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Contact Information
Department of Social Medicine
Division of Medical Ethics
Harvard Medical School
641 Huntington Avenue, 4th floor
Boston, MA 02115
Email: robert.truog@childrens.harvard.edu
Dr. Robert Truog is Professor of Medical Ethics and Anesthesiology (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.
Dr. Truog’s major administrative roles include Director of Clinical
Ethics in the Division of Medical Ethics and the Department of Social
Medicine at Harvard Medical School, Chair of the Harvard Human Subjects
Research Committee at Harvard University, and membership on the Harvard
University Faculty Committee of the Edmond J. Safra Foundation Center
for Ethics.
His academic work has primarily centered on the ethical issues that
arise in anesthesia and critical care, and he recently authored national
guidelines for providing end-of-life care in the Intensive Care Unit.
He lectures widely nationally and internationally. His writings on the
subject of brain death have been translated into several languages,
and 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 many 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
Program to Enhance Relational and Communication Skills (PERCS)
"Interpersonal and Communication Skills" are one of the six core competencies identified by the ACGME. Robert Truog is the Principal Investigator for an innovative program to enhance and evaluate these skills at Harvard and at sites throughout New England. The program is funded through grants from the Argosy Foundation, the Harvard Risk Management Foundation, the New England Organ Bank, and the Children’s Hospital Center for the Critically Ill Child. 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. We are currently conducting and/or developing programs in breaking bad news, disclosing and apologizing for medical error, approaching families for consent for organ donation, working with "angry" patients and families, prenatal counseling for "at risk" pregnancies, and strategies for conducting the preoperative interview and obtaining informed consent for anesthesia and surgery.
Specific projects include:
PERCS in the Pediatric ICU – This program is currently offered
monthly to physicians, nurses, and other clinicians who work in intensive
care, focused on challenges relating to "breaking bad news." This
work is funded by the Children’s Hospital Center for the Critically
Ill Child
PERCS in Neonatology – This project is currently under development,
and
will become a one day workshop based on the original PERCS format, focusing
on challenges that arise in the perinatology setting, including perinatal
counseling and challenging conversations that occur in the NICU. This
work is funded through the Argosy Foundation from May 2005 to April
2007
PERCS in Situations of Medical Error and Conflict – This project
is currently under development, and will result in several pilot workshops
on disclosing medical error to patients and families as well as dealing
with situations of conflict. This work is funded by the Harvard Risk
Management Foundations from May 2005 to April 2006.
PERCS and Organ Donation – This ongoing project is focused on
building collaboration and communication skills between ICU clinicians
and coordinators from the New England Organ Bank around approaching
families regarding organ donation. Two training sessions have already
been completed, on April 22 and 29, 2005.
PERCS and the Neurosurgical Patient – This was a one-day workshop,
conducted on May 24, 2005, designed to bring together physicians and
nurses from neonatology, neurology, neurosurgery, and anesthesiology
to learn communication skills around complex neurosurgical patients
and their families. This work was funded by the Contini family in memory
of their son Paul.
PERCS and the Preoperative Anesthesia Interview – This project,
currently under development, will address improving communication skills
in the challenging and often stressful conversation that occurs during
the preoperative interview.
The Harvard Ethics Consortium
The Harvard Ethics Consortium (HEC), begun in 1999, is a monthly meeting
of individuals from throughout the Harvard system who participate in
clinical ethics and case consultation throughout the Harvard system.
The HEC is organized and facilitated by Robert Truog and Christine Mitchell.
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.
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 consultation across the Harvard
teaching hospitals.
The Journal of Clinical Ethics
The Journal of Clinical Ethics now publishes a regular feature entitled
Cases from the Harvard Ethics Consortium, edited by Christine Mitchell
and Robert Truog, which contains several articles in each issue written
by various participants from selected HEC cases, including physicians,
nurses, social workers, and the patient or family members, accompanied
by commentary from an ethicist. These constitute the most thickly described,
real, multiple-perspective bioethics cases widely available for teaching
clinical bioethics and have produced broad discussion within the field
of bioethics, including sessions at the meeting of the American Society
for Bioethics and Humanities devoted to published HEC cases. They have
also generated widespread awareness of and interest in Harvard's program
in medical ethics.
Harvard Ethics Leadership Council
While all of the Harvard-affiliated hospitals have active ethics programs
and consultation services, few opportunities have existed for these
programs to mutually benefit from interaction related to shared problems
and missions. The Partners-affiliated programs recently initiated such
cooperation under Dr. George Thibault, and following a series of meetings
between Dr. Thibault and Dr. Truog agreement was reached on expanding
this collaboration to include all of the Harvard-affiliated hospitals,
under the leadership of Robert Truog and Christine Mitchell. The Council
began regular quarterly meetings in the spring of 2005.
