Category Archives: Philosophies

What is ‘Bronchosophy’


Interventional pulmonologists live simultaneously and sequentially in many worlds. One moment, they may find themselves directly responsible for the life or death of a patient with advanced disease; in the next, they might be delivering bad news, making prognoses under uncertain conditions, wrestling with the uncertainties of a novel technology, initiating long-term strategies, or advocating for their approach in a multidisciplinary care meeting. 

Many interventional pulmonologists are naturally curious and enthused to learn how to perform new procedures that require manual dexterity and analytical precision. But the profession demands more than technical skill to truly serve its patients. Equally important are a doctor’s abilities to communicate with clarity, courage, compassion, grace, and humility. Practicing medicine with such depth and professionalism is both a challenge and a virtue. 

It is not surprising, therefore, that bronchoscopy, a fundamental component of interventional pulmonology, is more than just a procedure. It is a way of seeing not only literally into the airways, but also metaphorically into a patient’s life. It is the means by which interventional pulmonologists contribute to another human being’s life story, often at a critical time of their patient’s journey between birth and death. 

More than forty years ago, one of the first bronchoscopies I performed prompted a difficult conversation with my patient about the effects of malignant central airway obstruction on their life and well-being. At that time, most oncologists and pulmonary specialists were still nihilistic about lung cancer treatments, and the value of palliative airway procedures was neither recognized nor accepted. My patient went on to receive chemotherapy and external beam radiation, sadly with little improvement in their symptoms and without a beneficial effect on their quality of life. During those weeks, I learned much from our bedside conversations, including humility. I realized that my ability to see into my patients’ airways granted me the privilege to hear their life stories. What remained was for me to determine the best ways I could help them.  

The results of this experience might be described as bronchosophy (pronounced /ˈbrɒŋ. kəˌsɒf.i or /ˈbrən kasəfi/), which is a term a few of us have used over the years, but has not yet entered common language. Just as philosophy might represent the pursuit of wisdom, truth, and knowledge, bronchosophy represents the pursuit of wisdom in the practice of bronchology. It can be defined as ‘a reflective and principled approach to the art and science of airway examination and intervention, combining technical skill with ethical insight, clinical judgment, and humanistic care.’ In other words, bronchosophy is the cornerstone from which the art and science of bronchology and interventional pulmonology blend with our humanity and heartfelt endeavors to do what is in the best interests of our patients.

Ethics in Interventional Pulmonology


Ethics, from the Greek words ēthos and ēthike philosophia (moral philosophy), is traditionally defined as the study of morality. What ought I do in a particular situation? What are the limits of my responsibility? How do my actions and behaviors relate to the particular norms, expectations, rules, or codes of conduct established by my profession, peers, and society, and how might these affect my community? 

The study of ethics also raises awareness and helps address other questions: Do my actions reflect a moral conscience at the center of my being or a system of thought dependent upon religious or societal models of expected behaviors? What are the emotional consequences if I must choose, in my desire to do what is right, from among potentially opposing ethical concepts, and might I rely on both subjective and objective arguments to justify my decisions? 

The Greek philosopher, Aristotle (384-322 BCE), was himself the son of a physician. He begins his treatise, Nichomachean Ethics, by writing, “Every art and every inquiry, and similarly every action and pursuit, is thought to aim at some good…will not the knowledge of it, then, have a great influence on life?”[i] Since its origins, the ‘art and science’ of bronchology and interventional pulmonology has grown in leaps and bounds. Focus has been on disease states, procedural techniques, training curricula, and how to best apply new technologies. The study of IP-related medical ethics, however, has sadly been neglected, as if medical doctors felt naturally inclined to ethical practices because they went to medical school and wear white coats or surgical scrubs. By no means do I suggest that IP specialists practice unethically. In fact, all the practitioners I know do their best to provide appropriate and competent patient care based on existing scientific evidence and the resources they have available. The practice of interventional pulmonology does, however, raise a variety of ethical dilemmas for which doctors are not necessarily trained, and situations for which doctors may not be fully aware of potential ethical issues at hand.

Therefore, based on my own experience practicing medicine and surgery around the world in diverse settings, my formal training as a medical ethicist, educator, mediator, and philosopher, and my current work as a philosopher practitioner, I decided to add an Ethics section to the Bronchoscopy International website at www.bronchoscopy.org. I have also prepared a first volume (available for free download in PDF form), Introduction to Ethics in Flexible Bronchoscopy, to serve as an introductory text for practitioners and IP specialists in training. My goal is to provide readers with fundamentals from which they may gain perspective to discuss, evaluate, reflect upon, and more readily address ethical issues faced in their daily practice of interventional pulmonology. My hope is to see ethics discussed in yearly training courses, national meetings, and IP societies’ international conferences. I welcome your feedback and hope this text is a helpful addition to other educational materials used by our profession.

[i] The Basic Works of Aristotle. Eds Richard McKeon. The Modern Library, Random House, NY, 2001. Nichomachian Ethics, book I, 1094a. WD Ross trans.