No Easy Answers in Bioethics Podcast

Social Justice-Oriented Bioethics: Kelly-Blake and Valles - Episode 25

May 7, 2021 Karen Kelly-Blake photoSean Valles photo

This month the Center was proud to officially announce its new name: Center for Bioethics and Social Justice. This name change reflects an updated mission with a focus on social justice-oriented bioethics. This episode features a conversation between Director Sean Valles, PhD, and Assistant Director Karen Kelly-Blake, PhD. Together they discuss moving forward in the bioethics space, what engaging in service to the people means to them, and the important work to be done to a create a healthier and more socially just world. They also explore questions related to the practical application of bioethics, and the challenge of preparing medical students for clinical practice in an inequitable world.

This episode was produced and edited by Liz McDaniel in the Center for Bioethics and Social Justice. Music: "While We Walk (2004)" by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License.

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Episode Transcript

Liz McDaniel: Hello and welcome to another episode of No Easy Answers in Bioethics, the podcast from the Center for Bioethics and Social Justice at the Michigan State University College of Human Medicine. This episode features a conversation between Center Director Sean Valles and Assistant Director Karen Kelly-Blake on the recent renaming of the former Center for Ethics and Humanities in the Life Sciences. This name change as of April 1, 2021 reflects an updated mission with a focus on social justice-oriented bioethics. Together they discuss moving forward in the bioethics space, what engaging in service to the people means to them, and the important work to be done to a create a healthier and more socially just world.

Sean Valles: So, I am Sean Valles. I am the Director and Associate Professor of the Center for Bioethics and Social Justice. And I am here today with...

Karen Kelly-Blake: Karen Kelly-Blake, the Assistant Director.

SV: And we're here to talk about something that's really exciting for both of us, and something that sort of near and dear to our hearts, which is the shifting of the name, and mission and vision of the now former Center for Ethics and Humanities in the Life Sciences, again, with its name changed to Center for Bioethics and Social Justice. This is something that's part of my sort of personal and professional trajectory. It's been in the sort of the tightening of my focus on social justice matters. Which is in some sense sort of both a narrowing, in terms of sort of, like, sort of shedding off some things that were not so connected to social justice, and also the broadening, in terms of thinking about all the different aspects of my work that could relate to social justice. So, I’m, I'm a philosopher of health, but I’m, I'm doing things like engaging with thinking about the way that employment law affects people's health. And like whether or not they, that they have a safe place to work. Or I've written about climate change and health and the way that, the subtle impacts of climate change accumulating over time can start to have, have real and very large impacts on people's health in terms of what kind of crops can grow, and that the spread of, the spread of infectious diseases, and malaria, things like that. And so, and so this tightening of this focus on social justice matters as they relate to bioethics is very exciting for me, and I'm happy to be able to do that as the new director of the Center. And Karen, this is something that's also been part of your personal interests for quite a long time now too.

KKB: Yes. Although I see myself as sort of coming at it sideways, where only recently I feel comfortable enough to even claim to be a bioethicist, with a small "b." So, my background and disciplinary training is as a medical anthropologist. A lot of my work revolves around health services research where my interests lie in the realm of shared medical decision-making, patient-physician communication, communication skills training for practicing physicians, and also in our medical school with our students. Also a lot of work with decision aid development to help improve those sorts of discussions that take place in the clinical setting. Specifically around screening, colorectal cancer screening. So, for me, it's been a lot of communication. So, communication to me feels relatively simple to be able to do well. But unfortunately, research and real life tells us that it is not as simple as we would like to think that it is. More recently, I have become interested in workforce diversity issues. Primarily medical workforce and other health professions workforce. Where we talk about the people who are actually providing health care services, and what that means for them long-term, the kind of services they are able to provide. And really what does service mean? When we say that health care providers serve a population of people.

