Roosevelt University in Chicago, Schaumburg and Online - Logo
Medicine's Moral Compass - Illustration by Dave Cutler

Posted: 11/07/2013

By Tom Karow

Alumna Mary Simmerling

Mary Simmerling is quick to give credit to those who helped her become one of the nation's most respected experts on medical ethics, especially the ethics of human organ transplantation, but one person she can't stop talking about is Roosevelt University Philosophy Professor Stuart Warner.

"Stuart had a huge influence on me," she said reflecting back to the courses she took with him in the early 1990s. "He opened me up to thinking about the world in a way that really made philosophy a living thing for me. I think that one of the reasons why I decided to pursue applied ethics and go into something where I use my philosopher's approach to the world is because of how very alive Stuart made philosophy for me."

In the grassy courtyard of her apartment complex in New York City where her two-year-old son loves to play, the 1993 Roosevelt graduate reminisced about her Roosevelt education and described her remarkable career. Now assistant dean for Research Integrity and assistant professor of Public Health at the Weill Medical College of Cornell University, Simmerling recalled how Warner custom designed a curriculum for her and a few other philosophy majors. "Stuart was just so in love with philosophy and so energized about it," she said. "He shared that passion with us in a way that wouldn't have been possible in a lecture hall with 100 students. He was really incredible and so dedicated to us."

For his part, Warner is extremely proud that one of his students is using her philosophy degree in a manner that is affecting public policy debates on important ethical issues in medicine and science. "Besides her intelligence, she was one of the most interesting students I ever had," he said. "She gravitated to everything from Plato to the Russian poet Anna Akhmatova to painting to civic life. It wasn't hard to see that she would shine not only in the world of academe, but in life and she has, in spades."

From her home on Manhattan's East Side, Simmerling has a short walk to the Weill Cornell Medical College, which is one of the top-ranked clinical and medical research centers in the country. Its 24 departments focus on the sciences underlying clinical medicine and the study, treatment and prevention of human diseases.

Simmerling's job responsibilities at the medical college, which she joined in 2007, are different from those at similar schools. No institution in the country has someone whose duties combine administration, teaching, medical and research ethics, human organ transplantation ethics and investigating misconduct. "I'm trained as a philosopher, but work with physicians and members of the academic faculty," she said. "I really strive to show people that ethics is not the enemy of science, but an essentially important component of good science and innovation."

Dr. Laurie H. Glimcher, the Stephen and Suzanne Weiss dean and provost for Medical Affairs at the college, said Simmerling's commitment to social justice carries over into all aspects of her work. "Mary Simmerling is a real leader at Weill Cornell Medical College in championing integrity and maintaining the highest ethical standards in all faculty research," she said. Faculty at the college appreciate the South Side Chicago native's insights and advice as well. Dr. Carl Nathan, professor and chair of Immunology and Microbiology at Cornell, said "Mary uses her authority not to dictate to the faculty, but to mediate for them. No regulations are too complex for her to grasp fully, explain clearly and help faculty comply with fairly and efficiently. No wonder that she is increasingly called on for her counsel."

From Philosophy to Medicine

Simmerling's interest in medical ethics began shortly after she graduated from Roosevelt, which she selected to attend following a recommendation from renowned musician and Roosevelt Music Professor David Schrader, a close family friend. She has six brothers and sisters and her late father, Jack Simmerling, was a highly acclaimed artist whose teacher was John Singer Sargent's last student.

While at the University of Illinois at Chicago, where she earned master's and doctoral degrees in philosophy, Simmerling discovered that there were very few professional articles written about transplantation ethics. One that piqued her interest was a New England Journal of Medicine article about living donor liver transplantation. She knew that to be meaningfully engaged in discussions of ethics in this area, she needed to understand the medical aspects of organ transplantation. So she reached out to the paper's authors and transplant surgeons in the Chicago area who immediately welcomed the opportunity to discuss the challenges they were facing. Dr. Joseph Leventhal, a kidney transplant surgeon at Northwestern University, invited her to join him in the operating room to watch him perform a living donor kidney transplant, while others spent many hours providing information and background for her dissertation on the ethics of living organ donor transplants.

""

As a graduate student in 2003, Simmerling created the Chicago Transplant Ethics Consortium along with Dr. Michael Abecassis, chair of the Division of Organ Transplantation at Northwestern and a member of her dissertation committee. The influential organization still meets regularly to understand and respond to ethical issues in organ transplantation on local, regional, national and international levels. The consortium includes physicians and nurses from various medical disciplines, social workers, ethicists and philosophers as well as recipients and living donors. One of the many issues consortium members have discussed is the use of medical excuses in organ transplantation. It was also the topic of a paper Simmerling co-authored in 2008 shortly after completing a twoyear fellowship at the University of Chicago's MacLean Center for Clinical Medical Ethics. The paper describes how potential organ donors who do not want to contribute an organ are often provided with blameless medical excuses by members of a hospital's organ transplant team.

"I think we really brought this issue to light," Simmerling said. "We worked together with hospital ethics committees to develop policies that hospitals should have related to medical excuses in a way that doesn't falsify medical records or put physicians in the position of lying to potential recipients, but that still allow potential donors to bow out gracefully without causing a family crisis."

