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. And there was something in that culture

114 that's at a level of refinement that I don't even understand. I think they just had

115 two cultures of medicine; there was sort of the political side and the sort of

116 internal medicine culture.

117 Other institutions, I'd have to say Seattle with Al Jonsen. I think that it's not....

118 FOX: What about Al Jonsen before Seattle?

119 CAPLAN: I was going to say this: I think Al was a one-man institution and it didn't matter

120 where he was.

121 FOX: Yes, that's why I asked.

122 CAPLAN: So at UCSF he had influence, at Seattle he had influence. And you've seen this

123 little history of bioethics he wrote, from the Seattle Dialysis Center to today.

124 Well, I think that's all nonsense. He happened to be in Seattle. There wasn't

125 anything bioethical going on in Seattle, but there were interesting events taking

126 place.

127 SWAZEY: In terms ofUCSF and Seattle, you're saying that as qua Centers ....

128 CAPLAN: They are meaningless. Al is the one-man Californiafigure. Hastings is trying to Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page7

129 get Al, at different times, to set up a west coast branch. To figure out some way to

130 get a presence in California. Al is clearly aspiring to do that on his own and turns

131 out to be not cooperative. This is an eighties phenomena. But he never brings off

132 the creation of an institutional base. To this day, for reasons no one can fully

133 understand, the west coast of the United States remains, relatively speaking,

134 bioethically barren.

135 FOX: BernieLo ....

136 CAPLAN: It's probably not until the 1990's that Berniesucceeds in setting up a small what

137 we would call institutional presence at UCSF, but that's not until really three or

138 four years ago. Until then there's nothing. There's people. Imagine this. Alex

139 Capron has never been able to set up a thing at USC. He has this little Center but

140 it's not really a Center, it's Alex.

141 FOX: It's sort of interesting too because the brilliant sociology that was housed at UCSF

142 was in the nursing school.

143 CAPLAN: Hyper-medicalized there way more than is often imputed to the east coasters.

144 UCSF, I mean, just hyper-molecular, hyper-reductionistic, hyper-medicalized.

145 FOX: What does Al Jonsen represent, just in terms of this institutional overview you're

146 giving us? In some ways he's a Commission man; he represents the "bioethics

147 goes to Washington" man.

148 CAPLAN: Yes, he is a fo rerunner of that.

149 FOX: And in addition, he'll always have around him the penumbra of a Jesuit, even Arthur Caplan Acadia Institute Study of Bioethics in American Society page 8

150 though he isn't a Jesuit any more, because he officiallystands for, in the eyes of

151 someone like Morris Abrams, somebody who is the incarnation of the learned

152 clergyman.

153 CAPLAN: Yup. The casuistry tradition which is AI, which is Catholicism secularized or

154 something. Yea, AI was an early model fo r something that takes a long time to

155 happen, which is the Commission man. That's what he is. He has more influence

156 in Washington D.C. than in Washington state. I would bet that people couldn't

157 recognize AI in Washington state but they'd know him in Washington D.C.!

158 FOX: Some of that is not unconnected with his years at Georgetown. In his years as a

159 priest, fo r example, he fe lt that the President of Georgetown was a very intimate

160 colleague of his. So he was tied into that Washington circle.

161 CAPLAN: I've introduced AI a couple oftimes as the Forrest Gump ofbioethics. He's been

162 present at all these different Commissions. You look back and he's in the

163 artificial heart thing and on the human experimentation thing and he's on the

164 President's Commission thing. I mean everywhere you turn, he's kind of in the

165 background as if he was inserted in, you know, standing next to somebody or

166 other. There he is!

167 FOX: The reason I ask you that is because he is a very intelligent and a very clever man.

168 CAPLAN: Yup.

169 FOX: But I don't think he's a terribly good theologian or a terribly good philosopher.

170 CAPLAN: And weirdly, his scholarly influence would almost be nothing if he hadn't teamed Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page9

171 up with Toulmin to do the casuistry book. On his own, probably not, with

172 Toulmin, something happened there and so he has this legacy of sort of reviving

173 casuistry, but I think it's actually Toulmin's voice and less Jonsen.

174 FOX: So there's no Center out there.

175 CAPLAN: No. There is another program that's of importance and that is Virginia and it's

176 John Fletcher. Fletcher is doing something which I have only recently come to

177 understand by watching Jonathan Moreno about to go there to take John

178 Fletcher's job. He just retired. Moreno worked part-time at the Hastings Center

179 with me. He is one of the Caplanesque figures that will now go and sour the

180 Virginia program. But, interestingly enough, I've been invited to Virginia a

181 couple of times, so I've seen snapshots of it at different times. There is an

182 institutional base at Virginia. Childress, Fletcher, a guy named Walter

183 Wadlington in the law school, Richard Bonnie in the law school. There's a

184 physician whose name I always forget in the medical school, who's a very

185 influential fe llow. So they have people and a subject. But it's very interesting.

186 Virginia, under John's leadership, did something unlike any other Center. It went

187 to grassroots bioethics education. It tried to outreach to the community.

188 FOX: Chapel Hill did too, didn't they?

189 CAPLAN: Not this systematically. This guy, Fletcher, was not a prophet in his own land.

190 I've only come recently to understand that the medical school deeply resented

191 John because he was pushing hard to put bioethics into hospitals and nursing Arthur Caplan Acadia Institute Study of Bioethics in American Society page 10

192 homes and other health care institutions around the state. He also spent a great

193 deal of time at the NIH. He was the house ethicist there for a long time. Virginia,

194 as a program, I would say, was a loose collection rather than a structured

195 institutional base. Its individual members had tremendous influence. It did have

196 a training program. Courtney Campbell would be an example of someone trained

197 in Virginia. Mark Hanson, who's currently at the Hastings Center, is a Virginia

198 product. They are the place that kept the flame of religious studies influencealive

199 in bioethics. However, that being said, it was more a loose collection than it was

200 a really pulling together a structured institution, because John took it off campus.

201 If you went to Virginia you'd be startled. You could go to almost any little

202 hospital and you'll find somebody went through their intensive course or spent

203 time with John learningto do bioethics consults. John starts the Society for

204 Bioethics Consultation.

205 FOX: John has an interesting history because he was an Episcopalian priest who had a

206 church in Washington D.C. that was enormously influential. Sargent Shriver was

207 a person who attended John's church.

208 CAPLAN: I didn't even know that.

209 FOX: We will interview John in depth.

210 CAPLAN: He should be.

211 FOX: Because he has undergone many metamorphoses. The religion thing remains; I

212 didn't know about the outreach to the community program, but it is part of the Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 11

213 pastoral role.

214 CAPLAN: His early formative years are reflected in what he does. He sociologically is still

215 ministering throughout his entire bioethics career. It's absolutely true. That's

216 what he is doing. He is spreading the word. He is proselytizing.

217 FOX: The only other place I can think of that would be a wonderful place for that kind

218 of thing would be Emory. We need a Southernmilie ux to do that kind of thing.

219 CAPLAN: I understand. The flavor of bioethics in that Southernculture is Protestant, is

220 ministerial, is proselytizing, is very different than the Northeast type thing. The

221 Northeast type thing is rabbinic, it's Talmudic, it's Yeshiva-like. And these guys

222 are ....

223 FOX: Caplanesque.

224 CAPLAN: Right. Or it could be Irish Catholicy in a sense ofbattles about church doctrine,

225 that influence is there too. I mean, there's Catholic-Jewish type things in the

226 Northeast, but the Southeast, with Virginia as the example, definitely reflects its

227 culture in ways that we just commented on.

228 FOX: Within this frameworkthat you're sketching out, some people, even though

229 they're not one-man institutions like AI, are like Jim Childress, who is not just an

230 important figure but is also a kind of institutional figure that is not summarized by

23 1 just Virginia ...

232 CAPLAN: But you know what's interesting there? Childress is an important figure and it Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 12

233 isn't just summarized by Virginia because he kept the ties to Kennedy. Childress

234 is as much a Kennedy Institute guy as he is a Virginia guy. Partof the reason is he

235 didn't have the intellectual community to talk to as a scholar; you know, his

236 background is Quaker. I think he very much does believe in consensus and the

237 values of consensus and so on. I'm speculating, he's never said this to me, but I

238 don't thinkhe felt quite intellectually satisfied just with the Virginia-type

239 operation. He was drawn again and again and again to Georgetown. He teamsup

240 with Beauchamp. I saw him many more times at Georgetown than I ever did

241 when I went to Virginia. He wasn't there. So, yes, you're right but I would

242 almost put him as half-Virginia, half-Georgetown.

243 FOX: He's also half religious and half (inaudible)

244 CAPLAN: Yea ...yea ...yea .

245 FOX: I've talked to him about this, and said he would do a great service to the

246 profession if he would write a piece about the moral dilemmas that are involved in

247 being in a public role, or having a public responsibility like running a

248 commission. And I'd like him to write about bioethics from thepoin t of view of

249 somebody who's now a figure dealing with policy, as compared with the way he

250 writes when he writes in religion journals, where it's a completely different voice.

251 And about the kind of real tensions that are involved in those two roles. So he

252 really is quite a radiant religious figure, but when he puts on his cap either to do

253 principles or to write about the transplantation commission that he ran, it's a Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 13

254 different person.

255 CAPLAN: That may be, having immersed a little in the Quaker culture through my kids'

256 school; it's a Quaker school. Quakerism is kind oflike that. It's personal-

257 religious, it's very individual religious and not much in groups. You can go to a

258 Quaker meeting discussion of should we build a new building and even though

259 there are deeply religious Quakers there they don't talk that way when they're

260 together. So I'm not sure ....

261 FOX: He uses rather standard Protestant theological language when he writes in

262 religious journals. You wouldn't necessarily know that he was a Quaker in terms

263 of the church language he uses. But anyway ....

264 CAPLAN: Other institutional things of importance in the mid to late eighties. Park Ridge

265 becomes of interest, I don't think of major importance but moderate importance.

266 Not major because of a couple of things. It has a mission. It wants to bring

267 religion explicitly in, but, it never finds apublication vehicle that succeeds. Its

268 journal, Second Opinion, is not widely read or quoted. It's never actually

269 overcome this problem of its outlet. The book series that they did, tend to be not

270 widely distributed. My estimate or my judgement would be that people know

271 Park Ridge is there and they know that it's trying to do a particular mission but

272 that it never marketed itself to penetrate seriously into the mainstream bioethics

273 dialogue.

