About

Mark Siegler is a Professor at the University of Chicago in the Department of Medicine-General Internal Medicine. His work focuses on clinical medical ethics, including the history and contributions of ethics to American medicine, and the ethical considerations in healthcare delivery, organ transplantation, and medical decision-making. Siegler has contributed to understanding the ethics of climate change and healthcare, disparities in medical treatment, and the development of ethical standards in critical care and transplantation. His research also explores physician-assisted suicide, surrogate decision-making, and the integration of ethics curricula into medical training. Throughout his career, Siegler has been involved in examining the legal and ethical frameworks governing medical practice, advocating for patient-centered care, and addressing issues related to resource allocation and medical futility.

Research topics

• Political Science
• Medicine
• Emergency medicine
• Internal medicine
• Medical emergency
• Intensive care medicine
• Cardiology

Selected publications

• Ethical dilemmas in climate change and healthcare delivery: a cross-sectional survey of US patient perspectives

  BMC Medicine · 2026-01-27 · 1 citations

  articleOpen access

  BACKGROUND: Healthcare delivery produces substantial emissions that contribute to climate change and harm human health. Patient perspectives on ethical dilemmas, such as tradeoffs between individual health choices and public health harms mediated by climate change, are unclear. METHODS: This cross-sectional survey randomly sampled adult patients across four US health systems to assess their perspectives on ethical dilemmas in climate change and healthcare delivery; results were compared to a previous nationwide survey of US-based physicians. The mailed survey was developed iteratively through pre-testing and was designed to detect a 15% difference in the proportion willing to limit treatment options because of environmental impact according to respondents' perceived impact of climate change on their health. Secondary outcomes included physician responsibilities for healthcare sustainability and acceptability of environmentally motivated treatment tradeoffs. RESULTS: Between 11/2023 and 9/2024, 289 of 516 patient surveys and 304 of 529 physician surveys were delivered and returned, for response rates of 56.0% and 57.5%, respectively. Most patients (79.1%) believed that environmental factors impacted their medical conditions, and 36.3% reported a moderate-to-high health impact from climate change, while 5.2% reported speaking with their doctor about climate and health interactions a moderate amount or more. Similar proportions of patients (35.8%) and physicians (35.0%) agreed with reducing healthcare's environmental impact even if it required limiting treatment options. Like physicians, patients' perceived health impact (moderate-to-high versus low-to-no) was associated with willingness to place such limits (adjusted OR 1.85; 95% CI 1.01, 3.41). Most patients (77.1%) were willing to accept some reduction in the likelihood of treatment response if that treatment was less environmentally impactful; unlike physicians, this did not vary by health impact (adjusted OR 1.16; 95% CI 0.63, 2.20). Almost all patients (96.8%) reported that physicians should help make healthcare sustainable, and 64.7% thought this included changing clinical practices. CONCLUSIONS: Many US patients and physicians recognize connections between health, healthcare delivery, and climate change, and accept environmentally motivated treatment tradeoffs, but do not discuss them in the clinic. Patient views largely parallel those of physicians, suggesting support for climate-informed medical practice and for incorporating environmental considerations into clinical decision-making.

  PublisherDOI

• The ethics of climate change and health-care delivery: a national survey of US-based physicians

  The Lancet Planetary Health · 2025-08-01 · 4 citations

  articleOpen access

  Health harms from climate change are partly driven by health-care emissions. Physician perspectives on the related ethical dilemmas of professional responsibilities, health equity, and trade-offs between individual health choices and the environmental impact of health care are not well described in current literature. We performed a cross-sectional survey of US-based physicians between July 18, 2023, and May 28, 2024 to assess related perspectives, and we analysed the results by the respondents' perceived impact of climate change on their patients' health (moderate-high impact vs no-to-low impact). 529 surveys were delivered, of which 304 (57·5%) were returned. 113 (37·4%) of 302 respondents reported that climate change had a moderate-high impact on their patients' health, whereas 249 (82·5%) respondents viewed climate change as having greater health impacts on patients with less access to health care. 105 (35·0%) of 300 respondents reported that the environmental impact of health care should be reduced even if it requires limiting treatment options of similar effectiveness. In response to hypothetical scenarios, the patients in the moderate-high impact group was more willing to place such limits (adjusted predicted probability=50%) than the no-to-low impact group (adjusted predicted probability=25%, difference=25% [95% CI 13-38]). In addition, the patients in the moderate-high impact group (adjusted predicted probability=86%) was more willing to initially trial a less effective but less environmentally toxic antihypertensive medicine than the no-to-low impact group (adjusted predicted probability=69%, difference=17% [95% CI 6-27]). A sample of US-based physicians accepted their health care-related responsibilities towards climate change and viewed its health impacts as inequitable. Perceptions of the health impact of climate change influenced willingness to accept limited treatment options for environmental reasons.

  PublisherDOI

• International Travel for Organ Transplantation: Provider and Patient Perspectives

  Transplantation Direct · 2024-07-18

  articleOpen access

  Background. Organ allocation in the United States to non-US citizen, non-US residents who travel for transplant (NC/NRTx) is controversial. Current policies may not be informed by stakeholder opinions, as limited data exist assessing the knowledge or opinions of providers or patients on this issue. Methods. A cross-sectional, hospital-based pilot survey was distributed to providers and patients from December 2019 to June 2020 at a single large urban transplant institute. Providers were members of the departments of surgery and medicine and included both transplant and nontransplant providers. Surveys included 10 questions on eligibility, prioritization, and limitations for deceased donor transplantation and 12 demographic questions. Results. A total of 209 providers responded (61% women, median age 40) and 119 patients responded (62% women, median age 54). Awareness of eligibility for transplantation of US citizens, non-US citizens residing in the United States (NC/R), and NC/NRTx was high in both groups, though providers and patients lacked awareness of the eligibility of nonlegal NC/R (those who live in the United States who are not citizens and are not legal residents) to donate and receive organs. Overall, 79.3% of patients stated that NC/NRTx should be eligible for transplant in the United States compared with only 60.7% of providers ( P = 0.001). Providers were more likely than patients to prioritize transplant to legal NC/NR over NC/NRTx (58.2% versus 35.1%, P < 000.1) and reported that families should be able to limit donations to NC/NRTx (34.9% versus 23.2%, P = 0.03). Conclusions. Surveyed patients and providers generally support transplant in non-US citizens; however, the strength of support varied considerably based on the legal status of the patient and the occupation of those surveyed. Larger studies are necessary to develop data-informed policy.

