The inaugural presentation of a new lectureship in the Department of Pediatrics, the Norman Fost Lecture on Skepticism and Critical Thinking, will take place on February 15, 7:30–8:30 a.m. In honor of the nationally known bioethicist and intended to promote critical thinking and skepticism, the initial lecture will be presented by Douglas Diekema, MD, MPH, a pediatric bioethicist from Seattle Children’s Hospital and the University of Washington. Diekema will offer his lecture, “Reflections on Trust in Medicine and the Physician’s Response to Vaccine Hesitancy.”
Norman Fost, MD, MPH, professor emeritus of pediatrics, Division of Child Protection, and of the Department of Medical History and Bioethics, joined the Department of Pediatrics in 1973 and founded the Program in Medical Ethics within the then Department of the History of Medicine that same year.
Fost had decided early in his education at Princeton, Yale, Harvard, and Johns Hopkins that he wanted to combine pediatrics and bioethics, even though there existed no such program or department anywhere. Fortuitously, his years at these universities intersected with the presence of several great seminal thinkers in medical ethics who became his mentors. Paul Ramsey was at Princeton while Fost was an undergraduate there (“I had this idea,” Fost said, “wouldn’t it be great to be Paul Ramsey but to be a doctor.”) Jay Katz, a physician and ethicist, was at Yale while he attended medical school there, influencing him greatly. Robert E. “Bob” Cooke, one of the leading figures in the history of pediatrics, was chair at Johns Hopkins while Fost was a pediatric resident. Fost was also the first fellow in the Kennedy Program in Law, Medicine, and Ethics at Harvard University, where he gained deep knowledge of and facility in legal and ethical issues in health care and also earned his MPH degree.
During his residency training at Johns Hopkins, Fost’s involvement with a child with Down syndrome changed his life course. The parents refused to consent to standard medical care and the child was allowed to die of dehydration over a 15-day period. Fost and his colleague John Robertson published a paper in 1976 about the legal liabilities of what was then a common practice of withholding lifesaving treatment from children with disabilities. It was conventional wisdom, widely accepted by a majority of pediatricians. In a more recent publication Fost further recounted this pivotal case, regarding it as a critical event at “the dawn of the bioethics movement.”
When Fost decided that he wanted to be both a pediatrician and a bioethicist, his mentors expressed doubts about a dual profession, and he realized he would have to create his own niche combining pediatrics and bioethics. He did, however, receive support from both Cooke and the UW School of Medicine’s Chair of Pediatrics (1964 –1974) Charles Lobeck, MD. From Fost’s first year at the UW and throughout the next 49 years with the Departments of Pediatrics and Medical History and Bioethics, he successfully combined his pediatrics and bioethics interests to great effect and benefit.
Fost was part of a UW research team, as a bioethicist, for the pathbreaking cystic fibrosis randomized clinical trial, an investigation initiated in 1984 by Philip Farrell, MD, PhD, emeritus dean and professor, Departments of Pediatrics and Population Health Sciences. It examined the benefits, risks, tests, and costs of early diagnosis of cystic fibrosis through newborn screening.
Farrell said: “I salute Norm and his unique career, which has greatly benefitted UW–Madison, pediatrics, and the world of clinical research. He came here as a pioneer in bioethics at the most opportune time, making an astonishing, internationally recognized impact. During my two decades as chair and dean, no one impressed me more than Norm.”
Farrell also acknowledged Fost’s role in the success of his work. “I am deeply indebted to him for his critical role in facilitating our randomized clinical trial of cystic fibrosis newborn screening,” Farrell said. “Moreover, his advice to me that ensuring the benefits of screening required me to be nationally engaged has fueled my last 20 years of academic endeavors.”
Fost has held many leadership positions throughout his long career, including service as vice chair of the Departments of Pediatrics and Medical History and Bioethics for 10 years, founder and director of the University of Wisconsin Child Protection Program for 33 years, and director of the Pediatric Residency Program for 21 years. In addition to his service as founder and director of the Program in Bioethics, he served as the chair of both the UW Hospital Ethics Committee and the UW Health Sciences Internal Review Board for 31 years.