274 FOX: We are interested in it fo r another reason, because of the way that it started Arthur Caplan Acadia Institute Study of Bioethics in American Society page 14

275 through the Lutheran system of delivery of health care and the linkingof it so it

276 has the faith and ethics.

277 CAPLAN: The best stuff it does actually is things like the recent organ procurement stuff.

278 FOX: Or the principles book and so fo rth ...

279 CAPLAN: That's been a long time coming. For a long time they weren't doing anything.

280 They were there but you, sort of, didn't know ....

281 FOX: The whole series that Martin Marty and others did about fundamentalism is not

282 totally a Park Ridge thing, but that is where the Park Ridge thing opens onto the

283 University of Chicago.

284 CAPLAN: Yea ...in terchanges there. Alright.. . .let's see ...other institutions ...AMA.

285 FOX: You leftout Minnesota.... (laughter)

286 CAPLAN: I'm getting there. I'd say Virginia is older than Minnesota. The AMA has an

287 influence. This Council of Judicial Affairs kind of thing, always viewed with

288 some scorn even to the present day as kind of an apology-for-the-profession type

289 stuff, occasionally fires out an interesting opinion piece or something and taken

290 very seriously by the AMA.

291 FOX: The AMA is a lot more complicated. Sitting on the board of JAMA all that time

292 I was struck by the degree to which one can write independent things and have

293 independent thinking; it is more than just a kind of spokespeople for the

294 profession.

295 CAPLAN: I think the Council on Ethical and Judicial Affairs was more of an apologist for Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 15

296 the profession in the fifties and sixties, but I actually think a synergy took place

297 and bioethics helped to beef-up that committee and gave it courage. I found my

298 most provocative opinions cited often in Council on Judicial Affairs opinions that

299 would make it into JAMA. "Oh, they actually read that?" They were out of the

300 organization a lot. The problem they had was they really did take on a serious

301 intellectual momentum and then the members of the AMA tried to restrain them

302 sometimes. They would get out of step with membership.

303 FOX: I think the kinds of issues they took on, with bioethics being synergist, you can't

304 exactly have a sort of officialAMA position on something like "What is life?" or

305 "What is death?"

306 CAPLAN: I think that's right. I think they were dragged, at first,into bioethical areas, and

307 some people on the Ethics and Judicial Affairs Council said we should be reading

308 some of this bioethics stuff. Andthey did and they took it seriously. I actually

309 wrote a review which shocked them. It was a kind of funny, sociological

310 phenomena. About fiveor six years ago I reviewed their code of ethics and I said,

311 "This is really worth reading, it's very interesting." They were so shocked they

312 keep using it on the back of the book, saying, you know, "Arthur Caplan says, it's

313 worth reading!!" (Laughter) ...

314 FOX: That's interesting, because ifit turns out that a prominent bioethicist, a

315 spokesperson for bioethics, provides an imprimatur of legitimacy for their

316 ethical.. .. Arthur Caplan Acadia Institute Study of Bioethics in AmericanSociety page 16

317 CAPLAN: Absolutely did. They were coaking it and saying it must be okay. (Laughter).

318 They actually worked. If you were into deconstructionism, you can just trace that

319 little event of the placement of this quote on the back of the book. It's the only

320 quote that appears on the back of the code of ethics book that's given to every

321 medical student. It's basically me blessing this! How did that come to be? Why

322 is he doing it??

323 SWAZEY: It's your early rabbinical exposure!! (Laughter)

324 CAPLAN: That's it!! Thank you!

325 FOX: Yes, because you would expect it to be the other way around.

326 CAPLAN: Sure! Exactly!

327 FOX: The AMA would speak approvingly of your work rather than ....

328 CAPLAN: So it's just funny. It almost made me blush when I first saw this. I thought, this is

329 papal. So now the Pope has blessed our work and we may go forward. I mean, I

330 said it but I wasn't trying to bless it. It was just a comment.

331 FOX: Okay, that's interesting.

332 CAPLAN: Modem institutions of importance. Minnesota becomes an important place

333 because it's there, fo r the first time I think in the eighties, that Centers begin to

334 move to tie-ins to medical schools as a structural feature; although bioethics is not

335 tied really, in a structural way, to medicine. Teaching is not going on. You've

336 had this lament fo rever: they won't let me teach in the medical school. I think

337 that's true up until about 1986-1987. When Minnesota starts, it's put in the Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 17

338 medical school; its mission is to try, among other things, to teach medical

339 students. I'm not saying no one was teaching medical students but structurally

340 this joint is housed right there.

341 FOX: It's a very interesting study that I don't think we can deal with, is where was

342 ethics taught in the medical school before bioethics? One of the places was

343 psychiatry.

344 CAPLAN: I understand that. I think there are waves of--who can save us fromour

345 mechanistic, fiendish, de-personalized.. .! mean, science goes through.

346 FOX: But this was an explicit decision.

347 CAPLAN: Minnesota was an explicit decision too, and it had structural features like my

348 being an equivalent of a department chair. It was very clear that our courses had

349 to be passed with grades. If you didn't pass you had to take them again. Teaching

350 bioethics, I think, prior to about 1985, meant an elective course or maybe a mildly

351 required course, but certainly if you failed it you weren't going to go back and

352 repeat it. That changes with the Minnesota-type model, which is, "this is serious".

353 FOX: Did you bring that to them, or did they bring you in to head the Center in order to

354 do that?

355 CAPLAN: They probably were ready to do it, to tell you the truth. But I said, look I'm not

356 doing this old style thing. If we're doing this, we're going to do it as a serious

357 thing and people are going to be evaluated. If I write a note saying I don't think

358 Mr. X has mastered what he needs to know about the core value of this discipline, Arthur Caplan AcadiaInstitute Study of Bioethics inAmerican Society page 18

359 he's going to get that in his evaluation and that's going to stay there. I didn't

360 write that too oftenbut I did write it once in a while. We institutionalized rounds

361 and things like that so they were beginning to just appear routinely.

362 END OF SIDE (CAPLAN, INTERVIEW 2, TAPE 1)

363 CAPLAN: Minnesota becomes a place where the first, what I would call, current turntoward

364 empirical synthesis is made. I'm bringing that and I'm certainly thinking, well,

365 bioethics is too ahistorical, bioethics is too asocial, bioethics is too American. I

366 don't know if it's too American but at least it's all-American. (Laughter)

367 FOX: It's going to be recognized as American. (Laughter)

368 CAPLAN: At least it is American and attempts were made to build into the faculty hires

369 people who can do something about that. Broaden the discipline out, to listen to

370 more voices and make ties to other departments.

371 FOX: Didn't you bring in Nursing, too?

372 CAPLAN: Yup. So we actually had crossed the point to the School ofNursing. We had

373 nursing faculty on the Center faculty. I don't even know if they did that before,

374 but it may have been a first for bioethics. The other structural feature or

375 interesting institutional fact about Minnesota is that, I'm going to hate myself for

376 telling you this, you could actually see for the firsttime Bioethics Centers

377 institutionally beginning to compete with the old line places for the best talent.

378 FOX: Why should you hate yourself? Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 19

379 CAPLAN: It's just someone would say, "I knew they were competing." (Laughter) Of course

380 we were competing. We were starting to look to see who could we hire. Susan

381 Wolf was brought to Minnesota from Hastings. That's a very interesting

382 phenomenon. I recruit her. Steve Miles is brought from Chicago to Minnesota.

383 So all of a sudden, there are others of this ilk, but I'm starting to look out there

384 and move talent away from Chicago, Hastings, traditional places of strength in the

385 field. This is serious. As sociologists you must pay attention to this because now

386 we're talking about redistribution of personnel and power within the field. There

387 is another program that deserves a mention here that is doing much the same thing

388 as Minnesota without the social science fo cus, but it's embedding itself in the

389 culture of it's medical school and institution. That's Case Western. That's Tom

390 Murray's activity.

391 FOX: And Stuart Youngner.

392 CAPLAN: They are a very good program and they are doing much the same thing, in terms of

393 hiring and looking to see where they can move people to come there. Tom, you

394 know, has got a social psychology background, he's one of the fe w social

395 scientists in the whole field. He and I overlapped at Hastings and we're friends.

396 We're sort of friendlyrivals now in the sense in which I thinkthe Case Program is

397 a good program. I consider that a real, sort of equal equivalent to the Penn

398 Program, almost. (Laughter) ...No, actually ours is better. It's a larger program.

399 We have much more strength but it's for a funnyreason. Case doesn't have a Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 20

400 college to bolster it. We have all the resources of a fullma jor research university.

401 They have a great medical school but it's sort of parlors a liberal arts campus. It

402 was an engineering school so it doesn't have the same sort ofstuffwe can bring to

403 bear in the masters program and stuff like that. They have a masters program, and

404 they're in the medical school in a very routine and expected way.

405 FOX: Yes, when I've been there they've brought in the chaplains, the nurses certainly ....

406 CAPLAN: They're tied to the medical school, very tightly.

407 FOX: Yes, and then, of course, Case WesternReserve has a very special kind ofhistory

408 in terms of the experimental edge to their educational ventures.

409 CAPLAN: Yes. They did their organ-based training and their patient-based training ....

410 FOX: Intellectually, though, I don't think it's the same stature as your program.

411 CAPLAN: No ..no ..

412 FOX: Because Tom Murray was a lovely man, but he's not got your political clout or

413 your intellectual stature.

414 CAPLAN: Yup ...but I think institutionally it's a good parallel type. That model now is very

415 different from the Penn State, UT Galveston model. You know this better than I

416 do, but I don't think the BU Program in Health Law has a particular type

417 integration with the medical school.

418 SWAZEY: Actually, I'm going to be talking to the folks there in a couple of weeks. They

419 don't formally teach as the Center for Health Law and Ethics because the faculty

420 in that program are faculty in the School of Public Health and the Medical School. Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 21

421 CAPLAN: That's the other one I was going to mention. The BU program is there but I just

422 wasn't sure how it works. There's a talent thing here; that's what I was getting at.

