In Memory of Al Jonsen, PhD

[Editor’s note: This is a remembrance written by UW Bioethics and Humanities Professor Nancy Jecker that was first published by the American Journal of Bioethics.]

A Tribute to Albert R. Jonsen, PhD (1931-2020)

by Nancy S. Jecker, Ph.D.

Dr. Albert Rupert Jonsen passed away October 21, 2020 at his home in San Francisco at the age of 89. He was known as “Al” to his many colleagues and friends, which I am fortunate to be among. A pioneer and founder of the field of bioethics, Al had been an ordained Roman Catholic Priest and completed a doctoral degree in religious studies at Yale University in 1967, yet left the active priesthood in 1976 to marry his wife, Liz Jonsen. Al served as President of the University of San Francisco (1969-1972) and was a faculty member and “roving bioethicst” at the University of California, San Francisco School of Medicine. His classic text, Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (1982), written with a physician, Dr. Mark Siegler and a lawyer, Dr. William Winslade, carved out a role for ethics in the daily practice of medicine, offering a toolkit that became known as the “the 4-box method” to assist clinicians with difficult ethical decisions. Prior to his death, Jonsen, Siegler and Winslade were preparing the 9th edition of Clinical Ethics (which is forthcoming). Al served as a member of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-1978) and helped write the Belmont Report (1979), which articulated ethical principles of beneficence, justice, and respect for persons, to govern the conduct of human subjects research. Al served on the President’s Commission for the Study of Ethical Problems in Medicine (1979-1982).

Al came to the University of Washington School of Medicine (UW SoM) in 1987 to chair the Department of Medical History and Ethics (now the Department of Bioethics and Humanities) and remained there until his retirement in 1999, transforming it from a department focused on biomedical history to a department that incorporated bioethics training, research, and service. Al recruited me in 1988, to join the newly formed UW SoM department. He wisely advised me to arrive early, before the academic year was underway, to attend his now famous, “Summer Seminar in Healthcare Ethics.” It was essentially a crash course in bioethics, which I sorely needed. In those early days, I struggled to figure out what bioethics was and what role I, as a philosopher, might play. Al himself was not a theoretician, yet he understood how philosophers like me often struggled when attempting to deal with practical cases. Trained in the ethereal world of ideas, I was ill prepared for the messy details of medical cases. Al helped. He likened the relationship between ethical theory and practice to the relationship between a hot air balloon and a bike (he actually had a sculpture showing this, a gift from a former student, who had fashioned it from a toilet float and toy trike). Al explained, with the humor and verve that was his trademark, that philosophy was like a hot air balloon; it gave a serene, grand view of an expanse. But he understood that most people did not live in balloons, so he focused, like a biker of sorts, on the rocky paths, turning this way and that, finding a way. Al was a tremendous support to philosophers. He took me under his wing and introduced me, along with a whole generation of philosophers, to practical ethical problems in medicine by introducing a paradigm approach (formally set out in his book with Stephen Toulmin, The Abuse of Casuistry: A History of Moral Reasoning). The paradigm technique enabled us to “hover” comfortably, close enough to the ground to discern and analyze a situation’s ethical features, without quite hopping on a bike to ride the rough terrain. Al showed philosophers a way to shift from the intoxicating heights of theory, toward the muddy earth, and to actually use what we had seen and learned to help people. I will always remember Al fondly and with gratitude for the pivotal role he served during my formative years.

He was a role model par excellence.

Al touched the lives of so many people over the course of his long career in bioethics that I cannot possibly do justice to them all. Al was known to his many friends as a warm and genuine human being, a loyal supporter of students and junior colleagues, a renaissance person, a lover of good food and drink, and a storyteller.  He had a deft sense of humor and an uncanny ear for accents, which he could flawlessly imitate. He often drew wonderful caricatures of people and ideas while sitting at a meeting. Below are some brief excerpts that give an impression of what Al was like and what he meant to some of us who had the privilege to know him.

“Al was pragmatic about things,” said William Winslade, Professor at The University of Texas Medical Branch at Galveston. “Solving problems was something that he believed in. As a priest that’s what you do. If people are having a problem, it means they don’t know what to do. Al helped them figure it out.” He adds that, when writing Clinical Ethics“we needed a way for doctors to think about ethics. So we came up with the 4 boxes to help them.”

Tom McCormick, Senior Lecturer Emeritus at UW SoM, also recalls Al’s problem solving tenacity. He notes that “Regardless of your theoretical approach, there are pragmatic questions you’ve got to answer when you’re doing clinical ethics. If you leave them out, you might be too theoretical.” Al’s tools helped people in the trenches: “many clinicians were able to adopt the 4-box approach and use it in their daily work”.

