The trusted source for
healthcare information and
"Why I Chose Bioethics as a Profession"
[Editor's note: This month's interview is with Laurie Zoloth, PhD, professor of bioethics at Northwestern University in Chicago.]
Q: Why did you choose bioethics as a profession?
A: The question of why I became a bioethicist is really a fascinating one to think about, because I was working as a nurse in infant intensive care. And I was in Jewish studies in philosophy graduate school, and I thought of the nursing part as the thing that enabled me to do something as esoteric as study ethics and philosophy and Jewish studies and literature and religion. I was really thrilled to be in graduate school and studying exactly what I wanted to study. And meanwhile, I had to work night shift to pay for it all.
But what happened was the dramas at the bedside became completely compelling, and it was just at the time that the field of clinical ethics was beginning to emerge and be written about. There have been some precedents, OK, so there had been scholarship, actually, but it hadn't been as prominent of an idea.
Clinical ethics consultation was still in its infancy
Q: About what time was this?
A: Mid-80s. And the Kaiser Permanente system had just hired its first bioethicist, John Golenski. It was just after a major case, and there had been some issues about bioethics. And so I went to him … at the time, and I introduced myself to him. And I said I'm really interested in learning and studying about it, and he was a Jesuit priest wearing clerics — this was early on, before he got into the order. And I said, 'I think the work you're doing is terrific, and I'm interested in bioethics committees."
And I think you need some help. You need a feminist. You need a woman to work with you, you need a Jew, not just a Jesuit, and you need a nurse. Hire me; I'll do all three things for you. So . . . he let me intern for a year.
At the time, I was studying with David Hartman, who is a philosopher who is a Canadian and Israeli philosopher, and he said to me, he was my professor, and he said, . . . You're right in the middle of an extradordinary set of dilemmas and concerns, which is — how does modern medicine, now that we can do everything — should we do everything? And you're right in the middle of an intensive care unit.
And since John Golenski was teaching at the Graduate Theological Union, too, it presented a really unique opportunity for me to do both the theory and the practice at the same time. And I followed Golenski around to learn how he did case consultation. That, for me, was interesting. At that point, that was the most interesting thing, that is, how did you work your way out of a dilemma when you were actually at the bedside?
It was a long time ago, and people didn't know the word bioethicist . . .
So, I became a bioethicist largely because there was an extraordinary set of dilemmas that were taking place, in the field of medicine as our capacities grew. And I was part of the people — in essence, I was concerned with the same issues.
The babies we were saving, which were able to save, were, you know, had terrible complications that left them so disabled and their families so devastated — of course, we had to raise the question of — what are the moral implications of this sort of technology on the actual lives of actual parents and families?
For me, those are critical issues, and I was able to turn to philosophy to take a look at them, and that was one part.
The second part was, there wasn't the health care system — and there still is the drama of justice, so for me, the issue of social justice was so acute working at an impoverished community where the infant mortality rate was so very high.
Even with Kaiser, where I guess people all had . . . health care coverage, the social milieu that the units were in was so catastrophic that we were constantly confronted with the question of justice.
So, it was impossible to really do medicine without thinking of justice. And it was at that time that Oregon was having its discussions about how it would reform its health care system. So, this was later. I had been looking around for a topic on which to do my dissertation work. And then, too, the fact that John Golenski was a consultant on the Oregon Health Care Decision Project, and he would come back from those meetings discussing that . . .whereby I was able to have a first-row seat in the health care decision-making process.
And at that point, I began [studying] with Karen LeBacqz. And she and Carol Robb — people at the Graduate Theological Union at Berkeley in my program — were primarily justice theorists.
So, we immediately turned our attention from clinical ethics to justice issues within health care. It was a time in which — for the first time we had a field emerging around a set of important moral questions. One was about the use of technology and the extent of technology — and two, it was about the catastrophe of the health care system that for the first time had lost its central safety net when unions lost power, and when jobs no longer entitled you to health care benefits. And, in fact, there was a growing number of people who were completely uninsured. That was a phenomenon of the late 80s and 90s, when there was a disconnect between employment and health care benefits, and so that led to a lot of interesting questions about justice.
The other part is having early and great teachers . . . people who said to me, early on, this is a field in which it's important to maintain your disciplinary particularity, and bring that particularity to a larger discussion.
Q: Do you mean what you uniquely brought to the discussion?
A: What I uniquely bring to it, which is justice theory, which is social ethics, they call it social ethics in religious studies, which is justice theory, a long tradition of moral philosophy, and also a separate and long tradition of Jewish philosophy — all of which is focused on these issues from a particular venue.