423 Wendy Mariner, Leonard Glantz, Grodin. Forget George Annas ...(la ughter).

424 Forget George for a second here. George is doing the same thing I'm doing. He's

425 building a talented pool of people. That's what I meant. He's there as an

426 individual for a long time and Judy's there. Now a program emerges with serious

427 younger talent that you would have expected to see at the Hastings Center or

428 maybe at Georgetown. Now they're at BU. That's what I meant.

429 FOX: Isn't there something else? Your program, I know, has Sally Nunn coming on

430 board and so forth. What about this whole other thing that you're shaping into a

43 1 kind of outreach aspect of it?

432 CAPLAN: That's a nineties phenomena. Now we've almost got to Penn, almost. So we've

433 got institutions ....

434 SWAZEY: BU is a nineties program, that whole law-ethics program.

435 CAPLAN: Although I'd say that some of the talent pool is starting to show up in the eighties.

436 Two other institutions of some note. David Rothman at Columbia has his little

437 program chugging along. It's not of the size of Case Westernor Minnesota, but

438 something's going on there, and he's bringing in some younger people to the

439 program.

440 FOX: This is another kind of variable. The program I think is of lesser consequence, but Arthur Caplan Acadia Institute Study of Bioethics in American Society page22

441 are things like David's relationship to Soros factors that get into making it more

442 important than it seems to be?

443 CAPLAN: Yes. I hate to say it, but the simple New York City location makes it more

444 important than it is. I mean, it's just a fact of sociology. He has the ear of certain

445 media outlets, certain foundation people, certain persons of influence,just by

446 being in New York. That boosts his efforts and his little program.

447 FOX: Do you think what David is doing is at all continuous with the Bernie Schoenberg

448 tradition? I mean, he has the chair.

449 CAPLAN: No .. no ...zero. I think Berniewould be disappointed.

450 FOX: I do too ...okay ..alright.

451 CAPLAN: New York also has the Montefiore Clinical Ethics Program ofNancy Dubler. It's

452 a teeny, teeny program. It's a Nancy Dubler, John Arras, who's now gone to

453 Virginia, by the way, along with Jonathan Moreno. They're both moving there.

454 Virginia will become a place of importance in the future, in a different way than it

455 has been in the past. But it continues to be, that's my point, that people are

456 moving there to take over the old guard positions and that program is actually

457 doing well.

458 FOX: So you're putting this against the background ofthe numbers of programs that

459 have basically faded out.

460 CAPLAN: Correct...correct.

461 FOX: Those that renew themselves and go on into the next decade are ones that you Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 23

462 think ....

463 CAPLAN: Correct. That's sort of interesting. Others like Penn State still endure but less

464 influential. Galveston is still there, far less influential. I'm not sure anybody

465 could ....can you tell me what they're doing? What field? I know they're there.

466 They go on but with less influence.

467 SWAZEY: They are really involved with medicine and humanities.

468 CAPLAN: Yea.

469 FOX: Even there the health and human values thing has more influence than the medical

470 humanities.

471 CAPLAN: Yea. You don't see it the way it used to be. You knew when they were speaking

472 for medical humanities things fifteenyears ago. Much less so today. I'm not

473 going to say zero but...

474 FOX: No ....no.

475 CAPLAN: This Montefiore Program's very important though because, like Mark's program,

476 it is clinical ethics driven. It is the place where this model of the consult begins to

477 really thrive. Nancy Dubler's forte is, much as Mark's was, although he'd kill

478 himself to think it, the bedside ethics consultation. When people in New York

479 City think ofbioethics, they think of Nancy going into a case situation and kind of

480 acting as a mediator or arbitrator to a problem. It affects a whole city's culture,

481 this little program, and is an influence in a lot of ways over one model of what a

482 bioethicist does. It's close to what Mark's is but institutionally it begins to really Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 24

483 roll in the eighties too, that's what I meant. So these programs are now ...

484 FOX: Albert Einstein has that model too.

485 CAPLAN: Well, it was the Macklin and Fleischman model. They were doing the exact same

486 thing. I hate to say it, they'd also go nuts if you said it, but they were influenced

487 by the Montefiore program. They'd like to think they did it themselves. I don't

488 think so. I think they were influenced by it. The programs are still there, but my

489 point is, as a sort of sociological observation, these programs--Einstein, the

490 Minnesota Program emerging, the Case Western Program emerging--these are

491 institutional bases that are now power Centers or points of influencethat are

492 pulling centrifugallyagainst the old Hastings-Georgetown axis, if you wanted to

493 say what "old" bioethics was. Into the nineties programs, this aircraft carrier thing

494 at Penn begins to appear and immodestly starts to take on some of the many

495 functionsthat Hastings used to do. I mean, it is now the home of the AAB

496 rebellion. The emergence of this idea that there should be a bioethics

497 organization, sometimes viewed as the philosophers rebel, but I don't see it that

498 way. I see it as the professional bioethicists rebel, as a matter of fact, against the

499 old medical humanities model. You have a program like Penn showing up and

500 saying, well, we will do many of the things that older bioethics programs did. We

501 will do outreach like Virginia and the John Fletcher thing. We will do case

502 consultation like Montefiore and Mark Siegler have done. We can integrate social

503 science in a cultural critique. We will look at policy like the Hastings Center Arthur Caplan Acadia Institute Study of Bioethics in American Society page25

504 should be doing but doesn't seem to want to. I don't know where they're going

505 now. Last time it looked like eco-philosophy in the woods or something. We will

506 continue this Minnesota tradition of being integrated in to the medical school.

507 Although a slight shifttakes place because Penn moves towards trying to integrate

508 a social medicine--bioethics sort of....

509 FOX: You have 30 undergraduates who are doing volunteer work in the Center, so you

510 are getting far more than ....

511 CAPLAN: We have so many bodies going by now. I used to think the fieldwas a fad; now I

512 think it ought to be stopped as a movement or a cult or something. (Laughter)

513 FOX: I'm teaching Sociology of Bioethics both semesters this year. Virtually everybody

514 I'm teaching has had some contact with your Center. They are also studying at the

515 same time they are taking everything in sight. Whether it's with Glenn McGee or

516 David Magnus, they're doing everything in sight that could be done. So we're

517 referring people back and forth.

518 CAPLAN: Here's even a stranger phenomena, probably not the most odd thing that you could

519 never think of, but is remarkable to me. The program at Penn succeeds in doing

520 the impossible, it re-integrates back to the philosophy department. It's like

521 whoa! ! We run the masters degree through the philosophy department. We

522 actually have appointments for all three of our philosophers in the philosophy

523 department. Arthur Caplan, when the philosophers come here this December, is

524 giving two invited speeches at the philosophy meetings. As medical ethicist not Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 26

525 as philosopher.

526 FOX: But you knew, you wouldn't have come here if you didn't think you could pull

527 that off.

528 CAPLAN: I thought I could pull it off, that is a very appropriate phrase. I THOUGHT I

529 could but wasn't sure but it's worked. Philosophy departments are everywhere,

530 they're always pains in the neck. I've been invited for years to speak at

531 philosophy meetings as a philosopher of science. I've never been asked to speak

532 qua medical ethicist...never. I've given talks over the years many times on the

533 philosophy of biology, all kinds of sociobiology things, theory change, and so on.

534 FOX: You want to know the analog to that? When Judith and I are invited to speak

535 nowadays, we are always invited because we're ethicists, never because we're

536 historians or sociologists.

537 CAPLAN: Really?!... (laughter) ... You don't come as sociologists, you come as bioethicists!

538 FOX: Yea!

539 CAPLAN: So personally, that may be the most interesting and rewarding intellectual

540 achievement of all.

541 FOX: But this doesn't square at all with the reason that you were brought here, and the

542 understanding of what you were going to be, that made our dean decide that this

543 was a major event rather than a minor one.

544 CAPLAN: But that never interested me very much. That vision was... alright, if you wanted to

545 have that vision then it didn't bother me. Coming in as cover for genetics or Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 27

546 coming in as police on the Gene Therapy Institute if not an apologist. We do

547 work with the genetic stuff. We have millions of dollars of grants now sitting

548 there to do things with the genetics stuff but I knew that would be just blown out

549 ofthe water.

550 FOX: I knew that we would get a bioethicist finally, once James Wilson appeared, not

551 just because of money but because of what it was that would represent. Then in

552 addition, I knew that if he met you that you would click. But actually it was the

553 role, the fact that a major work in gene therapy was going on at Penn, and they

554 couldn't hold their heads up and say we don't have a single presence on campus

555 that has any ethical competence whatsoever.

556 CAPLAN: You know more about that history than I do. I had this discussion with Kelley and

557 I knew what message he was sending about his hopes and dreams that we would

558 have ethics for genes. I kept saying ethics for genes is okay, but I have bigger fish

559 to frythan just running around looking at genes all day. And I told him so. I said,

560 "Look, I think that's a narrow vision." I mean, this is actually funny because this

561 guy isn't used to being told that his vision is wrong. So he's sitting there saying,

562 "What??" I think I actually did say it was stupid, it's not what you want for a

563 bioethicist.

564 FOX: That's probably why he liked you, as a matter of fact. Not just because you talked

565 back to him but because you talked "big".

566 CAPLAN: Big visions he likes. When I told him he had a little vision ...(l aughter) ... he said, "I Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page28

567 do??" It's true! He said, "I do??" I said, "Yea, genes is a piece of it." I told him

568 too, "Look, the other thing to do with Penn, we should do outreach and public

569 education." It was very good that he did not care and still said he didn't. But over

570 the time that we've been here, if you ask Bill, if you were to interview him, he'd

571 say, "I can't believe what Art did. He has pushed this thing into some visibility

572 beyond ..."

573 FOX: But the visibility thing, without cheapening his appreciation of you, this kind of

574 putting Penn on the map that you're doing, at a time when he's doing what he's

575 doing with the health care system and competing for the market share and so

576 forth ....

577 CAPLAN: But he couldn't have dreamed he'd be sitting there, when he was trying to set this

578 thing up, he thought a big gene push would do it. He didn't know that we were

579 going to be the paratroopers to go in and make the first visits to the places he was

580 going to try to buy, or acquire, or affiliate with. A whole different phenomena, the

581 managed care thing has shifted.