Al “had a very large soft spot for physicians and other health care provides,” Mark Tonelli, UW SoM Professor, recallsnoting “The fact that he immersed himself in clinical medicine, really seeking to understand what it is that we do… projected a sense of humility and respect that was impossible to miss. While he was an astute observer of the medical endeavor, when he dealt with clinicians it never felt like you were being studied or judged. Rather, interactions with him always felt like an act of sharing and support, discovering together what mattered in trying to do the right thing.”

“Among the things that I will always remember and treasure about Al as a mentor was how much he trusted and believed in me,” says Clarence Braddock, former UWSOM faculty member and now the Professor of Medical Education at the University of California Los Angeles School of Medicine. He remembers how “The media office would call the department looking for commentary on some topical issue in medical ethics, and he would direct them to me for comment. The first time, I was petrified – he just calmly told me ‘you’ll do terrific, you know what to say.’ The same happened when the Washington State Health Services Commission called asking him to testify on the then new health care reform legislation. He asked me to go in his place. For a young physician-ethicist, his belief in me and the confidence he showed rubbed off on me and helped me feel like I belonged in bioethics.”

Al’s taught from a broad repertoire of knowledge recalls Mark Sullivan, UW SoM Professor. In a faculty seminar Al led on Aristotle, “when we would have a debate about what Aristotle meant, Al would read from the original Greek version and then explain to us the nuances of the words used. It made me thankful we had a chair that could offer such academic leadership.”

Al’s keen intellect was on display while working on the forthcoming 9th edition of Clinical Ethics, according to Ruchika Mishra, Director of the Program in Medicine and Human Values at Sutter Health who joined Al as associate editor for the book: “during this entire process he knew with perfect precisions…where each concept belonged and how the 4 box method of analysis should best be described and applied to different clinical situations. It was a privilege to see firsthand, and in such a focused way, inside the mind of one of the leading historic figures of bioethics.”

As a beloved colleague and mentor, Al took a genuine interest in people’s lives. Jack Berryman, UW SoM Professor Emeritus, recounts, “I was usually the first in the office every morning so I would leave my door open until things got busy. As soon as Al arrived, he would come into my office, sit down, and ask how things were going. He loved and appreciated history and liked to discuss Hippocrates and Galen with me. He always asked about my family, my classes, and my research. It was so evident that he genuinely carried about me and my work.”

UW SoM Professor, Douglas Diekema, remembers the major impact Al had on his career when he reached a crossroad. “When I came up for mandatory promotion …. I was hearing rumblings that … the kind of scholarship I had chosen to pursue [involved] ‘Too much commentary and not enough data driven science.’ Al offered to write an internal referee letter as part of my promotion package. I later heard that his letter convinced even the sceptics that my work was important and legitimate scholarship and of a quality worthy of promotion. As my career progressed, Al continued to take an interest in my writing and work. That continued even after he left Seattle for San Francisco. Each year I would look forward to catching up at the annual Summer Seminar. He not only asked about me, but always asked about my father (who like Al, had been a college president). He had become a good friend and I will always cherish those times together.

Al was a fine food and wine connoisseur, recounts James Whorton, UW SoM Professor Emeritus. “Whenever I traveled to a city I knew Al had been to, even though I had my own favorites there already, I would ask him if he had any dining tips—he always did. From The Bon Ton in New Orleans, to Le Refuge du Passé in Paris, to more than a few others, Al never steered me wrong… Al also enjoyed good drink, and introduced me to his favorite blended scotch, The Famous Grouse. The Grouse soon became my favorite blend too; it is the dram I will lift tonight in Al’s memory.”

As a companion and friend, Al exuded warmth and he hosted many of us at his home. Sarah Shannon, former UW SoM faculty member and now the Dean of Montana State University College of Nursing, recalls that “Al was funny. He and his dear wife, Liz, frequently entertained in their home. I remember one particular night when he regaled me, my husband and another guest with a story of the Australian roots for both his and Liz’s families, delivered in a flawless Aussie accent. Al’s storytelling was enthralling. Embellished with his knowledge of history, philosophy, the ancients, and delivered with an uncanny ear for local dialects, Al was the “James Michener” of dinner table conversationalists.