A Multi-Disciplinary Approach

The ability to look out for people's welfare while also advocating for scientific discovery is a special expertise that Simmerling has, said Dr. Lainie Ross, associate director of the MacLean Center. "In a world of ever greater subspecialization, individuals who cross disciplinary bounds are to be admired as they bring insights from one area to another. Mary has done this and more, for both the medical and lay communities."

Another transplant issue Simmerling has written on is federal legislation that restricts financial reimbursement for organ transplantation for undocumented residents. This makes it difficult for many immigrants without health insurance, including children, to access the transplants they need. In their paper, she and two bioethicists from Northwestern University argue that undocumented immigrant children deserve the same access to kidney transplantation as do legal residents. "We need to look at many factors, including cost," she said. "How do the costs of keeping a child on dialysis compare to paying for a kidney transplant?"

Simmerling also has worked with the Ministry of Health of China in its efforts to regulate organ transplantation and abolish organ trafficking. In 2007, she gave the keynote address on ethics at the International Organ Transplantation Forum in Beijing, China. At that time, China's Deputy Minister of Health, Jiefu Huang, who is himself a transplant surgeon, had just written an article in which China admitted for the first time that it uses organs from executed prisoners for most of its transplants.

Dr. John Fung, professor of surgery at the Cleveland Clinic who first met Simmerling at the Beijing meeting, said she didn't scold the Chinese, but presented a thoughtful assessment of their culture and laws. "Clearly Mary did not endorse their practice of using executed prisoners as donors," he said, "but rather encouraged them to understand why that was not the best way to go and encouraged dialogue between China and developed systems of deceased and living donor options. Her philosophy of engaging rather than ostracizing the Chinese transplant community has opened the doors for important changes in the way they are developing transplantation."

"Mary is successful because of her passion for ethical systems and thought," added Dr. Michael Millis, director of the University of Chicago's Transplant Center, who has worked with Simmerling and Fung on advancing transplantation reform in China. "She understands the complex and often competing interests in medicine in general and specifically in transplantation and helps determine an ethical paradigm to advance the field."

In the United States, hospitals and doctors still struggle with who is able to receive a transplant because organs are such a scarce resource. "The rules are intended to be clear and equal," Simmerling said, "but there's a lot of debate about whether or not they actually are. Some people are still able to game the system, while others are left out entirely. It's a challenging area."

In her multi-faceted position at the Weill Cornell Medical College, Simmerling interacts with scientists and doctors on a variety of levels, including reviewing research and overseeing and investigating charges of research misconduct. But one of her favorite places is in the classroom. She teaches the Medical Ethics section of a course called Physician, Patient and Society for second-year medical students and a semesterlong course for post-doctoral and MD-PhD students on the responsible conduct of research that includes sections on research integrity and the scientist as a responsible member of society. She also teaches a course in the summer for graduate students on social, ethical and legal issues.

"Through formal coursework and during day-to-day activities in reviewing and overseeing studies, Mary is passionate about educating student researchers and staff in both the ethical and practical aspects of conducting clinical research," commented John Leonard, associate dean for Clinical Research at Weill Cornell.

"I tell the students to take advantage of the courses to tune their moral compass," Simmerling said. "I remind them how privileged they are to take care of people. Dean Glimcher has made it the mantra of the medical college that the patient is at the center of everything we do. Whether the students are future doctors or researchers who are working on drug development, it's really all about taking care of patients and people. My contributions are on the side of ethics and justice and fairness."

A Family Devoted to Social Justice

Simmerling isn't the only member of her family devoted to social justice. Her husband, Thomas Epting, co-founded UncommonGoods, a Brooklyn-based online company that sells handmade gifts for the home. UncommonGoods donates a portion of each order to a non-profit organization and it is the first company in New York State to be certified as a B Corporation, allowing it to create value for society, not just for shareholders.

Mary Simmerling and son play in the parkWorking in New York City near the United Nations and the New York Academies of Science and Medicine gives Simmerling an opportunity to take part in international conversations on grim issues like trafficking in people for the purpose of removing organs and selling them. Her efforts to affect policy changes in this area include work with the global ethics initiative at the U.N. and the Initiative to End Slavery at Massachusetts General Hospital. She also is supporting the research of Dr. Mark Lachs, professor of medicine at Weill Cornell Medical College, who has published widely in the areas of elder abuse and neglect. "Given the aging population and the burden of Alzheimer's disease, we both believe that the future of medical ethics is going to be in geriatrics and the aging brain," she said. "One of the things I do is help him and other researchers work with the institutional review boards at Cornell."

Simmerling's activities at the medical college allow little free time but when she has an opportunity, she enjoys writing poetry. "In addition to philosophy, I studied literature and art at Roosevelt and I love poetry. It's a big part of my life," she said. Her works are about life and ethics and some were inspired by medical issues facing members of her family. One of her poems was featured in a publication of the International Museum of Women and was also the only poem to have been included in a Stories on Stage performance.

"I often think back to all of the things that Stuart taught me and how they helped prepare me for this exciting position," she said. "What I do doesn't feel like work to me. I'm part of a wonderful community at Cornell and I have such an amazing and inspiring team of people that I work with. It's really a privilege to be in this role."