582 FOX: Why did he send you in?

583 CAPLAN: He doesn't, we just de facto were there first. I always come back to him and say,

584 "You know, I understand you're trying to run a system and acquire things or sell

585 things or do whatever the hell you do. (Laughter) But, you have to keep in mind,

586 Bill, they know us before they know you." We are literally there long before your

587 system is. We get invited to Brandywine Hospital or Delaware Memorial Chronic Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 29

588 Facility or whatever it is. They don't even know what Penn Health Systems is but

589 they know who we are. We're like the Airborne, we show up way in advance.

590 SWAZEY: The Recon Squad.

591 CAPLAN: Exactly. So I say, you've got to realize that you should build to this strength.

592 He's slowly getting it and so are the people on the marketing side. He's certainly

593 pleased that the name is out there. We've had approaches at this point, this is

594 sociologically interesting, from at least two institutions; Holy Redeemer System

595 and Catholic Health System have come to Penn and said we want to consider

596 affiliation. One reason is because you have the Bioethics Center. Bill's in a

597 spasm of delight over this. (Laughter) So in a sense, bioethics has hooked him a

598 fishthat he never dreamed of. He thought maybe he'd keep the regulators away or

599 there wouldn't be demonstrators yelling that they didn't want to be cloned. I had

600 a dim idea but he never thought that we would have any influenceover the

601 direction of the way the system went.

602 FOX: I think you saw this.

603 CAPLAN: I did. I absolutely thought, this is great! We can use this to buy intellectual

604 freedom.Penn becomes a major player in the contemporary scene for sure. I

605 mean, personally, I think it's THE major player. I'm willing to write that offto a

606 certain amount of immodesty.

607 FOX: We'll see how dormant the others are.

608 CAPLAN: Today too, I think Case is lively and has activities going on and is doing lots of Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page30

609 work and I thinkhas built up a pretty good group. Chicago has not succumbed to

610 malaise, they do things.

611 FOX: Chicago is important too, because of your emphasis incidently, the whole

612 university kind of thing that Chicago is embedded in also.

613 CAPLAN: Yes.

614 FOX: A lot ofthe names, just as an example, a lot ofthe names you've been talking

615 about at Chicago, who recruits Nicholas Christakis? Not for bioethics, but never-

616 the-less, it's Chris Cassell. And then, who is one of his bosses? John Lantos, and

617 so fo rth. There's that much larger configuration, there's a lot going for them.

618 CAPLAN: It's still there. Jason Carlowit, this young geriatrics guy that we just had, was a

619 Lantos-Cassell product. They're still putting out people who are definitely

620 talented. I'm not sure I have a vision of which direction BU is going to go in right

621 now. I don't know. George is still a major voice, a very important figure.

622 FOX: Georgetown, is it fading away a little?

623 CAPLAN: I think it is a little. I think Georgetown is fading, not to the Hastings level but

624 today, in contemporary structure, I'd say it's not got the same punch. Its

625 leadership, interestingly enough, is also dropped from Andre Hellegers and Ed

626 Pellegrino to Kevin Wildes, I think, is the director now. A young guy, nice guy,

627 but that's not the same stature. Those aren't the same figures.

628 FOX: Both Hastings and Georgetown have very many ofthe attributes of the

629 charismatic movement with the founder/leaders and the whole business of the Arthur Caplan Acadia Institute Study of Bioethics in American Society page 31

630 classical thing, the succession of the fo under/leaders. Dan Callahan is certainly a

63 1 case and Georgetown is.

632 CAPLAN: I don't think George Annas is anything like that. George's model isn't the

633 charismatic, father-figure, leader type. He's a major voice, I don't have a sense of

634 where the BU program is moving to. But I do have a sense of where the

635 Georgetown and Hastings things are as much more culty-figure type leaders and

636 it's not in a positive direction, I think.

637 FOX: They have certain institutional things going for them. They have The

638 Encyclopedia of Bioethics. They have The Bibliography of Bioethics. They have

639 the two journals, particularly The Hastings Center Report.

640 CAPLAN: They have something at Hastings which I can't even believe they have, but they

641 do. They have an endowment, which they never had when I was there. That will

642 keep them chugging for some time.

643 SWAZEY: I have one more Center question. I wanted to ask you about where you'd put

644 Wisconsin?

645 CAPLAN: Well, Wisconsin I would put in a Virginia, I forgot about them but they're

646 important, they're an eighties important. They too are fading out right now. Oh,

647 you know who else I forgot, we should mention Pittsburgh just briefly. Wisconsin

648 is a program that is in jeopardy of not being there in fiveyears. The way it looks

649 now, at one point they had some of the brightest stars going: Robertson, Fost,

650 Wikler, Alan Buchanan, Alan Weisbard, Alta Charro. But that is not a program Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 32

65 1 that ever integrated into its medical school in any serious way. It was a free

652 standing sort of Center. It was closer to the loose association model that Virginia

653 had, is really the way I would describe it. It did not train many people. It had

654 major voices and contributed vitally important scholarly things to bioethics, as

655 individuals but not qua a systematically integrated program, is what I would say.

656 Today, Norm Fost is looking to move on fromthere, for personal reasons.

657 Lickland will leave the day his last kid gets out of high school because he wants to

658 be near the opera and the theater. So he will be out of there. Alta is being

659 recruited by every law school there is. This is a bright young law faculty type that

660 people want to get at. Weisbard has actually been isolated at Wisconsin for two

661 or three reasons because the religious stuff doesn't sit well there.

662 FOX: I would imagine. He doesn't belong in Madison. He belongs in New York City.

663 CAPLAN: Correct, and that just doesn't sit well. Robertson's moved to Texas. Alan

664 Buchanan was there in the philosophy department, now he's in Arizona. So my

665 prediction for that program is that it was a loose association that's going to kind of

666 Brownian-movement itself to a no-association. I don't think they're going to be

667 there for very long. Pittsburgh, similar kind of phenomenon, important in the

668 eighties. The program begins to gel. Meisel, Bob Arnold, Lidz, Roth, there's

669 more, I'm forgetting some of them. On the physician's side, the anesthesiologist,

670 critical care guy. Starzl's own bizarre influence, either generating ethics problems

671 or ... Frader is there. Schaffn er is there fromthe philosophy end. Again, that's ArthurCaplan Acadia Institute Study of Bioethics inAmerican Society page33

672 more the loose association type model. They're not pulling together in an

673 organized structural way. Often a lot of what they do is in response to innovations

674 at Pittsburgh, mainly in the transplant area.

675 FOX: They not only turnaround transplant, they turn around intensive care ....

676 CAPLAN: ...and mental health.

677 FOX: Psychiatry has played an important role there.

678 CAPLAN: You have to say, outside ofBU, where occasional words are muttered about

679 mental health psychiatry, it really was Pittsburgh that kept that flame alive. They

680 are it, that's where it was done. But they too have begun to dissipate. Frader went

681 to Northwestern. Roth is going to retire soon. Schaffner's gone. He went to

682 George Washington University. He moved away. They never really replaced him

683 in the philosophy department.

684 FOX: There's a tremendous amount of ambition there though. I guess I think of Bob

685 Arnold and thinkof how ambitious he is to be, I don't know... to be .. Mr.

686 Bioethics ...Dr. Bioethics

687 CAPLAN: It's going to be hard fo r him to have it in a programmatic way. I think

688 individually ...perha ps. People see a lean and hungry look about old-young Dr.

689 Arnold. There's a certain problem about that. I mean, I will take second place to

690 nobody on the ambition scale but I'm not going to steamroller people to get there.

691 It doesn't matter. Whatever happens at Pittsburgh, it's not going to be an

692 institutional center. But Pittsburgh and Wisconsin also represent examples of the Arthur Caplan Acadia Institute Study of Bioethics in AmericanSociety page34

693 university phenomena of the eighties that I was talking about. They're right there

694 with Case and with the Virginia type model. They become centrifugal forces

695 against the Kennedy-Hastings axis.

696 FOX: You can't really put Hastings and Kennedy in the same exact box because of...

697 You do in spite ofthe Georgetown link?

698 CAPLAN: Yes! Yes, absolutely! Yes, I still will. They were different places but they were

699 still...

700 FOX: Would they make the same resolute decision that they would not allow themselves

701 to get too tangled up with a university. Is that it?

702 CAPLAN: In a funnyway they did. Even though Georgetown-Kennedy is kind of nested in

703 the institution. You knowall the tensions they've had. Are we a medical school?

704 Are we a free-standing Center? They never really go out and make institutional

705 ties past Georgetown. They're in the place but, you know, Pellegrino runs off and

706 sets up a little satellite operation at one point, just because he's not convinced

707 that they've ever done anything in the medical school. They've just had ten

708 scholars down the hall at the Kennedy Institute ....

709 FOX: In some ways, I guess, both Hastings and Georgetown-Kennedy are unique, but

710 because of the location of the Kennedy Institute in Washington and because of the

711 influence ofthe Kennedy-Shriver thing; I don't know to what extent that

712 continues latently, but at any rate, it's not the same as Dan Callahan's setting up

713 Hastings. Arthur Caplan Acadia Institute Study of Bioethics inAm erican Society page 35

714 CAPLAN: Hastings Center is a one-man show, or a two-man show...

715 FOX: Having been on the board in the early stages ofHastings, one ofthe big problems

716 was that it was asked to do all kinds of jobs for the Kennedy Institute.

717 CAPLAN: Yes ....true ...true ..

718 FOX: The Board's admonition to Dan was, not that Hastings shouldn't be happy to

719 cooperate with Kennedy, but not to let the Kennedy Institute and the Kennedys, so

720 to speak, set the agenda for Hastings so it basically just did jobs for the Kennedy.

721 CAPLAN: Very different places but an axis. It's like, you might say, there was a German-

722 Japan axis but they were still an axis.

723 FOX: Okay.

724 CAPLAN: These institutions that I'm talking about now are university-based programs like

725 Pittsburgh and so on. There's one more that we forgot about is McGill. It has its

726 own orientation and stuff, but it is a truly integrated program, unlike Pittsburgh or

727 Wisconsin. They really work as a group and they're Penn-like in their structure.

728 You know, they got devastated by a weird thing, which Judy will understand, a

729 fire. Their headquarters burned down. They lost books and papers. It set them

730 back for a year. They've never recovered. And then Benjamin Friedman died.

