Division of Medical Ethics
651 Huntington Avenue, FXB Bldg.
Boston, MA 02115
Dr. Robert Truog is Professor of Medical Ethics, Anaesthesiology & Pediatrics at Harvard Medical School and a Senior Associate in Critical Care Medicine at Children’s Hospital Boston. Dr. Truog received his medical degree from the University of California, Los Angeles and is board certified in the practices of pediatrics, anesthesiology, and pediatric critical care medicine. He also holds a Master’s Degree in Philosophy from Brown University and an honorary Master’s of Arts from Harvard University.
Dr. Truog practices pediatric critical care medicine at Children’s Hospital Boston, and served as Chief of the Division for ten years. His current major administrative roles include Director of Clinical Ethics in the Division of Medical Ethics and the Department of Social Medicine at Harvard Medical School, Director of the Institute for Professionalism and Ethical Practice at Children’s Hospital, and Chair of the Harvard Embryonic Stem Cell Research Oversight Committee (ESCRO).
Dr. Truog has published more than 200 articles in bioethics and related disciplines, including recent national guidelines for providing end-of-life care in the Intensive Care Unit. He is Principle Investigator on an R0-1 grant from the NIH to improve end-of-life care in pediatric intensive care units. In his role as Director of the Institute for Professionalism and Ethical Practice, he conducts research and develops educational initiatives related to communication and relational skills.
He lectures widely nationally and internationally. His writings on the subject of brain death have been translated into several languages, and in 1997 he provided expert testimony on this subject to the German Parliament. Dr. Truog is an active member of numerous committees and advisory boards, and has received several awards over the years, including The Christopher Grenvik Memorial Award from the Society of Critical Care Medicine for his contributions and leadership in the area of ethics.
Ongoing Research and Major Activities:
Toward Optimal Palliative Care in the PICU Setting
Dr. Truog is Principle Investigator on an R01 funded through the National Institutes of Health and the National Institute for Nursing Research (NR09298-01A1): The goals of this project are to develop tools to evaluate the quality of end-of-life care in the pediatric ICU. These tools will then be used to investigate both qualitative and quantitative aspects of fifty consecutive deaths occurring in each of eight geographically dispersed pediatric ICUs, from the perspectives of parents, patients, and clinicians.
Institute for Professionalism and Ethical Practice
As Executive Director of IPEP, Dr. Truog oversees the development and delivery of all of the Institute’s workshops and programs. The work of the Institute is targeted on improving “Interpersonal and Communication Skills,” one of the six core competencies for clinicians identified by the ACGME. The template for the program is a one-day workshop featuring opportunities for trainees to practice communication and relational skills with trained actors around specific scenarios, with videotaped review and structured feedback. Programs have focused on the difficult conversations surrounding breaking bad news, disclosing and apologizing for medical error, approaching families for consent for organ donation, working with “angry” patients and families, counseling the parents of premature newborns, and strategies for conducting the preoperative interview and obtaining informed consent for anesthesia and surgery. The program is funded through philanthropy and registration fees, and has trained more than 1000 clinicians to date.
Harvard Bioethics Course
Dr. Truog and Christine Mitchell initiated the annual Harvard Bioethics Course in 2005. The 2-3 day course has attracts over 100 participants each year, and involves faculty from throughout the medical school. The course is dual-purposed, providing a basic component to meet the educational needs of those who are new to bioethics and are becoming involved in their hospital’s ethics activities, while also including a day devoted to “cutting edge” issues for the benefit of more senior members of the ethics community.
Harvard Ethics Consortium
Dr. Truog and Christine Mitchell organized and have conducted the Harvard Ethics Consortium since 1999. It is a monthly meeting of all of the ethics committees, ethics consultants, academic bioethicists, and fellows in medical ethics from throughout the HMS affiliated institutions. Physicians, nurses or other professional staff members describe cases for which they have sought ethics consultation within their hospital or health care facility, followed by analysis and commentary from an ethicist, faculty member, or staff member from a different Harvard institution. Having now facilitated more than a hundred HEC sessions, we have covered topics related to a very broad range of the clinical and organizational issues that arise in healthcare. This program is consistently well-attended (30-60 staff and faculty from a variety of specialties and disciplines) and provides an important forum for peer review of clinical ethics advice across the Harvard teaching hospitals.
In addition, selected cases are published regularly in the Journal of Clinical Ethics, which has provided an academic outlet and publication opportunity for many of the Harvard faculty. The cases have been very well received and are used in many bioethics curriculae around the country. They are distinguished from other case descriptions by the fact that we insist upon publishing the perspective of the patient and/or family, either by asking them to contribute in the first person or by interviewing them personally.
Truog RD. Consent for organ donationbalancing conflicting ethical obligations. N Engl J Med 2008; 358(12):1209-1211.
Truog RD, Campbell ML, Curtis JR et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American Academy of Critical Care Medicine. Crit Care Med 2008; 36(3):953-963.