SV: You know, it's funny, it's funny you mentioned that because I had been thinking about, for a while now—and this comes up inside my book as well—is our colleague on campus here, Kristie Dotson, has an article talking about philosophy from a position of service. And that's something that struck me when, when I read it, when it came out. And I had been thinking about what does it mean for me to do my, my work from a position of service? It's something I have to sort of, it's been evolving for me about like, who can I serve? What are my responsibilities to them? What's my role in this? And so there's, there's sort of an infinite amount of work to do to try to make a world in which it is easier to be healthy person, in which that, that ability to live a healthy life, to choose what one's healthy life might be, and also to be able to actually carry it out in an equitable way so that, so that it's not just contingent on whether one has a large income. Or whether one has to access to high-quality medical care whereas if they lived 20 miles away, they would not have that kind of access. And so trying to think like, what can I sort of bring to the table is something I've tried to figure out over time. And so trying to balance being an academic and also trying to, to speak to public audiences, and to try to write in the popular press, that sort of thing. It's a, it's a difficult thing to balance. And I think it feels like the most important thing is to sort of always be willing to sort of have it shift.

KKB: It sounds like what you're talking about, what we've talked about offline is this idea of a social justice-oriented bioethics. And what does that mean? And, you’ve said before that that means there has to be a goal. And what is that goal? And what do we want to see that goal being for us in our newly named, our newly envisioned, our new mission-focused Center for Bioethics. And I think we both agree that it's about meaningful, practical application. It's about moving from the sort of theory-based approach and educational model to what can we do with those ideas and make them applicable, and have them be able to be practiced in real-world settings. I was just talking to one of the luminaries in bioethics, Dr. Anita Allen. And she said something that really struck with me. She said “translational bioethics.”

SV: Ooo, I like that. Yeah.

KKB: This idea of how do we translate bioethics and make it applicable in the real world. So, Sean, your thoughts about that.

SV: Yeah, I think it's, for me it's important, I'm a pluralist, and I think it's important to not sort of, to not devalue theoretical work. There's a lot of important stuff to be done there. So, I feel like the simplistic version of trying to do something like this is to say that it's all that matters is sort of like on the ground practice. And I don't think that's the only thing that matters here. But the idea that, thinking about this idea of a translational spectrum. So that's drawing on the medical literature saying that what we need to do is to sort of translate that process where you have scientists working at a, at a laboratory bench somewhere, all the way through this process of research, design, and development, and further research and testing, until it eventually ends up in affecting, affecting positively real patients. And so as long as, I mean, at least as long as we're sort of working somewhere on that spectrum and we're sort of thinking about, I'm doing this work and what is it for? What am I going to do with this kind of thing? I'm, I'm very wary of, of academic work, especially academic work related to ethics, that's so divorced from real-world application. It can be a lot of, sort of the, one of the worst versions I think is, is sort of devil's advocate kinds of things, where you sort of take, you sort of see what, what are the boundaries of something that might be sort of like, on the face of it relatively unacceptable like, well, it, would it really be so bad if we let this kind of patient die? Or something like that, this shows up inside bioethics, for instance. And I find that so, so disheartening because it's sort of, as an intellectual exercise there's nothing inherently wrong with it as a purely intellectual exercise. That's not what we're doing here. When we do intellectual exercises that actually, it should be for something. That seems relatively obvious to me, but it also is, that's also controversial I realize.

KKB: So it really does highlight the tension, again, something that you and I discuss offline, about what bioethics is, and what it should be. And, what you just described illustrates that tension very much about what, and even historically, what bioethics has been, and what it should be moving forward. And who should be in that bioethics space.

SV: Mm-hmm.

KKB: And who has been excluded from that bioethics space in the past. And how, I think one of our goals moving forward is how we want to expand and broaden that. So that we are a more inclusive, not just in representation of people, but also in what bioethics can be and what it can bring to a whole host of areas of concern.