73 1 FOX: I'm glad to see you are going to have a memorial to him.

732 CAPLAN: Actually I'm going up there to do a thing for him in two weeks at McGill.

733 They're doing a little in-house thing. I liked Benji a lot, probably one ofthe

734 smartest of the people who ever got into bioethics, I have to say, very smart guy. Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 36

735 They were important. This is another eighties phenomenon, another program that

736 emerges is ...

737 FOX: So eighties is, in terms ofthe decades ofthe development ofbioethics, you're

738 really talking about eighties as being a time of great ...

739 CAPLAN: ...dissemination ....

740 FOX: ...i nstitutional florescence and not just, who's publishing how many articles on

741 such and such a topic.

742 CAPLAN: It's moving fromthat to institutional bases and people say, "Oh, I'm with the

743 McGill Program .. .l'm with the Wisconsin Program."

744 END OF TAPE (INTERVIEW 2, TAPE 1)

745 FOX: We have this florescence of Centers in the eighties of different types. A great

746 many of them, as you're saying, seem to be not modeling themselves after

747 Kennedy or Hastings but actually trying to create their own ethos. They are

748 somewhat in revolt against those Centers wanting to be distinctively different

749 from them in certain ways.

750 CAPLAN: I think that's true.

75 1 FOX: Now, between the decades of the eighties and the nineties, on the other hand, a

752 great many such attempts sortof shrivel up and die. Now we have the landscape

753 that you have depicted. Are there any new budding places where you think

754 something might grow? Arthur Caplan Acadia Institute Study of Bioethics in American Society page37

755 CAPLAN: It's not clear what's going to happen at Harvard; that is a mystery. Something

756 could happen there, out of the ashes. Clearly the Emanuels were controversial

757 figures and I don't knowwhat their fate or future will be. There is an interest in

758 doing something at Harvard. There is an interest in doing something, of all

759 places, at Princeton. Princeton has money, it's waiting to spend it. It will not take

760 a medical turn but it certainly will take ...i t's what Bill Kelley thought he was

761 going to get, which was genes.

762 FOX: Princeton could do better with its Divinity School and with its Institute for

763 Advanced Studies.

764 CAPLAN: We can sort of keep Princeton as good partners because we can offer them

765 something they don't have, the medical side. That may be a place that may well

766 do something in the next five or seven years.

767 FOX: That's very interesting.

768 CAPLAN: I think there's been sort of an agitation of interest. I know the drums are beating

769 under the ground, interestingly enough, up at New York University. NYU has

770 grown and has prospered and has money and is probably one of the most

771 successful schools around. Dorothy Nelkin and a student of mine, Eric Feldman,

772 who's her junior colleague, are not unaware; they're sort of taking a bioethics turn

773 there. And so, to be honest, are some of the philosophy department people

774 they've recruited. NYU has the distinction of having the only philosophy

775 department that has grown a lot in the past ten years. As soon as Farber, their Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page38

776 cranky old dean, gets out of there, I think things will change at NYU.

777 FOX: In what orientation is the philosophy department going?

778 CAPLAN: It's analytical but softly so; it's not bearishly analytical. I think Virginia, under

779 Moreno, is going to grow into something unlike that which it was. I think it's not

780 going to take the Fletcher model. I think it's going to become a much more

781 integrated program and will have influence.

782 FOX: And what about Minnesotathat you love?

783 CAPLAN: I expect Minnesota to stay about where it is. I don't think it's going to grow. I

784 think that Duke, under the ambitious Dr. Sugarman and with other people around,

785 may turn into something there. It could, I wouldn't bet on it, but it could. Emory

786 has money. It has made noises. Periodically they try to recruit me so I don't

787 think ....

788 FOX: But they're losing Gustafs on so the same problem is going to be there. Who

789 would be this ....

790 CAPLAN: I don't know. I'm serious. They try to recruit me there periodically and they say

791 they're going to do something there. I think I know who's going to wind up there

792 down the road. I'll make a prediction. I think Glenn is going to wind up there.

793 FOX: That would fit.

794 CAPLAN: He's a Southerner. He would someday want to do his own program. That'll be a

795 bet. Five years out, I'll bet.

796 FOX: A particularly good one for him because the Divinity School has always been very Arthur Caplan Acadia Insti tute Study of Bioethics in American Society page39

797 active, and the Medical School and the Law School and the Divinity School.. ..

798 CAPLAN: The guy was raised as a Baptist. He knows the culture, he understands it.

799 FOX: He's not that strong in social science but that's not his thing.

800 CAPLAN: You know,the program for Emory to do, if it really wants to do it, is what you

801 guys have tried to do at BU. Emory could capture the CDC and take a public

802 health turn, it's across the street! You could have a ball just doing public health

803 things there. Glenn knows thatmuch, he understands that. If I were grooming

804 Glenn fo r a leadership thing I would almost say that's the place that he should

805 head toward.

806 SWAZEY: Is that something you see yourself doing?

807 CAPLAN: Yes. I don't want to get into a situation like Hastings where there isn't an obvious

808 leadership hand off. I think we actually have on board fo ur or fivepeople that

809 could emerge to run the Penn Program or run other programs. Ubel could do it,

810 and will. Glenn could do it, and will. Magnus could do it, and will. Sankar could

811 do it; I don't know if she wants to, but she could. I don't think Mildred has

812 administrative aspirations. Asch could do it, and will. He'll do it in a particular

813 way but go run something somewhere. He doesn't have a big vision but he can

814 take a unit and turn it in to a particular style of doing studies.

815 FOX: A health care services model.. ..

816 CAPLAN: I findit too dull but it could go that way. We will produce. I'd be very

817 disappointed if we didn't have some people out there who were running programs. Arthur Caplan Acadia Institute Study of Bioethics in American Society page40

818 Wolpe might actually turninto this too, in his own way. He needs more

819 scholarship to back him up so he's more credible. To tell you how much I think

820 about this, when I sit and talk to Glenn I've said, "Glenn you've got to get some

821 large RO 1 grants under your name because no one can give you responsibility for

822 their career unless they can be sure you can get them support."

823 FOX: So you're training people not just to do intellectual work in this fieldbut to create

824 programs.

825 CAPLAN: Lots of discussions with Peter Ubel about this openly, just sort of saying, "Look, I

826 don't want you to leave Peter. I hope you stay here but if you do decide Duke is

827 going to recruit you ...." It's not an impossible place for him to wind up. Or

828 Moreno before he left, that is an example of somebody for whom it's already

829 happened. We've put Moreno into this Virginia Program as the director. I tried

830 pretty consciously to talk to him about what I think fe atures are to run or lead

831 programs.

832 FOX: In terms of this stage of the development or institutionalization ofbioethics, why,

833 rather than just being a teacherly person who will groom somebody to do good

834 intellectual work in the field and become prominent in that respect, do you think

835 your special mission is to groom them to do that but also to create and run

836 Centers?

837 CAPLAN: I don't see where the apprenticeships for that are coming from. Hastings is not

838 doing it. Georgetown doesn't do it. So it's a need more than a desire. To be Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 41

839 honest, I don't know that I would do it otherwise. Oh, you know another program

840 I fo rgot about? The eighties Medical College of Wisconsin. That has a little

841 program too. It's another one ofthose ....ju st so you list them right. Even the

842 Cleveland Clinic might hit this area; they did a little two year program. Weirdly

843 enough, in Cleveland, who would think of this, but the Clinic and Case Western

844 are actually bioethics competitors. If you interview Tom Murray, don't forget to

845 tweak him about the Cleveland Clinic. They have money, they oftenrun a

846 conference or something that Tom would like to do. It's kind of funny, he has a

847 cross town rival. If Alleghney had a bioethics program, even a small one, it would

848 kind of be like that here.

849 FOX: One of the models that you're talking about is a public health model and it's just

850 been announced, as you know, that Jonathan Mann is coming to head the

851 Allegheny School of Public Health.

852 CAPLAN: To me that is actually a great thing because his personal interest is HIV AIDS and

853 Third World things and we stink at that. So I'm actually excited that he is

854 showing up. He does things that we don't do.

855 FOX: And also, human rights.

856 CAPLAN: We don't do any ofthis so, it's like, "Oh, this could be good!" I just have to

857 figureout some ways to keep Bill Kelley frombiting me rabidly if I tryto get an

858 association with Jonathan Mann. We are already sponsoring a Jewish Bioethics

859 meeting with Allegheny. Arthur Caplan Acadia Institute Study of Bioe thics inAm e rican Socie ty page 42

860 FOX: Believe it or not, you could also get Jonathan Mann into your Jewish Bioethics

861 meeting because he is profoundly interested.

862 CAPLAN: Is he? I didn't know that.

863 FOX: I believe he has a brother who is a rabbi. But in any case, just to go back to the

864 Harvard model again, the reason I mentioned public health is not just to drop the

865 name of Jonathan Mann. Arthur Kleinman's current activities at Harvard tum

866 around interviewing people intensively, certain key people, about what he thinks

867 they are doing in social medicine. Charles Rosenberg has been one of his key

868 informants. He is also interviewing David Rothman. I don't know what the

869 model is that he seems to be going with--he is the Chairman of Social Medicine. It

870 needn't be called social medicine every place but definitelyPenn, not only what

871 you're doing but with what Charles Rosenberg is trying to do and so fo rth, is

872 moving in that direction too, in another way. Arthur's whole configuration, which

873 is this integration of bioethics and social science with medicine is called social

874 medicine. I don't know what that bespeaks.

875 CAPLAN: I wouldn't be surprised at Penn if there wasn't a Social Medicine Division, to tell

876 you the truth, at some point.

877 FOX: This patternseems to be sort of a public health-social medicine pattern of the

878 nineties. I don't know exactly what but there's something going on

879 independently, in different locales.

880 SWAZEY: BU's been doing it for quite a while. Arthur Caplan Acadia Institute Study of Bioethics in American Society page43

881 FOX: Yes, but that would be a vintage model.

882 CAPLAN: This isn't in response to your question, but another program that I think could

883 evolve is Utah.