Beyond his efforts at the University of Wisconsin, Fost worked with newly formed institutional structures to explore and inform ethical issues in medicine and research. He was involved in the early development of institutional review boards (IRBs) with the first National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (known as the “National Commission”), and with President Clinton’s Health Care Task Force.
Fost has also served as an elected member of Princeton University’s Board of Trustees. In 1997, he was awarded the Nellie Westerman Prize for Research Ethics (with Richard Love). In 2003, the American Academy of Pediatrics selected Fost for the William G. Bartholome Award for Ethical Excellence. In 2016, he was honored with the MacLean Center Prize in Clinical Ethics and Health Outcomes. Conferred by the MacLean Center for Clinical Medical Ethics, it is the largest prize in bioethics and clinical ethics, “[celebrating] individuals who have made transformative contributions to the field of clinical medical ethics through scholarship, practice, leadership, and policy development.”
Ellen Wald, MD, professor, Division of Infectious Diseases, and previous chair of the department from 2006 to 2022, interacted extensively with Fost throughout her tenure as chair. She called him the ethical conscience, the “super-ego of our department.” But not only that. “He is also the gadfly, the eternal skeptic, voicing concerns that issues may not be as they seem,” Wald said. “He makes us think of things from the other side. He demands that we not accept anything at its face value but question to be sure that the claims being made are true. He asks us to view the advice through a different lens. Are we making a decision in the best interest of the patient? He makes us ask, what is in the best interest of the child?”
Wald explained that this position and Fost’s requests always made those who listened more informed and brought about a better level of understanding of the issues pertinent to making a decision. “We absolutely need this perspective,” Wald insisted, “and we are grateful that this lectureship will help us continue this tradition of natural skepticism, in order to be better doctors and better human beings.”
Sharing both his deep knowledge of medical ethics and his understanding of the importance of skepticism and critical thinking, Fost has taught bioethics to medical residents throughout the training program, including a course on ethical and regulatory issues in human subjects research.
Informed consent remains one of Fost’s interests. He has also been involved in projects that explore end-of-life decisions in infants, genetic screening, performance enhancing drugs, organ transplantation, access to growth hormone, and youth tackle football. He is often sought out as a consultant on ethical issues in health care beyond the university and has appeared on many national television shows.
David Allen, MD, professor and chief, Division of Endocrinology and Diabetes, praised Fost’s mentorship. “For me, as for so many others, Norm Fost – and the critical thinking environment he espoused and developed— was a major attraction for coming to the University of Wisconsin,” Allen said.
He described Fost’s constant encouragement to challenge conventional wisdom and to critically examine the benefits and burdens of medical interventions. “Both in general and in one’s own daily practice, it truly distinguished this training program from others with profound and lasting effects on the careers of those he mentored,” Allen noted. “In this way, perhaps Norm’s most treasured legacy is the healthy spirit of skepticism that has been a hallmark of this department, its training programs, and its graduates for the past 50 years.”
Robert Golden, MD, dean of the University of Wisconsin School of Medicine and Public Health, emphasized Fost’s “incredible impact” on the fields of pediatrics and medical ethics, in Wisconsin and beyond. “A true pioneer, he led the development of medical ethics at our School of Medicine and Public Health and in the spirit of the Wisconsin Idea, shared his work with the nation,” Golden said. “Dr. Fost has thoughtfully analyzed our most pressing ethical questions and has helped others in health care and research do the same.”
Throughout his career, Fost’s dual profession has allowed him to be involved as a pediatric clinician, at the bedside of patients, as well as engaged intellectually and pragmatically with leading scholars, lawyers, and philosophers at every level addressing questions of medical bioethics nationally. Fost considers himself fortunate beyond measure to have experienced the satisfaction and rewards of his long career in what had been, when he started out, a non-existent field.
Photo by Bob Gordon/Department of Pediatrics