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1 November 21, 1997. Acadia Institute Study Ofbioethics in American Society Arthur Caplan Acadia Institute Study of Bioethics in American Society page 1 1 November 21, 1997. Acadia Institute Study ofBioethics in American Society. 2 Interview #2 with Arthur L. Caplan, Ph.D., Director, Center for Bioethics, Trustee 3 Professor of Bioethics, and Chief, Division of Bioethics, University of 4 Pennsylvania. The interview is being conducted by Dr. Renee C. Fox, Dr. Judith 5 P. Swazey, and Dr. Carla Messikomer, in Dr. Fox's apartment in Philadelphia. 6 SWAZEY: If you had to focus on a fe w centers in terms oflooking at the institutionalization 7 of bioethics, what centers would you mention besides Hastings? 8 CAPLAN: Now? 9 SWAZEY: Historically and now. 10 CAPLAN: Penn State was important. It was a place that did medical humanities early, and 11 had a certain vision of what medical humanities is, as opposed to what medical 12 ethics was going to be. When I came into the field,I encountered Al Vastyan and 13 Dan Clouser. I'm not sure I agreed with what their vision of medical humanities 14 was, but it was a vision that was interesting. It didn't strike me as completely 15 plausible to try and synthesize art, music, history, philosophy, religion, behavioral 16 aspects; it was almost too much. But I understood something that I'm not sure 17 people at Penn State even did. Part of the reason they set it up the department the 18 way they did was they were trying to literally do humanities in a setting where the 19 medical school was nowhere near the rest ofthe university. So it was a structural 20 fe ature; it was driven less by an intellectual vision than a necessity. Same thing 21 for UT Galveston: very similar kind of programs, similar location, far fromthe 22 rest of the school, I mean, hundreds of miles. An important program. Ron 23 Carson and Harold Vanderpool, were people that I met when I was just coming Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page2 24 into the field. I think the UT Galveston Program produced scholars that sort of 25 wove their way into bioethics. Other institutions that were important? Well, the 26 journal, Perspectives in Biolo� and Medicine was important although not read by 27 many of the philosophers. I happened to read it because I had the biology 28 background, so I came froma weird direction. I was interested in reading it to 29 findout that there were biologists who had humanistic thoughts, which was 30 unnerving to me. I didn't realized there were going to be any others like this. 31 FOX: For example? In terms of the biologists. 32 CAPLAN: Well, there was Landau, himself, Leon Kass and Roger Masters and Clifford 33 Grobstein. E.O. Wilson had some early papers in Perspectives place; I am very 34 interested in early sociobiology writings. So I looked at those and thought they 35 were all interesting, sort of an anti-reductionism even. That journal was a voice 36 that we could sort of go to. Another weird journal,which no one even 37 remembers anymore, was Zygon? It was trying to bridge religion and science, 38 hoping, in fact, that they could reconcile the two. I never believed this was 39 possible. I think religion and science actually are at each others' throats, 40 fundamentally, about the way the world is. But, they hoped to do what today 41 would be called a Darwinian foundation fo r religion, or something. Most of the 42 stuffin there was pretty bad. 43 FOX: Who were the movers and the shakers? Anyone in particular? 44 CAPLAN: The editor, I'm trying to remember his name. What was his name? They actually Arthur Caplan Acadia Institute Study of Bioethics in American Society page3 45 invited me to a retreat in New Hampshire at one point which was pretty weird 46 because, it was like, you know, 400-year-old people and me. (Laughter) It was 47 very odd, but as goofyas they were, they were trying to do something interesting, 48 which was to at least confrontreligious and scientificviews . And that was an 49 influentialjo urnal-structure type thing because it was the place you could go to 50 see people try to talk. The religion people had no understanding of science, and 51 the scientificpeople all thought the religion stuff was goofybut they tried to be 52 polite to one another in these pages, which was unusual because they normally 53 just ignored each other. 