884 FOX: Is Margaret Battin a Mormon?

885 CAPLAN: No, she's actually a Quaker too. She comes from Philadelphia. She went to Bryn

886 Mawr. There's a middle-aged, law professor there named Leslie Francis who's

887 very good and works with Margaret. Jeff Bodkin is there in genetics. I don't

888 know if you met him. But there is something happening there that might tum in

889 to something down the road. It still remains the case that opportunities in the

890 West are there. Baylor, under Brody continues to grow and produce things. I

891 think they're a serious place fo r the future. I think there's this Health Law

892 Institute at UT Houston, I guess it's called, under Rothstein. It seems to be doing

893 pretty well. It's got more of a law fo cus than it does ... You know, Kleinman's

894 program in social medicine is to bioethics as Rothstein's program in health law is

895 to bioethics which is law, with the kind of interest in bioethics questions and not...

896 It's not bioethics but it's a cousin.

897 FOX: Let's put it this way, Arthur has to take into account bioethics.

898 CAPLAN: Right.

899 FOX: This is one more time of trying to do what Harvard has never been able to do. But

900 on the other hand, when you keep talking about bioethics as a synergistic

901 influenceyou can't make moves like this any more without factoring bioethics in Arthur Caplan Acadia Institute Study of Bioethics in American Society page 44

902 to this.

903 FOX: Where is bioethics now? You know, this whole issue of "What is bioethics?" Is

904 it a discipline?

905 CAPLAN: You can't ask me that yet because I have to tell you one other phenomenon. The

906 international presence of some programs. I think that the Maestricht program in

907 Holland continues to thrive. When you said, what's in the future? Something's

908 cooking in the Dutch bioethics centers. They are at Maestricht, at Leiden, there's

909 probably fo ur or fiveof them that are doing interesting things, have lots of people.

910 I hear from my friend at Stockholm that the Swedish thing is going to gel. There

911 was a furtive attempt to get something going at Oslo under Ryder Lee. It kind of

912 fe ll apart because Lee wasn't a good leader but it's not dead.

913 FOX: In France, it's too much under the government's....

914 CAPLAN: Still, Britain has Manchester and this new, what do you call it, where Chadwick is

915 there? Central Lancashire.

916 FOX: Also, University of London and Ian Kennedy. What is going on in England is not

917 so much identifiable institutionally, but I had the sameexperience last year at

918 Oxford. Everything that I do is defined as ethics, and wherever you go that's what

919 people want to hear about.

920 CAPLAN: Something's cooking there and something is going on at the University of British

921 Columbia. There's a guy named Mike Burgess who is starting up a program there

922 at Vancouver. The Australians have activities. I actually think there's going to be Arthur Caplan Acadia Institute Study of Bioe thics in Ame rican Socie ty page 45

923 the creation of some influential program in Japan in the next five or six years; just

924 again, the number of visitors, government, kind of welcome-like interest on the

925 part of some foundations. Although the current financial situation may set them

926 back a little but something is going to happen in Japan too.

927 FOX: Isn't there anything like a guest book at Hastings, for example, where people

928 signed who came to visit fromother countries?

929 CAPLAN: No guest book, but you know what ¢ey did keep, they kept their calendars and

930 logs.

93 1 FOX: Usually everybody in bioethics, no matter where they were on the face of the

932 globe, at a certain point came through both Kennedy and Hastings.

933 CAPLAN: I have a story to tell you about that. This isn't of particular interest, it's just really

934 funny. A Japanese visitor shows up at the Hastings Center in 1984. It's a summer

935 day. I'm there literally in a tee shirt, old football jersey, shorts. No one's in the

936 place. These Japanese guys come, 20 of them on a bus. No one's there, the place

937 is almost closed and so the secretary says. "Do you want to come down and meet

938 them?" I'm just in casual attire and that's a generous description. My dog is

939 there. I'm running around the back of the building. So I go down. They are

940 saying, "Please, ifyou could take the time to meet us ..." Nineteen of them are

941 nodding. This one guy translates a little bit. I said, "Pleased to meet you ..." They

942 say, "You've done tremendous work. . .tremendous work!" I'm saying, "Yes, I

943 know that. ..." He said, "Yes, you've chaired the President's Commission and Arthur Caplan Acadia Institute Study of Bioe thics in Ame rican Socie ty page 46

944 you've written this wonderful book with the Professor Katz ..." I say,

945 "Ah... ummm ... well yes, those are very important works." He said, "Yes,

946 Professor Capron ...." (Laughter) He said, "May we take your photograph?" I said,

947 "Absolutely!" So there are these twenty little guys and me in my fo otball thing,

948 and the dog and the whole bit. They take pictures and leave and I know all over

949 Japanese Medical School somewhere there are pictures of Alex

950 Capron ...(l aughter).

951 FOX: Do you have it up in your study at home?

952 CAPLAN: I wish I could've! That's true, that's a true tale!

953 SWAZEY: About the same time, a Japanese delegation came to Bar Harbor to talk to me

954 about transplantation and death and dying with their video cameras and spent a lot

955 of time outside filmingmy house, and inside filmingmy dogs. It was a whole

956 day!

957 FOX: I want to make one comment on the international presence just for the record. I

958 see this as problematic, not because it's competitive. But I see the American side

959 of the agenda, for example, when I see the way we're dealing with physician

960 assisted suicide in Holland. It is the same model as our being completely

961 oblivious to the fact that the Netherlands is a particular society and culture. Even

962 if you see the role ofthe psychiatrist, if you don't understand what Catholicism is

963 in Holland and what Protestantism is in Holland and a whole series of things, it's

964 completely bleached out so that it's called a Dutch model, but nobody knows Arthur Caplan Acadia Institute Study of Bioe thics in Ame rican Socie ty page 47

965 anything about Dutchness. And with all these diffe rent things, if this gets to be

966 important we're going to have to do a lot of work.

967 CAPLAN: I'm going to tell you something frightening though. You know Jack Geiger. He

968 showed up the other day. I've known Jack for a long time. He said, "you know,

969 I'm an outside adviser to this committee on reconciliation and so on, in South

970 Africa. The medical schools have asked me to make a pilgrimage to Penn to ask

971 you if you would come and bring bioethics to South Africa, if your Center would

972 do this. There's no professional guys, there's no nothing." So I'm thinking, we

973 don't know anything about South Africa, we'll just go and infuse them. I mean,

974 people coming out of the hills with spears and we're telling them, "Yes, you must

975 have a written thing."

976 FOX: Well, you could. Not that you have the spare time to do it, but if you get an

977 opportunity to do it in the way that you think is a really important mission ....

978 CAPLAN: We might do this but we're going to do it as a learningthing.

979 FOX: What I would do ... it's very relevant to the way I'm trying to think about Doctors

980 Without Borders and Doctors of the World. I start out with the assumption that if

981 you go in and do human rights witnessing and medical humanitarian work, it is

982 going to be less good if you don't know anything about the society and culture

983 that you go in to. And yet, on the other side, when I begin to think about what a

984 difference it would have made, when these people went to Somalia, if they had

985 read everything that Evans Pritchard had to write about the clan structure ... I'm Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page48

986 not sure . . . l believe what I believe, but I'm ready to examine what difference it

987 makes. I would take on a job like that and I would assemble a team with, first of

988 all, people who know something about Central African culture, and who know

989 something about South Africa's history in particular.

990 CAPLAN: My only point in telling you this was because they were begging fo r your

991 nightmare. They wanted a direct export of American bioethics, culture free.

992 FOX: If you get a really interesting opportunity and one where you could make a

993 tremendous moral difference in the society to do it, you just tell them you have

994 another model that you want to try. If you do it, I want to go too because this

995 really is the whole business of talking about integrating social and cultural

996 understanding into bioethical thinking.

997 CAPLAN: It would make a great lab experiment actually.

998 FOX: Yes, and to examine the difference it does or doesn't make to have this kind of

999 cultural understanding. Not just understanding, real knowledge.

1000 CAPLAN: So, do you have to go overseas was your question. No, but let me say this, I do

1001 have a whiny complaint about a Fox-Swazey thesis. You don't want to over-

1002 Americanize bioethics by not asking for any input from the Europeans. You make

1003 it look weird, weirder than it might be. I don't think you have to visit. But there

1004 are times when some of the Europeans are here fo r conferences that you could talk

1005 to them, or at least e-mail some of them and say, "Give me your impressions." I

1006 think its future is internationalizing .... Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 49

1007 SWAZEY: Unfortunately, Art, looking at the internationalization ofbioethics is beyond the

1008 scope of what we can do in this proj ect.

1009 CAPLAN: Yes.

1010 FOX: We're just talking about this as a phenomenon. I think in the Principlism book

1011 that Park Ridge did, it was very fruitful to have those thinkers fromthe different

1012 countries actually offering their critique ofAmerican bioethics. The problem that

1013 besets bioethics in this regard, which we didn't pick up at the time, is the terror

1014 that so many ofthe people in the field feel about what they call "cultural

1015 relativism." And the fact that the minute you begin to factor in any recognition of

1016 social and cultural and historical differences their whole commitment to universal

1017 human principles is shattered. As if you have to either choose between saying

1018 everything is relative or the thing you don't believe in, which is some kind of

1019 doctrine that is eternal....

1020 CAPLAN: I believe that is why cultural difference or history has never troubled me so much.

1021 I never believed in science either. If you were going to ask me, sort of, why no

1022 foundationalism? In some sense, putting aside personal autobiography statements

1023 about religious skepticism or life experience. I would say intellectually, coming at

1024 bioethics froma science point of view, I've always been pretty leery of

1025 fo undationalism. Foundations shiftall the time. I'm not going to say that

1026 Newtonian physics doesn't form a foundation, as I understand it, for engineering

1027 and mechanics, but it has evolved. It's not a static theory. I've never seen a static Arthur Caplan Acadia Institute Study of Bioe thics in Ame rican Socie ty page 50

1028 theory in science.

1029 FOX: Do you have to deal with fo undationalism in genetics at the moment?

1030 CAPLAN: I actually believe that the picture of genetics that is out there, sort of one gene, one

1031 trait type stuff, will not endure fo r long. To tell you the truth that is an artifact of

1032 mapping enthusiasm. It's not even a theory, it's just a correlations phenomenon.

