Comfortable with Questioning

Jeffrey Kahn, deputy director at the Johns Hopkins Berman Institute of Bioethics, works to create policy that helps people navigate through difficult decisions in the evolving medical and public health fields. (Melissa Gerr)

Jeffrey Kahn, deputy director at the Johns Hopkins Berman Institute of Bioethics, works to create policy that helps people navigate through difficult decisions in the evolving medical and public health fields. (Melissa Gerr)

As a pre-med student, an aversion to hospitals turned out to be one of the best things for Jeffrey Kahn’s career.

During his undergraduate work in medicine at the University of California, Los Angeles, Kahn was advised to gain hospital experience, so he took a job drawing blood from pre-operative patients.

“I really hated going into people’s hospital rooms and smelling the sickness and touching people who were ill,” he recalled. But Kahn thought he could get beyond those feelings because he remained passionate and committed to study in the field of medicine.

Then he began a required course called Medicine, Law and Society that turned out to be a divining rod for him.

“I thought, ‘Oh my gosh, this is all the interesting stuff, but it doesn’t smell bad, and there’s no blood,’” he said. An adviser explained it was bioethics he was interested in and directed Kahn to the only place in the country with an academic focus on bioethics at the time, the Kennedy Institute of Ethics at Georgetown University in Washington, D.C.

Interdisciplinary in nature, bioethics as an academic field has only been around since the 1970s. It encompasses medical ethics but also includes questions surrounding biomedical research and the application of leading medical or other biological technologies. The field has also evolved to include public health concerns such as global justice in relation to food availability and fair access to medical treatments.

Kahn entered the Kennedy Institute after obtaining his undergraduate degree in microbiology at UCLA. It was necessary to study bioethics within another context, and in this case it was through the philosophy department. With this new direction Kahn remembered that his life was slightly upended, but he was excited about it.

“A nice Jewish boy from the San Fernando Valley,” Kahn said, laughing, “went to a Jesuit institution, switched from hard science to philosophy and relocated from the West Coast to East Coast.

“Everything just got turned upside down,” he added, “but it was new and fresh and different in a great way.”

Now Kahn holds a Ph.D. in philosophy/bioethics from the Kennedy Institute and a M.P.H. in health policy from the Johns Hopkins Bloomberg School of Public Health. Kahn has held faculty positions at the Department of Medical Humanities at East Carolina University School of Medicine; the Center for the Study of Medical Bioethics at the Medical College of Wisconsin; the Department of Medicine and also the Center for Bioethics at the University of Minnesota; the Bloomberg School of Public Health at Johns Hopkins University; and since 2011, Kahn is the Robert Henry Levi and Ryda Hecht Levi professor of bioethics and public policy and the deputy director for policy and administration at the Johns Hopkins Berman Institute of Bioethics, one of the first of its kind in the nation.

Kahn, and his more than 30 colleagues, address a wide range of topics such as “bedside” bioethics issues, where they help health care teams, families and patients understand options and make decisions about sustaining or withholding treatment or even navigating access to expensive therapies; and they are also involved in broader-reaching ethics such as global food-access policies and ethics of working with human and animal research subjects. The challenges evolve as quickly as the medical field evolves, so currently the ethical questions involving synthetic biology are also on their docket.

During his time at the University of Minnesota, Kahn was plunged into a highly publicized case. Lisa and Jack Nash gave birth in 1994 to a baby girl, Molly, with Fanconi anemia, a genetic disease that can have many ill effects and at its worst can result in leukemia by age 6 or 7. Molly’s chances of survival required either a bone marrow donor or an umbilical cord blood donor. The couple became pregnant again (via in vitro fertilization) and used embryonic testing to ensure choosing an embryo that didn’t have same disease and was a genetic match to the first child in order to be a donor.

Kahn was made aware of the situation when it was well underway, and he said it raised a lot of ethical questions such as, did they create a child to save their daughter? The couple had planned to have more children and chose to use genetic testing to ensure the next child did not carry the same disease and at the same time they could possibly save their first child’s life. But if the cord blood donation didn’t work for Molly, which would be confirmed within the first three months, then it would be necessary to put the infant under anesthesia and remove bone marrow from its hip with a very large needle.

“The parents said absolutely we would do that,” recalled Kahn.

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