  PublisherDOI

• A focus group study of ethical issues during climate-informed health decision-making

  Nature Climate Change · 2024-09-12 · 24 citations

  article
  PublisherDOI

• Addressing sex-based disparities in solid organ transplantation in the United States – a conference report

  American Journal of Transplantation · 2023-01-12 · 32 citations

  articleOpen access
  PublisherOA PDFDOI

• The Bucksbaum Institute for Clinical Excellence and the Doctor–Patient Relationship: Origins, Programs, and Future Directions

  Academic Medicine · 2023-02-16 · 1 citations

  articleSenior author

  Abstract The Bucksbaum Institute for Clinical Excellence at the University of Chicago was established in 2011 with the mission to improve patient care, strengthen the doctor–patient relationship, enhance communication and decision making in health care, and reduce health care disparities. The Bucksbaum Institute supports the development and activities of medical students, junior faculty, and senior clinicians who devote themselves to improving doctor–patient communication and clinical decision making. The institute seeks to enhance the skills of physicians as advisers, counselors, and navigators to help patients make informed decisions when facing complex treatment choices. To achieve its mission, the institute recognizes and supports the activities of physicians who excel in clinical care, supports an array of educational programs, and funds research into the doctor–patient relationship. As the Bucksbaum Institute enters a second decade, its focus will begin to extend beyond the University of Chicago, leveraging alumni and other relationships to improve patient care everywhere.

  PublisherDOI

• Disparities in Unilateral Do Not Resuscitate Order Use During the COVID-19 Pandemic*

  Critical Care Medicine · 2023-03-30 · 17 citations

  articleOpen access

  OBJECTIVES: A unilateral do-not-resuscitate (UDNR) order is a do-not-resuscitate order placed using clinician judgment which does not require consent from a patient or surrogate. This study assessed how UDNR orders were used during the COVID-19 pandemic. DESIGN: We analyzed a retrospective cross-sectional study of UDNR use at two academic medical centers between April 2020 and April 2021. SETTING: Two academic medical centers in the Chicago metropolitan area. PATIENTS: Patients admitted to an ICU between April 2020 and April 2021 who received vasopressor or inotropic medications to select for patients with high severity of illness. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 1,473 patients meeting inclusion criteria were 53% male, median age 64 (interquartile range, 54-73), and 38% died during admission or were discharged to hospice. Clinicians placed do not resuscitate orders for 41% of patients ( n = 604/1,473) and UDNR orders for 3% of patients ( n = 51/1,473). The absolute rate of UDNR orders was higher for patients who were primary Spanish speaking (10% Spanish vs 3% English; p ≤ 0.0001), were Hispanic or Latinx (7% Hispanic/Latinx vs 3% Black vs 2% White; p = 0.003), positive for COVID-19 (9% vs 3%; p ≤ 0.0001), or were intubated (5% vs 1%; p = 0.001). In the base multivariable logistic regression model including age, race/ethnicity, primary language spoken, and hospital location, Black race (adjusted odds ratio [aOR], 2.5; 95% CI, 1.3-4.9) and primary Spanish language (aOR, 4.4; 95% CI, 2.1-9.4) had higher odds of UDNR. After adjusting the base model for severity of illness, primary Spanish language remained associated with higher odds of UDNR order (aOR, 2.8; 95% CI, 1.7-4.7). CONCLUSIONS: In this multihospital study, UDNR orders were used more often for primary Spanish-speaking patients during the COVID-19 pandemic, which may be related to communication barriers Spanish-speaking patients and families experience. Further study is needed to assess UDNR use across hospitals and enact interventions to improve potential disparities.

  PublisherOA PDFDOI

• Preface

  Academic Medicine · 2023-02-16

  article

  Cifu, Adam S. MD1; Sorrentino, Matthew MD2; Siegler, Mark MD3; Krapec, Joni MA4 Author Information

  PublisherDOI

• Ethics of Extracorporeal Membrane Oxygenation in Medical Practice (S502)

  Journal of Pain and Symptom Management · 2022-04-11

  articleOpen accessSenior author
  PublisherDOI

• The Importance of Formal Education and Training in Clinical Medical Ethics for the 21st Century

  Difficult decisions in surgery: an evidence-based approach · 2022-01-01

  book-chapter1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Carol Stocking

  Leibniz Institute of Virology (LIV)

  73 shared

• Erin S. DeMartino

  Mayo Clinic

  65 shared

• Fay J. Hlubocky

  University of Chicago

  47 shared

• Andrew Hantel

  Dana-Farber Cancer Institute

  46 shared

• Christopher K. Daugherty

  University of Chicago

  44 shared

• Samantha Bastow

  Becton Dickinson (United States)

  36 shared

• Trinh T. Nguyen

  The University of Texas MD Anderson Cancer Center

  36 shared

• Ashley M. Egan

  Mayo Clinic

  36 shared