SV: Yeah. And I think it's probably no accident that both of us sort of see ourselves as being "lowercase b" bioethicists or something like that. That's, I mean my training is in history and philosophy of science primarily, although I've been working in the bioethics space for most of my career as well. Yeah, it's, it's not always a perfect fit between having these, these kinds of interests and the way that the particular American context of the bioethics field has developed since roughly the 1960s or so. And it's evolving, the field, and so I don't wanna sort of cast aspersions on bioethics as a whole, but it's, like many other fields, it's trying to sort of find its way in the contemporary world. And sort of reacting to social change, and doing things like encouraging more work on, on race, and injustice and things like that. Although it is a little bit frustrating to be someone who works on things like, on social injustices like racism and how it impacts people's health, and lack of resources and things like that. And to sort of see some of my colleagues who have been working on health sort of, like, discover or rediscover that these things matter, or something like that? So it's this combination of encouragement and also great frustration is something that comes up every single day for me. [Laughs]

KKB: Mm-hmm. And I think it's, it positions us differently perhaps from other bioethics centers across the country in that we are in a medical school. We are housed within a College of Human Medicine, and a college with a specific mission to prepare our students to go out and become primary care providers, become specialty care providers. And to do that across a spectrum of geographic locations. Rural, urban, suburban, people who will serve in the military and provide military medicine. So, for us, with the community-based medical school, it really does afford us a different opportunity to engage in these sorts of conversations and these sorts of practices about what bioethics is, what it should be, and how we can partner with our community across the entire state of Michigan. That community-based model, I think, positions us in a way that others may not have the same opportunity. Can you speak to that?

SV: Yeah, I mean, I see this as going back to the original sort of founding aspirations of Michigan State University, and the other land-grant universities. This idea of having educational institutions that are oriented towards service to the people. And, you know, and Michigan State University, obviously, is sort of like oriented in some, in some sense for the people of Michigan, although that, that in and of itself is extremely diverse. And so the health issues and challenges and needs of people in, in the Detroit area and people in the Upper Peninsula are just radically different. Although they're also more similar than we sometimes recognize. And so, do you have access to healthy, nutritious food that you can afford on your salary? Are you able to get high-quality medical care in a timely manner? Is that access contingent on your employment, such that if, only if you have good insurance through a good job, that's the only way you can actually get high-quality care? Or the, or the problem of substance use disorders being spread across the state. And so it's, there's an important diversity even within just the state of Michigan, but also it also quite a lot, quite a lot that's, that's really the same. The sort of, the challenges that bind us together. So the idea that we should be, we should be doing our work for the people, again, this idea of what is, what is the service that we ought to be doing? It's near and dear to my heart. And so, what it, what it makes me excited to do is to actually get to work. I mean, I've only been in this position and have you for—your position as assistant director—for just a few months now. And so, the important first step for us is to actually spend some real time doing—I know terms like "stakeholder" can be a little obnoxious to people. But maybe sort of rethinking about the idea of stakeholder and thinking in terms of who are we trying to serve? We're trying to serve the people of Michigan and the region, and even more broadly, to, to engage with them and find out what are the challenges that you face in trying to live a healthy life, that are created by the world in which we live. There are a lot of ways in which, whether it's the stressful life of being a student at Michigan State University. Or whether it's the lack of a living wage, or having a, having a high enough minimum wage for instance. These kinds of things are, they matter, but also trying to figure out what are people's challenges, what are some possible solutions, who are some potential partners for us to work with? And so, so this first year or two, I think, is going to be really crucial for us to try to really spend some time talking to the people that we are, that we are trying to serve in the first place, because otherwise we're doing, we're doing service wrong if we're not actually having those conversations.

KKB: And I agree with you there, Sean, because I think it'll be important for us to say perhaps at this point that the Center, the former center name, the Center for Ethics and Humanities in the Life Sciences, began in 1977. So we have a long history here at Michigan State University, as well as here in the college and in the community at large. So, it really is going to be work for us to engage with our partners and our future collaborators, and build on some of those previous relationships, but expand and build new relationships so that people know that we do have a history. But that history, and as it should be, is different from how we are envisioning moving forward with the Center for Bioethics and Social Justice. And like you said, that pivot, in some way, has to do with really focusing on this work for the people. And what does that mean? What does that mean when we say we want to do this sort of work, engage in this kind of service? So we are going to need others to speak with us and help us recognize what those, what the most important priorities will be for us to engage in so that we can move forward in those areas. Some of the areas like you just mentioned. Substance use disorder, housing, mass incarceration. There are all these issues that are just boiling at the top, but there are other things as well. A lot of things that we won't have time to mention here, but this is where those conversations will come into play for us to work with our community partners and collaborators so that we can make priorities and invest the time that's needed to ensure that service is actually being done.