54 FOX: Would you put your former Center, Minnesota, on this map? 55 CAPLAN: Later. These were early institutions, ones that then get influential, sort of building 56 along. In Chicago, the medical ethics program that Mark Siegler created is a very 57 important place, fo r lots of reasons. It represents a shiftto the clinical. It 58 represents the move of physicians to take charge. You'll hear many times in your 59 interviews about the battle between doctors and non-doctors. Whatever Arthur 60 Kleinman thinks, he's battling with the social sciences versus everything else. A 61 much more vicious battle was engaged in by Mark when he directed the Chicago 62 program toward physician-driven ethics. That still lingers in the field to the 63 present day in bioethics but it was really Mark's program that did it. 64 FOX: I'm sure younger people now are saying that it is interesting that the people 65 coming into the field, whoknow bioethics as a third generation, includes a Arthur Caplan Acadia Institute Study of Bioethics in American Society page 4 66 significant number of physicians. 67 CAPLAN: They do, but not in the way Mark thought they would. Mark thought they'd be 68 clinical types. I used to make a bad joke to myself, I rarely made this in public, 69 which is unusual because, I'll make almost any bad joke in public. Mark's vision 70 was that clinical skills would drive an understanding ofbioethics. Today's 71 physicians believe that health services research, that outcome study, that a group 72 community fo cus is what you do in medicine. It's very different...they wouldn't 73 even have the time of day for Mark, to tell you the truth, because he is so clinical. 74 It's not that they don't see patients, but their intellectual fo cus is very different. 75 So it's a different kind of doctor coming in today. It's a different world fromwhat 76 Mark was doing. It's very different. His vision was closer to Ingelfinger, to the 77 great tradition of clinical diagnostician, of the art of medicine; you had to have 78 that empathy and time with patients. It was irresponsible to just sail in as a 79 philosopher or somebody fromthe outside and say, "Well, I think this and I think 80 that." 81 FOX: Did Mark Siegler have any kind of a relationship with Ingelfinger? 82 CAPLAN: Not that I know of. I'll bet that all of Mark's mentors were trained by or interacted 83 with Ingelfingerextensively. I don't know that. I'll make a sociological 84 prediction about an invisible college there. 85 SWAZEY: We'll findout. 86 CAPLAN: Yeah ...(laugh ter). Alvin Tarloff, who wound up going to the Kaiser Foundation, Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 5 87 was a close mentor of Mark's. I bet Tarloffwas a friend oflngelfinger's, they had 88 to be. And Sam Thier was wandering out to Chicago at different times to help 89 them organize some of their clinical stuff; when he was here at Penn. There's a 90 figure that no one remembers but I think was influential aboutthe time of Mark 91 Siegler. He didn't have an institution or anything-- Robert Morrison. I think he 92 played an interesting role because he was another grand old man, clinical, Yankee 93 doc-type. People paid a lot of attention to him. He really had influence. I can't 94 remember, but I think he was tied in closely with the Rockefeller Foundation, with 95 funding sources. 96 FOX: Yes, he was an officerof the Rockefeller Foundation. 97 CAPLAN: So the institutional thing was there, he became a person who was influential both 98 because of his ideas and because he had contacts to the foundation world, and so 99 Hastings could get money, or others, if Bob liked you. So Chicago becomes a 100 crucial program in the 1980's for bringing physicians in. Many, many physicians 101 now in the field,not of Glenn McGee's generation but my generation came 102 through that Siegler program. Steve Miles, who was at Minnesota with me, was a 103 Chicago product. John Lantos and Dave Ducas and John Lipoma; there are just 104 lots of these people running around. 105 FOX: They're still grouped around Chicago. 106 CAPLAN: A lot of them are still in the neighborhood. Lipoma is still there. 107 FOX: Lantos is still there. Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page6 108 CAPLAN: Lantos is there. Ducas left,went to Michigan. Chris Cassell actually counts here 109 too. 110 FOX: She became head of the general internal medicine division. 111 CAPLAN: Although interesting gossip to record for historical purposes. Mark and Chris did 112 not like each other. I'm not sure why. I think Chris was more the political doc 113 and Mark was more the bedside doc.
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