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10/20/2017

ASBH Lifetime Achievement Award-2017-Steven H. Miles

bioethics.net is proud to present this live release of the talks given by the 2017 ASBH Lifetime Achievement Award honorees. If you are at the ASBH Meeting, you can read along; if you were unable to attend, then you can see their talks here. Please join us in congratulating these luminaries who have contributed significantly to the field of bioethics.

ASBH Lifetime Achievement Award-2017
Bioethics and an Ethics of Solidarity
Steven H Miles, MD
Professor Emeritus, Department of Medicine, Center for Bioethics
University of Minnesota

I am deeply honored to receive the ASBH Lifetime Achievement Award. Time is too short for the infinite thank yous that I owe to colleagues, patients, and administrators who taught me and accommodated my quixotic career. Myra Christopher and I are probably among the last awardees

Steven H. Miles, MD

blessed with knowing all of the past nineteen years of Award recipients. We also benefitted from many wonderful colleagues who have not received this honor. Twenty years is a generation. I will use my time to speak about a generational turn for Bioethics.

It is axiomatic that every right implies a duty.

Similarly, every vulnerable person lives in a system of neglect, stigmatization, or exploitation. Vulnerability is a health imperiling condition.

  • The health vulnerability of sixty-five million refugees arises from the pretense that statelessness justifies inattention to their full humanity.
  • The health risks of those with compromised access to health care is augmented when bioethics turns from them to focus on persons who are ensconced in specialty clinics, intensive care units, or clinical studies.
  • And so on.

Bioethics’ “Principle based analysis” presumes the privilege of being in the global North rather than the global South, of being a citizen rather than stateless, and of being respected rather than stigmatized. Bioethics must shift to what might be called an ‘Ethics of Solidarity.’

An Ethics of Solidarity is an interpersonal ethics. With empathy at its core, it lifts up justice and community. It redresses, not supplants, the imbalanced genuflection to autonomy. Its broader field of vision sees health determinants outside of clinical or research encounters at our places of employment. Its greater depth of vision sees dimensions of humanness off of the clinical and clinical research planes.  It sees those who live on streets, in prisons, in the slums in other countries or those whose health is compromised by castes of race, gender, sexuality and privilege. A Bioethics of Solidarity would address what Alexander Capron called our “10/90 problem” in which 90% of bioethics scholarship focuses on matters germane to 10% of people.

An Ethics of Solidarity is not a call to become ‘public intellectuals.’ Too many academicians speak to public affairs while remaining aloof from the humanity of those who are dispossessed, imprisoned, institutionalized or refugees. For example, our Academic Health Centers proudly address Parkinson’s Disease with specialty clinics and innovative research and ethicists to untangle research and clinical dilemmas. And yet, in the United States, there are as many torture survivors as persons with Parkinson’s disease. There are torture survivors among our patients, colleagues and people in this room. Depression, wounds and chronic pain disable many. Many do not reach their potential as students, workers, parents and citizens. Where are the clinics and researchers to serve the needs of these people? Where are the ethicists and ethics committees speaking against the castes that make such suffering invisible to our academic health centers and health care system?
This is not a call to ‘politicize’ bioethics. I simply note that if bioethics must confront how political cultures manufacture vulnerability with laws, opportunities, entitlements and social conventions if it would address the health effects of vulnerability.

Our scholarship and associations should embrace an ‘Ethics of Solidarity.’

  • We should assert that this country has a duty to ensure comprehensive medical care to all.
  • We must hold that all women, in refugee camps and in the United States, have the right of unfettered control over their reproductive lives.
  • In the public square, we must challenge castes of wealth, religion, color or sexuality that carve chasms of health disparities.

Human rights and humanity–bioethics and the humanities–are yoked synonyms. A generational turn to an Ethics of Solidarity would enable bioethics’ scholars and societies to more effectively join a broader civil society striving for human rights in the service of health.

 

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