago. “You don’t take the black-and-white position.” When an attending physician asks Shelton for an ethical opinion, he said, “I talk to legal counsel here at the hospital, to the nurses, to various other caregivers. I consider the patient’s values and preferences, and the family’s comfort. I’m a philosopher and I do this. A lawyer can do this.” Baker expanded the view that bioethics is an interdisciplinary field involving doctors, nurses, theologians and attorneys. “We’ve had lawyers at the [bioethics] table from the beginning,” said Baker, who earned his doctorate in philosophy at the University of Minnesota. “What we’re doing now with this program is to have lawyers get a more synergistic sense of bioethics than in a pure law school environment, and to give them mediation skills they’re not likely to get in law school.” Ouellette provided an example. “Our law students will spend time in a neo-natal intensive care ward with one-pound babies,” she said. “They will see other medical situations where ethical issues are raised constantly. They would never otherwise get such a depth of knowledge. We’ll be creating lawyers who fully appreciate the different sides of medical situations — and ethics.” She added that there is an evolving market for attorneys with a specialty in medical bioethics. “For lawyers who want to work in the medical area, this will provide an edge in being considered trustworthy,” she said. BARRIERS TO TRUST Shelton and Ouellette spoke of barriers to the trust that stem from the differing professional cultures. “Doctors tend to have an erroneous understanding of the law,” said Shelton. “They think it’s a set of rules to be followed. Plus, they’re afraid of being sued. The first question for both lawyers and doctors should be, ‘What’s right for the patient?’ I find that asking, ‘What’s the law?’ is working backwards.” Ouellette said she “always” feels the need to apologize for being a lawyer when walking into a room full of doctors. “It doesn’t have to be that way,” she added. “Lawyers can be an enormous help in advising doctors.” McCann did just that for a number of years after leaving corporate law in Manhattan to become a staff attorney in the legal department at Albany Medical, where her academic interest in the philosophical was rekindled. “To me, it’s fascinating,” she said. “It’s an area where there are no answers, but where we have to keep trying to find them.” Baker, the philosopher, suggested the practical. “If you’re a young lawyer out there, you should be interested in the health area,” he said, noting several congressional budget studies in his explanation why. “One out of every $7 is spent on health care,” he said. “So, you can be sure that lawyers are going to be doing this stuff. We want to know that they’re doing it well.”

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