The Harvard Bioethics Course
All of the Harvard-affiliated hospitals share a need to educate and
support the clinicians and other staff members who are asked to serve
on their ethics committees and consultation services. While excellent
courses exist, all require travel to other cities and charge significant
registration fees. Beginning in the spring of 2005, the Division of
Medical Ethics will provide a Harvard Bioethics Course (HBC) aimed at
educating staff of the Harvard teaching hospitals and affiliated institutions,
many of whom serve on hospital ethics committees and participate in
ethics consultations. The course entails two stand-alone, two-day sessions:
one in the spring on ethical theory and cases; the other in the fall
on ethics committees and consultations. The faculty are entirely drawn
from the Division of Medical Ethics and colleagues active in ethics
at the HMS affiliated institutions. Currently, we expect the HBC to
be offered annually with changes and improvements based on participants’ evaluations
and evolving concerns and controversies in clinical bioethics.
Select Publications
Truog RD, Fletcher JC. Anencephalic newborns. Can organs be transplanted
before brain death? New England Journal of Medicine 1989; 321(6):388-391.
Truog RD. "Do-not-resuscitate" orders during anesthesia and
surgery. Anesthesiology 1991; 74(3):606-608.
Truog RD, Brett AS, Frader J. The problem with futility. New England
Journal
of Medicine 1992; 326(23):1560-1564.
Notes: 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. Triage in the ICU. Hastings Center Report 1992; 22(3):13-17.
Notes: Special Recognition: Jeanette Lappe Memorial PrizeReprinted in:
Howell JH, Sale WF, editors. Life Choices: A Hastings Center Introduction
to Bioethics. Baltimore, Maryland: Georgetown University Press, 1995.
Reprinted in: Glannon W, editor. Contemporary Readings in Biomedical
Ethics, First Edition. Fort Worth, Texas: Harcort College Publishers,
2002: 128-132.
Truog RD. Randomized controlled trials: lessons from ECMO. Clinical
Research 1992; 40(3):519-527.
Notes: 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.
Truog RD, Berde CB, Mitchell C, Grier HE. Barbiturates in the care of
the terminally ill. New England Journal of Medicine 1992; 327(23):1678-1682.
Truog RD, Brennan TA. Participation of physicians in capital punishment.
New England Journal of Medicine 1993; 329(18):1346-1350.
Truog RD, Berde CB. Pain, euthanasia, and anesthesiologists (Special
Article). Anesthesiology 1993; 78(2):353-360.
Nelson LJ, Rushton CH, Cranford RE, Nelson RM, Glover JJ, Truog RD.
Forgoing medically provided nutrition and hydration in pediatric patients.
Journal of Law, Medicine, and Ethics 1995; 23(1):33-46.
Truog RD. Is it time to abandon brain death? Hastings Center Report 1997; 27(1):29-37.
Notes: 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.
Truog RD, Robinson W, Randolph A, Morris A. Is informed consent always
necessary for randomized, controlled trials? New England Journal
of Medicine 1999; 340(10):804-807.
Notes: 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. "Doctor, if this were your child, what would you do?" Pediatrics 1999; 103(1):153-154.
Truog RD, Waisel DB, Burns JP. DNR in the OR: a goal-directed approach.
Anesthesiology 1999; 90(1):289-295.
Burns JP, Mitchell C, Outwater KM, Geller M, Griffith JL, Todres ID,
Truog RD. End-of-life care in the pediatric intensive care unit after
the forgoing of life-sustaining treatment. Critical Care Medicine 2000;
28(8):3060-3066.
Truog RD, Burns JP, Mitchell C, Johnson J, Robinson W. Pharmacologic
paralysis and withdrawal of mechanical ventilation at the end of life.
New England Journal of Medicine 2000; 342(7):508-511.
Burns JP, Mitchell C, Griffith JL, Truog RD. End-of-life care in the
pediatric intensive care unit: attitudes and practices of pediatric
critical care physicians and nurses. Critical Care Medicine 2001; 29(3):658-664.
Truog RD, Cist AF, Brackett SE, Burns JP, Curley MA, Danis M, DeVita
MA, Rosenbaum SH, Rothenberg DM, Sprung CL, Webb SA, Wlody GS, Hurford
WE. Recommendations for end-of-life care in the intensive care unit:
The Ethics Committee of the Society of Critical Care Medicine. Critical
Care Medicine 2001; 29(12):2332-2348.
Notes: Abstracted in: Dellinger RP, Parrillo JE, editors. Yearbook
of Critical Care 2003. St. Louis: Mosby-Year Book, Inc, 2003.
Meyer EC, Burns JP, Griffith JL, Truog RD. Parental perspectives on
end-of-life care in the pediatric intensive care unit. Critical
Care Medicine 2002; 30(1):226-231.
Burns JP, Edwards J, Johnson J, Cassem NH, Truog RD. Do-not-resuscitate
order after 25 years. Critical Care Medicine 2003; 31(5):1543-1550.
Hardart GE, Truog RD. Attitudes and preferences of intensivists regarding
the role of family interests in medical decision making for incompetent
patients (Feature Article). Critical Care Medicine 2003; 31(7):1895-1900.
Truog RD, Robinson WM. Role of brain death and the dead-donor rule in
the ethics of organ transplantation. Critical Care Medicine 2003; 31(9):2391-2396.
Truog RD, Waisel DB, Burns JP. Do-not-resuscitate orders in the surgical
setting. Lancet 2005; 365(9461):733-735.
Truog RD. Will ethical requirements bring critical care research to
a halt? Intensive Care Med 2005; 31(3):338-344.
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