1033 The last vestige of fo undationalism in intellectual life is in ethics. It's very bizarre

1034 but there it is. The drive is there and it's still taught that way: you need a theory to

1035 operate out from and that theory has to be eternal and timeless and true. That is

1036 going back to its older link to religion. Again, I would be happy to hearthe

1037 announcement of what this theory is. I just don't believe that intellectually that is

1038 the right base.

1039 FOX: That leads me to the question I've been trying to ask that I don't expect you to be

1040 able to answer in five minutes: the whole question of what bioethics is froman

1041 intellectual point of view. It is easier to look at it from the point of view of

1042 institutional development. Since it is multi-disciplinary, since it doesn't have,

1043 except for a certain kind of reductionistic version of analytic philosophy, it

1044 doesn't have an over arching shared conceptual framework. Since it isn't

1045 embedded in, even from the point of view of institutions, a department of

1046 bioethics and so forth, or Ph.D. in bioethics, what is this thing?

1047 CAPLAN: Well, you know, it's funny, I have a thought about that and it comes back to an

1048 older intellectual puzzle. Ask that question about what is evolutionary theory. Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page51

1049 Evolutionary theory, in one sense you could say, is natural selection plus some

1050 assumptions about genetics. You could say that but you'd be completely wrong.

1051 That's not what it is. It's not really a theory. Evolutionary theory is the

1052 combination of a bunch of theories that try to explain the phenomena of evolution.

1053 Some are morphological, some are developmental, some are genetic, some are

1054 actually physiological, some have to do with gene flows and population, some

1055 have to do with molecular biology. That's what bioethics has always been to me.

1056 The vision that I bring to it is, it's not a theory, it's a field likeevolu tionary theory

1057 lS.

1058 FOX: It's not a discipline either?

1059 CAPLAN: I don't think it's a discipline. I actually think it's a collection of theories and

1060 perspectives that are trying to explain a common set of problems. I think it's a

1061 mistake to see all of science as theory driven. Big areas of science are field

1062 driven.

1063 FOX: But as the model of consolidation and perpetuation and creating still new people

1064 to the field gets more and more embedded in the university, it does present an

1065 interesting problem. Because, in terms of configuration of the university, it has to

1066 fall between all these different. ..

1067 CAPLAN: Again, not to beat this analogy to death but evolutionary theory is this problem of

1068 where you teach it from. Who owns it? There's sometimes programs that are set

1069 up on evolution and behavioral biology, but they don't do well. It gets odd Arthur Caplan Acadia Institute Study of Bioethics in American Society page52

1070 because somebody says, "Where's the genetics guys?" In evolution you're just

1071 standing in a pond up to your hip waders looking for which fish live and which

1072 fish die. The study of evolution, just take that one example, although I think this

1073 has analogies for things like cognitive science or other things, it actually doesn't

1074 take place in disciplinary places. Some people are taking aspects of it to their

1075 genetics department. Some people take aspects of it and study it in their

1076 agricultural sciences. Some people do it and are making contributions over the

1077 behavioral sciences end. They may not even talk to each other but the field moves

1078 in a funny way because it's got disciplinary things flowing out...

1079 FOX: Should it be called bioethics at this point?

1080 CAPLAN: I think of it as a field, and what I mean by a fieldis it has sub-disciplines or sub-

1081 areas, clinical ethics, social medicine, history .... Things that should be driving it,

1082 but it's a place that is rooted by a common domain of problems. That's how I

1083 conceptualize it. The problems being the ones we all know about: should you die

1084 now, and should you take blood, and should you get a transplant, and should you

1085 pay for this ...

1086 FOX: Frankly, I don't know when I'm doing bioethics and when I'm not. Do you?

1087 CAPLAN: I do. Yes, I can tell pretty quickly. Sometimes you're studying bioethics but

1088 sometimes you're in it. If you read that paper about the retransplant phenomenon,

1089 for example, that's bioethics to me because it's offering a commentary about a

1090 particular problem set that is definitive of what the area is. Arthur Caplan Acadia In stitute Study of Bioethics in American Society page53

1091 FOX: That's true. There's nothing particularly sociologic about that.

1092 CAPLAN: No.

1093 FOX: Except in the observation which you also made in your masterful article, that if

1094 you look at this from the point of view of the lived experience of the transplanters,

1095 it is problematic for them to let go and...

1096 CAPLAN: Right. ..abandonment is not good. (Laughter) You know that and I know that and

1097 that means as a sub, sub, sub-problem, within the zone of interesting issues in

1098 transplant, the abandonment question and the loyalty to the patient...

1099 FOX: But that's more into social science in a way.

1100 CAPLAN: But they're there and that's bioethics to me. So to me it's the problem drive.

1101 You'll hear me say time and again, "Who cares what fieldthey come from,"they

1102 have interesting things to say about the problem. Well, to me, the definition of the

1103 fieldis the problem drive. I know I have an iconoclastic view about this because I

1104 don't think, by any means, that this is the dominant view of what bioethics is. But

1105 my quirky view is shaped by this early science experience of mine, trying to think

1106 about things like how would you test evolutionary theory? And in one sense there

1107 are tests of evolutionary theory, you can see moths go from black to white, or

1108 somebody does something that shows that genes shiftin a population. In another

1109 sense, that's kind of stupid to say that's a test of evolutionary theory.

1110 FOX: But there are things going on here that wouldn't be going on in evolutionary

1111 theory if you say that strictly on the intellectual level it works. You do not have Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page54

1112 the institutionalization of institutes of evolutionary theory.

1113 CAPLAN: The closest you get is the museums, like the Museum ofNatural History, that's as

1114 close as it gets.

1115 SWAZEY: I think a better example for science is neuroscience, maybe because I studied and

1116 wrote about it.

1117 END OF SIDE ONE (INTERVIEW #2, TAPE 2)

1118 SWAZEY: In a sense, Kuhn might say neuroscience is preparadigm, and you might say the

1119 same about bioethics.

1120 CAPLAN: Normally I get tired of paradigm talk, I don't know what the hell they're talking

1121 about. In one sense, if you take the notion of paradigm as Kuhn had it, a field of

1122 intellectual enterprises hang together around key problems. They hang together

1123 around key solutions or demonstrations. For him, part of what physics is is you

1124 do pulley problems and you show mechanics problems and you show how fluids

1125 move. I think bioethics actually has some of this too. It has its key solutions.

1126 Here is what we do when a parent wants to refusetreatment, and these are the

1127 steps you take. And here is what we would say about the classic paradigmatic

1128 case of telling the truth to the patient. It is not that there is no consensus; we have

1129 our standard problem sets that we think we've solved. But it's not based on any

1130 theory, it's based on both, that's where the germ of truth about the casuistry stuff

1131 is. The casuistry tradition is showing you do use examples, you do use

1132 paradigmatic cases, you do reason by analogy frequently. I agree with all that. I Arthur Capl an Acadia Institute Study of Bioethics in American Society page 55

1133 think that's one slice of it. Is there a theory ofbioethics? I'd faint if there was

1134 such a thing. Is there a theory of consent? Probably that's one sub-area. Is there

1135 a theory of equity about distribution of certain kinds of resources? Probably.

1136 Could you formulate a theory, if you wanted to, about personal responsibility?

1137 Maybe. But there's no common area ...

1138 FOX: There's at least one way that this differs from any ofthe scientific analogies and

1139 that is there is a whole set of problems which can be considered to be irreducible

1140 dilemmas but that are not soluble. That's not the same thing as uncertainty in

1141 science when you haven't yet solved something.

1142 CAPLAN: I'll fight withyou even there because what I'll say is this: if you look at geology,

1143 archeology, even parts of anthropology, they too are unresolvable in fundamental

1144 ways. I have my theory about the evolution of cities or the origins of metallurgy

1145 or something like that, but I'm never going to prove this. I'm just going to spin

1146 tales that seem understandable and plausible, they're scientifically done. I can't

1147 just make them up, but the solution to understanding certain things in historical

1148 science is just lost.

1149 FOX: The mysteries that science screens out, let's say we know precious little about

1150 embryology at the moment, as to how a developing embryo knows to form a hand

1151 or whatever. Presumably one could eventually know a lot more about that on a

1152 scientific level but as to the mystery of knowing, I mean, what is it in the universe

1153 that accounts for this kind of order? Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page 56

1154 CAPLAN: But that's a different type of epistemological problem. I understand what you're

1155 saying. In bioethics certain things are recognized, you might say, as ontologically

1156 in dispute.

1157 FOX: That makes it sound so unethereal.

1158 CAPLAN: But fundamentally, some people like A and some people like B. I'm just saying

1159 that we deal with uncertainty of a diffe rent sort, what I would call as a

1160 philosopher, epistemic uncertainty in the historical sciences because the data is

1161 gone. You're never going to prove to me that you really understand how

1162 civilizations evolved in archeology. You won't. You're never going to prove to

1163 me you understand human evolution. You won't. You'll give me stories that I

1164 think are okay and that might be true, and I actually think that's true of

1165 cosmology. I think that it's irreducibly disputable. I read it with some interest

1166 and I think that's all interesting but I don't think the level of disputability is any

1167 the less than bioethics carries. Although I would agree that the source in the

1168 sciences is the loss of data. In ethics it may be fundamental value disagreement. I

1169 understand that but they're still dealing with...

1170 FOX: Cosmology is a good case in point because ifyou push scientificcosmo logy hard

1171 enough you get religion.

1172 CAPLAN: Right. I mean, you're stuck there, and if you push theology hard enough you get

1173 stuck there too. You sort ofwind up saying, "Well, there are these plates ..."

1174 FOX: What I'm saying is that all this is probably too esoteric for writing about bioethics Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page57

1175 in the way we will. But I really fe el that whereas the sciences can push that out of

1176 their frame, bioethics is more stuck with those questions. We've tried to do that

1177 too, haven't we? Bioethics has tried to do that too. Fundamentally, the issues

1178 about...

