Evolution of the role of an applied bioethicist in a research hospital

This paper traces the evolution of the role of an applied bioethicist in the research hospital of the National Institutes of Health (NIH). The historical background of the NIH's leaders' development of a policy to protect human subjects is presented as prelude to a need for an "on-the-scene" ethicist in clinical research. The first year's work was marked by communication problems and role conflicts. Following a period of evaluation, with the help of a psychiatric consultant, a support system was fashioned for the new role that helped it evolve more effectively. The bioethicist's role as teacher, consultant, and bridge to authority is described. Case examples are included that depict the kinds of ethical problems in clinical research for which consultation is sought from a bioethicist.