What about the 'H' in 'ASBH'?: A junior bioethicist's perspective


Keisha Ray

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Tag(s): Legacy post
Topic(s): ASBH Medical Humanities Professional Ethics Professionalism

by Keisha Ray, PhD 

This was originally given as part of the plenary session “What about the ‘H’ in ‘ASBH'”? at the 2020 annual meeting of The American Society of Bioethics and Humanities

As many of you may recall, when you are junior bioethicist, like myself, you often get a lot of unsolicited advice from more senior bioethicists. One piece of advice that I have received beginning in grad school days and as recently as a few months ago, is to make my work distinctly bioethics. From what I gather from this advice is that I should make sure that my research projects follow the principles and methodologies of bioethics; that my work should not be confused for any other discipline. Similarly, I get told to make sure that my tenure file is solidly bioethics, which I take to mean that I should publish in top bioethics journals, get research grants from top health and scientific organizations, participate in bioethics, scientific, and medical research, and teach bioethics courses at my medical school. 

I have received this advice during ASBH (The American Society for Bioethics and Humanities) conferences from attendees who are chairs of their departments, mentors to bioethicists, and are well known and well respected scholars in our field. This advice has been more frequent than I can adequately express, however, this advice has always troubled me because it poses a problem for my research agenda.  

So let me put this into context by giving my research area. My primary research project focuses on the intersection of structural inequities and social determinants of health and its influence on black individuals’ generally poor health outcomes and experiences with health care. To efficiently do this research, however, I have to use both bioethical and humanities values, principles, and research methods so the advice to make my work distinctly bioethics would make my research project incomplete. 

On one hand bioethics gives me the “how” to do this work. I do this work to bring justice to black people, a group who has been denied basic human dignity by health care for too long. Bioethics helps me to theorize what justice for black people means in name and in practice. But health humanities gives me the reason why I do this work. Health humanities gives me insight into human nature, into what it means to live a life of well being, to theorize different perspectives on what it means to be healthy and live a life with dignity, and what all of this means for black Americans. Health humanities gives me examples of how inequities in social determinants of health affect individual lives and how it continues to affect generations of black people. Bioethics gives me the tools to help students see the problem, especially at the population level, but health humanities gives me the tools to show my medical students why this problem matters, why this problem is unjust, specifically at the community level. The point is that to be a good researcher and professor of black people’s health, I have to use both bioethics and humanities. And as a scholar, junior or senior, this should be the ultimate goal. 

But the advice to make my work more bioethics prioritizes hubris and ego over the research. To tell me to make my work distinctly bioethics is just another way to say that research into racial justice is not truly bioethics and that scholars who study these topics are not true bioethicists but rather they are humanities scholars and that somehow makes our work less worthy and the study and practice of humanities inferior to bioethics.  

At one point in time this type of advice may have been great advice for any bioethicist that is just starting their career. This kind of advice may have been key to securing tenure. However, I suspect that this advice was more appropriate during the genesis of bioethics, when early bioethicists were working to establish bioethics as a professional discipline. But for junior bioethicists like myself who’s research is bioethical in nature and involves social justice issues, and issues of race, this very narrow advice stifles our research projects.  

It’s also bad advice for bioethics in general. It keeps bioethics from being a driving force in contemporary social justice issues that affect marginalized populations. In other words the advice to make our work distinctly bioethics misses the mark. In particular, it ignores that our work is bioethical in nature, sure, but it also draws on various disciplines in the humanities, which makes our academic contributions better.  

Furthermore, I fear that if bioethics does not embrace humanities in its own right and as a compliment to bioethics, then bioethics will only be the handmaiden of medicine and not a proponent of social justice and not an advocate for vulnerable populations which based on the principles of bioethics, it is in a unique position to do.  

For bioethics to provide a suitable backdrop for the kind of social justice work that draws on the humanities, that many new bioethicists are doing bioethics, as a profession must make a few changes.  

For one, ASBH must first set the example. The ASBH annual meetings, intentionally or unintentionally, send the message that bioethics is its primary concern, and the humanities are an afterthought. This can be seen in the topics that are covered by the main sessions, including the plenary sessions. They are overwhelmingly set in traditional bioethics. There are sessions that are humanities in nature, however those sessions are not as abundant as the bioethics sessions. If ASBH were prioritize presentations, workshops, and plenary sessions that are both bioethics and humanities in nature that would send a clear message to everyone in bioethics that this is the way of the future. This would set the tone for what it means to practice bioethics at a professional level. This would also make it clear to junior bioethicists that this is what is expected of them to be a professional bioethicist, also setting the tone for those committees granting junior scholars’ promotions. 

Secondly, as many centers in medical schools are in name called centers for humanities and ethics, teaching, publishing, and service expectations should include expectations that faculty involve themselves in both humanities and bioethics. Center directors must encourage their faculty to center their work in both humanities and bioethics and reward those efforts. It’s not that very siloed, singular work in bioethics is not important to progressing scholarship as well as one’s career, but if we are going to name our centers as centers for humanities and ethics then it should not be in name only but also in practice. 

Lastly, grant giving institutions that fund bioethics and humanities research ought to fund those projects that actually meet their requirements. For example, grant proposal instructions will often say something like we are looking for the ways bioethics and the humanities intersect to reveal innovative solutions to the world’s most pressing issues of health or something similar to this. But when the winning projects are released the project abstracts will be overwhelmingly bioethics in nature and will perhaps have a small portion of the research set in the humanities. Sometimes there will be no apparent humanities topics in the projects at all. If you are a junior scholar this sends the message that if you want your bioethics research to get funded, and to be funded well, humanities should not be an equal partner with bioethics in your proposal. And in fact, any significant work in the humanities in your proposal will mean that your proposal will have less of a chance of being accepted. If this is not what grant giving institutions in the bioethics intend, then the accepted proposals ought to reflect their preferences. But arguably accepting mostly bioethics proposals does show their preferences. Their preferences just don’t align with say the name of ASBH or the name of our humanities and ethics centers. 

When the relationship between humanities and bioethics is unclear and scholars’ work and perception of bioethics reflects this lack of clarity, junior scholars are left in a confused limbo state with no clear guidelines on how to succeed in the profession. When the ASBH also does not serve as a source of clarity on the issue, this limbo state is magnified. As the most influential organization in bioethics, ASBH has the perfect opportunity to model what it means to be a bioethicist and a humanities scholar to junior faculty. The annual conferences should model a seamless, co-operative marriage between bioethics and humanities for junior faculty; however, in my experience the annual meetings make it clear that bioethics is the priority and humanities is an afterthought. Which again is problematic for scholars like myself whose projects focus on social justice.  

In closing, the ASBH recently issued a statement on racial injustice and professionalism in bioethics and health humanities. In it, it states that racism and racial injustice stand in direct opposition to the goals of ASBH. As we know, there are many subtle ways to be racially unjust. One subtle way to be racially unjust is to not have clear standards on what it means to succeed. This is particularly true when the people who are most subjected to these unclear standards are junior faculty of color, because for one, scholars of color are more likely to be junior scholars than senior scholars, and more likely to research social justice topics, which lie at the intersection of bioethics and humanities. To be more racially just, and to help bioethics maintain its position as a leading field of study suited to aid social progression, ASBH must set an example for us all on the relationship between bioethics and humanities and how this relationship should play out in our careers as bioethicists, especially for junior bioethicists who are hoping to make worthwhile contributions to the profession. 

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