1179 CAPLAN: I wouldn't disagree. What I'm saying is the level of disputability is the thing,

1180 even though the source in bioethics might be more fundamentally that you and I

1181 just don't agree about that. Which leads me to one other dispute about how

1182 bioethics works. Mcintyre, Englehardt, libertarian traditions, Zeke Emanuel

1183 carrying it forward now, to some extent, Troy Brennan would be modem

1184 examples. There is a view afoot that says that we can't do bioethics, or what is

1185 bioethics in a society that has no consensus. How could you do it outside of

1186 community? I mean, Tris, who we haven't even commented on, has run offto

1187 Greek Orthodoxy now to findsome roots or values that he can cling onto. I think

1188 this is, again, completely wrong. And the reason I think so is this; I think

1189 bioethics does have something to root it; it's not ethereal, it's not even an

1190 agreement that there's some fundamental values thing out there in some

1191 metaphysical sense. What roots it is the very pragmatic nature of medicine. If

1192 you take medicine seriously, it is a community. I mean, very few people come in

1193 who don't want to fe el better or functionbetter, or get to certain goals that

1194 everybody agrees on. There are people who stay out. Jehovah's Witnesses might

1195 with blood or Christian Scientists might, or I don't know, people might just not Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page58

1196 like medicine and stay away from it. But it is unfair to say that the object of your

1197 study, if you took it as medicine, doesn't have goals and purposes. And they do

1198 drive what goes on. I never fe lt bereft of being able to say to somebody, "Wow, if

1199 you're trying to make this person fe el better then you should talk to them as part

1200 of their treatment because you're ignoring that." It's part of that engineering

1201 ethics type of thing . Well, let's treat them decently or at least pay attention to

1202 courtesy or humaneness, but we all knew what we were trying to do. We were

1203 trying to get the guy's kidney to function again or at least replace it or something.

1204 When Tris says, there's no basis for findingany agreement ever, I say, go walk in

1205 the hospital door. If the guy's arm is over there and the rest of him is over here,

1206 he wants it put back with the rest ofhis body. If you break your leg, you want to

1207 be able to be mobile again.

1208 FOX: Does that come from your pragmatic philosophy orientation or does that come

1209 from a kind of inductive thing fromworking in the field of medicine?

1210 CAPLAN: Both. A lot of the philosophy of science stuffgot haywire by only studying areas

1211 like theoretical physics as exemplars of science. There you'd think you'd never

1212 be able to prove anything for the reasons we were just talking about with

1213 cosmology and so on. Well, if you just take a different vision instead of engineers

1214 and call them scientists, or veterinarians and call them scientists, or take people

1215 who study agriculture and call them scientists, then you realize that another way to

1216 findout if the theory is true is if it came fromthe crops. Lysenko was wrong, he Arthur Caplan Acadia Institute Study of Bioethics in American Society page59

1217 couldn't fe ed anybody with his theory. This is a very important fact. One of the

1218 things that rivets me about medicine as a science, when I put on my philosophy of

1219 medicine hat, is how do you test out certain things. After all the social

1220 construction is done, all the commentary is done, if the guy's still coughing,

1221 you're wrong. You ain't got it! A lot of science doesn't have this, but medicine

1222 does and it's that aspect of medicine that drives the ethics. In terms of saying,

1223 "Yea, you can root to this," I don't say, "You can't solve the fundamental

1224 disagreement of, is medicine a good thing." Or should I want to be healed as

1225 opposed to be a mystic or should I want to be healed as opposed to having

1226 communion with the Divine. I don't know, but if you're in medicine and you've

1227 decided vomiting is bad, and you don't want to do that any more, which most

1228 people do when they get to the doctor, that then sets a values direction for a lot of

1229 instrumental values to be used about how to make you cared fo r as we try to fix

1230 your vomiting.

123 1 FOX: It seems to me that given the extreme position Tris Englehardt once took in regard

1232 to analytic philosophy, you can't live with that. It's interesting to see how people

1233 are converted. In his case, he's been VERY converted. He was the embodiment

1234 of the most extreme and the most elegant fo rm of analytic philosophy which is

1235 almost terrifying. I was frightened by him in his other guise; maybe I'd be

1236 frightened by him in his Greek Orthodoxy guise too. I don't know. But on a

1237 sociological level, one of the most interesting questions, closer to Englehardt, that Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page60

1238 does not seem to be resolvable as yet, is how does an entire societal community

1239 achieve consensus about some of these very large questions that bioethics is

1240 addressing? Whether it's abortion or physician assisted suicide or assisted means

1241 of reproduction, none ofthese questions on that level go away. Even ifyou get

1242 the Supreme Court to rule on it, it doesn't resolve it.

1243 CAPLAN: They don't, but there I'll challenge you in a different way. True enough about

1244 assisted reproduction. True enough about genetic engineering. True enough

1245 about a host of things about where do we want to go. Not so true about, "do I

1246 want the doctor to speak in a decent way to me when I'm in the waiting room."

1247 And so what you'll see me sometimes push is about the ethics of everyday life, or

1248 the ethics ofthe mundane. You can go crazy. It's almost as ifyou said to

1249 physicists or engineers, "Well, you know, we don't know what fundamental

1250 particles are. We haven't figured out what quarks are. We don't know really

1251 what the constituent matter of the universe is. So I guess we can't build any

1252 bridges today." But people are building them all the time, and they don't even

1253 know where the bridge is supposed to go, but they throwup buildings and build

1254 bridges. It seems to me that if you immerse yourself in the culture of medicine,

1255 you can't help but notice that a lot of day to day interactions do eventuate in

1256 solutions that people are happy with or satisfiedwith. And there are a set of rules

1257 and principles about how to make that go.

1258 FOX: On that level. Arthur Caplan Acadia Institute Study of Bioethics in American Society page61

1259 CAPLAN: And that's the rooting part that you lose ifyou just struggle with abortion all day

1260 or how many babies should we make or should we genetically engineer ourselves.

1261 I mean, I'm happy to make a living out of torturing people to thinkabout those

1262 things, but you go to the nursing home and the lady says, "Why do they have to

1263 wake me up for breakfast ifl don't want to eat it everyday?"

1264 SWAZEY: In some ways, to me, those everyday ethics issues are more interesting.

1265 CAPLAN: They're equally interesting. I don't know about more but they're equally

1266 interesting. But you could darnwell answer a lot of those. You could say, "Stop

1267 waking her up !" It's like a gross violation of her self-determination. Is self-

1268 determination a fundamental good for all eternity and every culture? I don't

1269 know. But fo r this lady, in this home, at this time, given her contextual place in

1270 the world .. .it is! You say you are here to serve the patient. Well, she does want to

1271 get proper care for her diabetes or whatever it is but she also doesn't want to get

1272 woken up for breakfast. So stop it! I think Tris misses that, or they lost it, or a lot

1273 ofbioethicists haven't connected with these issues. But a lot ofbioethics also gets

1274 put on its plate. What do we do about genetic testing or where should we wrestle

1275 with brain death, or....

1276 FOX: But that term I despise in philosophy, not because I think there is anything

1277 inherently wrong with it, but because I think we need better language than the

1278 slippery slope thing. What worries me about this level is that by resolving a

1279 number of these issues on that level, cumulatively and inadvertently one may be Arthur Caplan Acadia Institute Study of Bioethics inAmerican Society page62

1280 moving along on a larger plane in a direction that is not one that you either

1281 intended to go in or is desirable to go in. I don't know who is keeping book on

1282 that.

1283 CAPLAN: A lament for me, a personal lament, if people look at my work they tend to say, "I

1284 see the visible Art Caplan, or I see his writing." So you haul the guy's CV out and

1285 there is an enormous body of writing about all sorts of things. Then people say, "I

1286 know Art best for his transplant work; it has been very interesting over the years

1287 what he's had to say about cutting edge issues in human experimentation." But

1288 they rarely will actually see that half the stuff in there is about rehab or nursing

1289 homes or home care stuff. It's not an accident. To me they are the most

1290 interesting places of all because it's the place where you can use the consensus

1291 points about what ordinary people and ordinary actions want out of health care. I

1292 think if you just spend all your time with the dilemmatic or the cutting edge of the

1293 tertiary care, then you do fe el ruthless or you fe el it's all hopeless. I don't believe

1294 that. The lament is that that stuff isn't very sexy. Who wants to say, "Should we

1295 give Mr. X a bath?" In one of my books on everyday ethics I have about three

1296 case studies on "Should we give Mr. X a bath?" Different things about, can you

1297 refuse a bath as medical treatment? That sort of question. They get answered. I

1298 thinkthat part of the despair about bioethics is it's not just a question of where are

1299 its big theories or where are its foundations. It's also this tendency to go towards

1300 the action packed adventures on the frontiers or the high tech stuff. Bioethics also Arthur Cap lan Acadia Institute Study of Bioethics inAmerican Society page 63

1301 has a core set of things, its home base that you see when we try to teach those

1302 students in the first year intensive course that we do. Don't talk in the elevator,

1303 and you should ask the patient how they want to be addressed. It's not very

1304 dramatic but that's there too. Part of that is the common problems that we've got

1305 answers to. You will address them according to how they want to be addressed.

1306 I'm oftensaying, "Did you knockon the door before you went in there?" That's

1307 back to the engineering ethics thing too. I don't know what theory this comes

1308 from but I will tell you fromthe problem set.

1309 FOX: That stuff antedates bioethics.

1310 CAPLAN: Sure! There are rules of etiquette, there are rules of professional demeanor, there

1311 are thoughts about how to resolve many of these things. They may be good or

1312 bad, they have to be understood. I think part ofbioethics' dilemma is that it gets

1313 pulled so hard toward headless clones. I love talking about that stuff. My lament

1314 is that bioethics only becomes that stuff and that has a very distorting impact on

1315 what people think. It's as if you did nothing all day except talk to theoretical

1316 physicists who are puzzled about foundational matter questions. And you never

1317 met engineers who actually succeeded in building a road or knocking up a

1318 building. You'd say, "Oh well physics, God, that's a mystery that has no theories,

1319 no agreement, fundamental disagreements. Physicists just don't know anything

1320 and clearly they couldn't solve anything." Meanwhile, there's a whole bunch of

1321 people who aren't worried about any of those questions. They're worried about a Arthur Caplan Acadia Institute Study of Bioethics in American Society page 64

1322 set of things where they've got answers. You may not like the design of the

1323 bridge but they can build one. You can critique it. It might fall down. And that's

1324 how I fe el about bioethics.

1325 END OF TAPE (INTERVIEW #2, TAPE 2)