Robert Pearlman, UW SoM Professor Emeritus, reminiscences that “Al was generous with his time, always thoughtful, open to new challenges, and a grandpa-like figure to my young children. I vividly recall an evening at my home in Seattle about 20 years ago where my daughter and Al were sitting next to one another on a couch and he was reading out loud a children’s story to her (probably a Dr. Seuss story). To me, Al’s passing is like losing a beloved family member.”

After retiring from the UW SoM in 2003, Al returned to his native San Francisco to cofound (with William Andereck) the Program in Medicine and Human Values at Sutter Health’s California Pacific Medical Center. Al is survived by his wife of 44 years, Liz Jonsen; brother, Robert Jonsen; and sister, Anne Marie Carrick.


As we mourn Dr. Jonsen’s passing, we invite you to pay tribute to his life and legacy: 

We don’t have plans for a virtual memorial service at this time but if you’d like to be informed of any future memorials or remembrances, please email bhchair@uw.edu.


Tributes to Dr. Jonsen


The New York Times "Albert R. Jonsen, 89, Dies; Brought Medical Ethics to the Bedside"


I've been thinking a lot about Al this past week. Al was one of the most important mentors I've had over my life, and had a profound impact on my career. What he saw in me and why he took an interest in me, I will never really know, but he did, and it put me on the career trajectory I now enjoy.

I moved to Seattle 30 years ago to start my fellowship in pediatric emergency medicine and complete a Master's Degree in Public Health. I came with the wild notion that I could make a career for myself in ethics and actually get promoted by doing ethics work in a department that considered scientific inquiry to be the only true form of scholarship. I was told in no uncertain terms that I could have ethics as a "hobby", but that I would need to publish enough traditional scientific scholarship to get promoted. Then Al came into my life and threw me and my dreams a lifeline.

I had been able to convince the school of public health to allow me to create an ethics track within health services, and I first met Al when I took his seminar on Ethics and Jurisprudence. Al taught me to read legal opinions, to appreciate the importance of the relationship between law and ethics, and introduced me to casuistry. But most importantly, Al took an interest in my life, goals, and future career. He checked in with me regularly during those early years, and shortly after I was offered a position as an assistant professor in pediatrics, Al casually asked if I would consider an adjunct appointment in Medical History and Ethics. He also asked me to take responsibility for the Pediatric lecture in the annual Summer Seminar in Healthcare Ethics. He continued to promote me as the pediatric ethics expert, provided me with a home for my academic work, and read my papers before I submitted them for publication. But perhaps his greatest impact on my life came in 1998 when I came up for mandatory promotion to Associate Professor in Pediatrics. I was hearing rumblings that at least some members of the department promotions committee were concerned about the kind of scholarship I had chosen to pursue: "Too much commentary and not enough data driven science."

Al offered to write an internal referee letter as part of my promotion package. I later heard that his letter convinced even the sceptics that my work was important and legitimate scholarship and of a quality worthy of promotion.

As my career progressed, Al continued to take an interest in my writing and work. That continued even after he left Seattle for San Francisco. Each year I would look forward to catching up at the annual Summer Seminar. He not only asked about me, but always asked about my father (who like Al, had been a college president). He had become a good friend and I will always cherish those times together. I will miss Al greatly, and he will always have a special place in my heart.

     ~ Doug Diekema, Professor of Pediatrics. Al was a wonderful mentor and eventual colleague


During his time as chairman, Al held a seminar for faculty on Aristotle's Nichomachean Ethics. When we got into debates about the meaning or importance of particular passages, Al would read the passage in the original Greek and explain to us what it meant. I thought this was a fine example of intellectual leadership by a department chairman. It made me proud to have Al at UW.

     ~Mark Sullivan, Professor of Psychiatry and Behavioral Sciences, adjunct faculty under Al Jonsen


Al and I became fast friends while he was at UW. I invited him to speak at the annual meeting when I was President of the Association of University Professors of Ophthalmology and he was such a hit that he was invited to keynote the annual meeting of the American Academy of Ophthalmology.

     ~Robert E. Kalina, MD, Professor Emeritus, Ophthalmology, University of Washington


My first exposure to Dr. Jonsen came about 25 years ago, when he was a featured speaker for a bioethics workshop sponsored by the Memphis Area Consortium on Biomedical Ethics. He encouraged me to attend a week-long intensive in Seattle and I began using his Clinical Ethics text shortly thereafter. When I was organizing the ethics committee at St. Jude Children's Research Hospital about 5 years later, I returned to Seattle with several of our inaugural committee members. I appreciated many things about Dr. Jonsen: his appreciation that the details of a case often matter; his insight that we can often agree on what should be done, even if we disagree on why that is so; his commitment to work as part of a inter-professional team; his practical bent. He will certainly be missed and remembered.