SV: And that aspect of our service that, you know, we have this, we have these two sort of obligations. We are both a sort of, we're a center rather than a department, although it's, the distinction is a little thin. So we, we contribute to the medical, the medical education mission of the College of Human Medicine. And that's, and that's great. And I think it's important to sort of see the continuity between doing that sort of day-to-day educational work, and then doing this external outreach work as a center, where we're trying to bring together to serve as a hub for these conversations on campus, and in the region, and the state, and nationally, internationally. And so, when we do our educational work, we're doing it under the aegis of this concept of the social context of clinical practice. And so, when we're, when we're thinking about what is the social context of clinical practice? And there are different ways of, different terminology to be used here. But the idea is that it's not just what's happening inside the clinic, it's not just what's happening inside that single exam room between the doctor and their patient. That everything that's happening, that's happened on the outside, over the previous—let's say it's your annual checkup, if you even have the privilege of having such a thing. The 364 days that came before that checkup matter quite a bit. When you actually show up in that exam room, and the thing that actually matters most is what's going to happen in the next 364 days. [Laughs] It' not as if the patient sort of stops existing the other, the other days of the year. And so, trying to, but that's actually a very frustrating thing for someone learning to be a physician where one would wish it's the case that they could sort of have the ability to sort of undo all the negative effects of what's happening outside of that context. Or like the fact that the patient isn’t able to afford their medication, or they are, they don't understand how to take it effectively, those sorts of things. And it's, it's hard to do, but, but trying to, again, trying to put these clinical issues inside the context of the world in which we live, and a very messy world. And a very inequitable world, is, is sort of the thing that ties together all of our work, whether it's inside the classroom or whether it's, whether it's having these conversations with, with other stakeholders. So we're gonna be doing a lot of work over the next, over the next couple of years. And then, and then henceforth. So, if people want to keep, keep an eye on what's happening with our work, if they want to see what kinds of, what kinds of events we're going to be doing. Like we're going to be doing plenty of publicly available events where people can see, can check in on what kinds of things we're doing. We're going to try to create some content that can be used inside classrooms, or that can be used as a way of starting conversations inside communities. We want to be having conversations with and actually getting, featuring work from non-governmental organizations, charities, things like that. And so, I'd really encourage people to sign up for our email list. If you go to our website, You can keep, keep abreast of whatever we are doing that week and that month. And I hope it'll be things that'll be really interesting to a lot of people. I'm really hoping that it will be.

KKB: Yeah, I agree with you, Sean. I hope that people reach out to us. That's what we want. We want to get that feedback. We want to get that, that interaction. And I think it's important for us to stress, too, that we together, you and I like you said, we are very new in our positions. Which has been a good thing because we've been learning a lot together.

SV: Mm-hmm.

KKB: Which I am very thankful for. And we just feel strongly that it is the right path for the Center, moving forward. We feel that our new mission really speaks to, sort of, perhaps moving some of that tension between what bioethics is and what it should be, and how we're envisioning it should be for the service we want to do as part of the college, the university, and Michigan as a whole.

SV: Yeah, and it'll be the case that we'll, we'll have a lot of, we'll have to create space for people to have really different views about what, what is the right thing for bringing about a more socially just world and a healthier world.

KKB: Yep.

SV: But having a, having a tightening of our, of our focus so that we can think, so we can at least have the question be “how do we create that?” As opposed to just creating a space for people to have ivory tower conversations or something like that. That's not really our interest. So thanks for talking to me about this today, Karen. It's been really enjoyable, and there's a lot of work ahead, and I hope more people will sort of join us in those conversations, either, or even just being observers and participants in that sense.

KKB: Thank you, Sean.

Liz McDaniel: Thank you for joining us today on No Easy Answers in Bioethics. Please visit us online at for full episode transcripts and other resources related to this episode. A special thank you to H-Net: Humanities and Social Sciences Online for hosting this series. This episode of No Easy Answers in Bioethics was produced and edited by Liz McDaniel in the Center for Bioethics and Social Justice. Music is by Antony Raijekov via Free Music Archive.