Truog RD. Tackling medical futility in Texas. N Engl J Med 2007; 357(1):1-3.
Truog RD. Brain death - too flawed to endure, too ingrained to abandon. J Law Med Ethics 2007; 35(2):273-281.
Truog RD. The ethics of organ donation by living donors. N Engl J Med 2005; 353(5):444-446.
Truog RD, Burns JP, Mitchell C, Johnson J, Robinson W. Pharmacologic paralysis and withdrawal of mechanical ventilation at the end of life. N Engl J Med 2000; 342(7):508-511.
Truog RD, Robinson W, Morris AH. Is informed consent always necessary for randomized, controlled trials? N Engl J Med 1999; 341:450. Abstracted in: Hastings Center Report, 1999; 29(4):45. Abstracted in: IRB: a Review of Human Subjects Research, 1999; 21(4):11. Reprinted in: Ethics and Socioeconomic Issues in Otolaryngology, Home Study Course 2001/2002, published by the American Academy of Otolaryngology - Head and Neck Surgery Foundation, Inc. 2002. Reprinted in: Emanuel EJ, Crouch RA, Arras JD, Moreno JD, Grady C, editors. Ethical and Regulatory Aspects of Clinical Research: Readings and Commentary. Baltimore: Johns Hopkins University Press, 2003: 207-210.
Truog RD, Waisel DB, Burns JP. DNR in the OR: a goal-directed approach. Anesthesiology 1999; 90(1):289-295.
Truog RD. “Doctor, if this were your child, what would you do”? Pediatrics 1999; 103(1):153-154.
Truog RD. Is it time to abandon brain death? Hastings Cent Rep 1997; 27(1):29-37. Reprinted in : Thomasma DC, Monagle JF, editors. HealthCare Ethics: Critical Issues for the 21st Century. Gaithersburg, Maryland: Aspen Publishers, 1998: 330-341. Reprinted in: Caplan A, Coelho D, editors. The Ethics of Organ Transplantation: The Current Debate. Amherst, New York: Prometheus Books, 1998: 24-40. Reprinted in: Arras JD, editor. Ethical Issues in Modern Medicine. 5th edition. Mountainview: Mayfield Publishing Co, 1999: 160-169.
Reprinted in: Robinson JH, Berry RM, McDonnell K, editors. A Health Law Reader: An Interdisciplinary Approach. Durham, North Carolina: Carolina Academic Press, 1999: 372-80. Translated into German and Reprinted as: Ist das Hirntod-Kriterium obsolet? In Firnkorn H-J, editor. Hirntod als Todeskriterium. Stuttgart: Schattauer, 2000: 83-102. Reprinted in: Dickinson G, Leming R, editors.Annual Edition: Dying, Death, and Bereavement, Sixth Edition. Guilford, Connecticut: Dushkin / McGraw Hill; 2002: 24-31. Reprinted in: Chadwick R, Schroeder D, editors. Applied Ethics, Volume III. Routledge: London: 2002: 122-139. (ISBN 0-415-20832-7) Translated into Italian and Reprinted as: È venuto il momento di abbandonare la morte cerebrale? In Barcaro R, Becchi P, editors. Questioni Mortali. L'Attuale Dibattito Sulla Morte Cerebrale e il Problema dei Trapianti. Napoli: Edizioni Scientifiche Italiane, 2004: 205-229. Reprinted in: Baylis, Downie, Sherwin, Hoffmaster, editors. Health Care Ethics in Canada, 2nd Edition. Scarborough, Canada: Nelson Thomson Learning, 2004. Reprinted in: Price D, editor.Organ and Tissue Transplantation. Volume in the series: Freeman MD, general editor. The International Library of Medicine, Ethics, and Law. London, England: Ashgate Publishing Limited, expected publication date October 2006.
Truog RD, Berde CB, Grier HE. Barbiturates in the care of the terminally ill. N Engl J Med 1993; 328:1351.
Truog RD, Brennan TA. Participation of physicians in capital punishment. N Engl J Med 1993; 329(18):1346-1350.
Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med 1992; 326(23):1560-1564. Reprinted in: Thomasma DC, Monagle JF, editors. HealthCare Ethics: Critical Issues. Gaithersburg, Maryland: Aspen Publishers, 1994: 241-248. Reprinted in: Thomasma DC, Monagle JF, editors. HealthCare Ethics: Critical Issues for the 21st Century. Gaithersburg, Maryland: Aspen Publishers, 1998.: 323-329.
Truog RD. Randomized controlled trials: lessons from ECMO. Clinical Research 1992; 40(3):519-527. First Prize: Nellie Westerman Competition in Clinical Research Ethics, American Federation for Clinical Research Foundation. Reprinted in: Emanuel EJ, Crouch RA, Arras JD, Moreno JD, Grady C, editors. Ethical and Regulatory Aspects of Clinical Research: Readings and Commentary. Baltimore: Johns Hopkins University Press, 2003: 121-126