    ~Christopher Church, Ph.D., HEC-C, Professor of Philosophy & Religion, Baptist Health Sciences University. Used Jonsen, Sieglar & Winslade's Clinical Ethics for many years, attended Seattle bioethics events many times


A  mensch. Funny smart innovative dynamic and great company! Bout says it all

    ~Arthur Caplan, Mitty Professor of Bioethics, NYU Grossman School of Medicine


Al Jonsen brought joy to bioethics. He had deep discernment, and an ability to analyze philosophical precepts with the best touch of practical wisdom, phronesis, necessary to bring caring bioethics to the bedside. His wisdom was shared generously to students, fellows, and clinicians. I had the joy of working with Al for a short duration during my masters training, and he always brought balance and depth to the work I engaged in. Truthfully, his joy and wisdom were behind my reasons to leave full time family practice and turn my career towards an engaged career in clinical bioethics. He will be missed.

     ~Deborah Kasman MD, MA, Bioethics Director at Kaiser Permanente Baldwin Park CA. Al Jonsen introduced me to bioethics in the UW summer intensive calls of 1996, and I was hooked. He also supervised some of my masters work at UW from 1999-2001.


Some reflections on the passing of Albert Jonsen

The philosopher Ludwig Wittgenstein once wrote, "Not how the world is, is the mystical, but that it is" (Tractatus 6.44). I muse in wonder that there is a multidisciplinary professional field called "bioethics;" that it is as a distinct multidisciplinary field is due in large measure to a handful of intelligentsia who envisioned its possibility and necessity and then acted to bring about its existence. Al Jonsen was central to this effort. He envisioned our field, wrote some of its fundamental texts (e.g.,Clinical Ethics a multidisciplinary text written with Mark Siegler & William Wimslade), he served on governmental bodies that birthed us (eg. the National Commission that wrote the Belmont Report), and he wrote our foundational history (Birth of Bioethics). Al was also an avuncular presence who offered a helping hand to younger scholars (including me). A brief chat, or even better an evening meal sharing anecdotes, was a delight and an intellectual treat. The breadth of Al's knowledge and the good will with which he shared it, his smile and humor, will be missed by all who had the good fortune to spend some time with him. And the fact of our existence represents a living memorial to him.

Sincerely

bb

     ~Robert Baker, Professor Emeritus, friend and fellow scholar


I knew Al from my roles as a member of the UWMC Ethics Committee and as the Medical Director for the ICUs. He is one of those people where everyone would smile when he entered a room as they knew that he would bring wisdom and support and sharp analysis to each patient's situation, no matter how difficult it might be. When I first started to work with him it became very apparent that he also spontaneously took on the active role of supporting and actually "treating" the healthcare providers who were trying to find the best route through complex problems.

     ~David Ralph M.D.


Al Jonsen brought joy to bioethics. He had deep discernment, and an ability to analyze philosophical precepts with the best touch of practical wisdom, phronesis, necessary to bring caring bioethics to the bedside. His wisdom was shared generously to students, fellows, and clinicians. I had the joy of working with Al for a short duration during my masters training, and he always brought balance and depth to the work I engaged in. Truthfully, his joy and wisdom were behind my reasons to leave full time family practice and turn my career towards an engaged career in clinical bioethics. He will be missed.

     ~Deborah Kasman MD, MA, Bioethics Director at Kaiser Permanente Baldwin Park CA. Al Jonsen introduced me to bioethics in the UW summer intensive calls of 1996, and I was hooked. He also supervised some of my masters work at UW from 1999-2001.


A photo I took at ASBH in 2017 of him and, I believe, John Moskop.

     ~Hannah I. Lipman, MD MS HEC-C. VP, Bioethics at Hackensack Meridian Health


 

 

 

 

 

 

Al was, along with Bernie Gert and Tom Beauchamp, exceptionally gracious in support of a 1994 conference in Miami to explore different approaches to doing bioethics. This was apparently the only program on which the three shared and debated their positions. The photo, from March 18, 1994, is of the three of them during a panel discussion.

     ~Ken Goodman, Director, University of Miami Miller School of Medicine Institute for Bioethics and Health Policy


 
Al Jonsen as I was thanking him at ASBH Kansas City MO, Oct 19. 2017
 
    ~Deborah L. Kasman MD, MA, Bioethics Director, Kaiser Permanente Baldwin Park