from time to time raised with me, who are closer to my age and are like my...

Transcription

1 Acadia Institute Project on Bioethics in American Society Thomas Murray, PhD, /0/98 November 0, 998. Interview with Thomas Murray, PhD, Professor and Director, Center for Biomedical Ethics, Case Western Reserve University. The interview is being conducted by Judith P. Swazey at the Westin Galleria Hotel, Houston, Texas, during the first meeting of the American Society for Bioethics and Humanities. Swazey: Start by giving me a little family background. I know you grew up in Philadelphia. Murray: Sure, I was born in South Philadelphia. My mother was conceived in Italy and born in the United States. My grandparents were from the Abruzzi region, the mountains of central Italy. My father was oflrish descent. The met at a dance. They're still excellent dancers. 7 8 Swazey: Does your family still live in Philadelphia? 9 0 Murray: My extended family all lives around Philadelphia. Few actually live in the city now. Particularly the Italian family has been very close. They were raised around my grandparents, even lived with my grandparents for a few years. Swazey: Do you have siblings? Murray: I have a sister, Donna, who is about 9 years younger than I am. I have cousins who were 7 from time to time raised with me, who are closer to my age and are like my... 8 particularly the two oldest daughters of my uncle... are like my sisters.

2 page Swazey: You really have an extended family. Murray: I've remained very close to them, yes. Swazey: What were your parents occupations? 7 8 Murray: My mother graduated from parochial high school in South Philly and became a 9 secretary. She's done some other things. She left the workforce to raise me and my 0 sister through my sister's early childhood, then she went back to work as a teacher and she was a secretary in a guidance office in a high school for the last years or so. They live in South Jersey now, it's a suburb ofphiladelphia but it's across the border. They've lived there since I was actually. She just retired about a year ago. As the superintendent of schools said, she came to work at an age that many people were thinking of retiring and she retired just because she said she felt guilty that she was taking a job that some young people might really have wanted. 7 8 Swazey: Self-imposed ageism. 9 0 Murray: Yea. My father left school in 7th or 8th grade. Had a variety of jobs. He had a newsstand in Center City Philadelphia. He worked in a news store, cigar store, or

3 page something, some place in the city for awhile. He loves to tell the story about when he applied for a job and he had to give references and his references were people like the Commissioner for the National Football League, the Conductor of the Philadelphia Orchestra, but they were all his customers! Swazey: That's great! They probably gave him glowing recommendations. 7 8 Murray: I think his prospective employer didn't believe he even knew these people. My dad got 9 a job at the Philadelphia Navy Yard and became a machinist there. He was proud of the 0 role he played in helping to build some of the ships that fought in the second World War. His hearing was damaged as a child and he couldn't qualify for the armed services. He got a high school equivalency degree there and took some courses at Drexel University in Philadelphia, at least few courses there. He was a machinist then he became a civilian inspector for the Navy, an inspector of things companies would manufacture for the Navy. That's the work I really knew him doing. I was sort of aware of what he was up to. 7 8 Swazey: Were you raised in a religious tradition? 9 0 Murray: My folks are Roman Catholic.

4 Swazey: Did you have a Catholic upbringing? Thomas Murray, PhD, /0/98 page Murray: I went to years of Catholic school, first grade through high school graduation. Swazey: Has that influenced your thinking in any way? 7 Murray: Yes, how could it not? Whatever we're raised in influences us, whether it influences us 8 to embrace or reject whatever it is we were raised in. 9 0 Swazey: How has it influenced you? Murray: I see much that is beautiful in that tradition. I have respect for people who have religious convictions. I'm not, myself, especially religious. I also see what could be... I hate to say... since this will appear in print... Swazey: You'll have the option of editing the transcript. 7 8 Murray: There are, at times, oppressive elements in religious traditions. The Catholic Church's 9 attitude towards women, in particular, and to some degree towards sexuality, is 0 regrettable.

5 page Swazey: What headed you into social psychology? Murray: I have to tell you one other story about my upbringing. My dad was also a watchmaker. To earn extra money on the side, he became a master watchmaker and, in fact, still does it at age 8. 7 Swazey: That's great. That's a vanishing skill and craft. 8 9 Murray: Absolutely. He teaches watchmaking at a community college and has for years... 0 Swazey: That's great. Murray: He loves it. It turns out, by the way, that my maternal great-grandmother was LaMaestra in Bomba, a little village in Italy, so teaching is in our blood. And I'll tell you one thing about religion and culture. It was kind of a joke in South Philadelphia where I was growing up that when the child of an Irish family entered a religious order, 7 there was a celebration. And when the child of an Italian family entered a religious 8 order, there was mourning. 9 0 Swazey: So, Tom Murray the social psychologist.

6 page Murray: Right. How did that happen. I was, like a lot of kids in Philadelphia with no family experience in higher education, I didn't really think broadly about choices, I actually went to Temple University which was a starting place for many first generation university students in that area and I actually had a terrific experience there. I found some indifferent teachers but I found some wonderful teachers. I was so damned curious and eager to learn, I think, that faculty took to me and I had several faculty who 7 really took a personal interest in me and encouraged my intellectual development. One 8 gave me a job in a biology laboratory. That's how I earned the money I did, working 9 part time both during the school year and then in the summers through college. I 0 checked coats for awhile but once I got the job in the biology lab, I took that instead. One of the people who took me under his wing was a social psychologist, a man named Bob Lana, he was an inspiring teacher. He actually thought philosophically, not just as a data gatherer. This was the 90s, mid- 0s, and the war was already hot and getting hotter. I had always been, to say fascinated isn't right because that implies a kind of intellectual thing, I'd always been deeply moved by social issues, by things like racism, by injustice of any kind. I know it sounds corny, but it's the truth. 7 8 Swazey: That doesn't sound corny at all. 9 0 Murray: Those things really matter to me. When I went to Temple, it seemed to me that the best way I could find to try to deal with those kinds of issues was to understand them as

7 page 7 social phenomenon. And the best way to do that, that I could see, was by becoming a social psychologist. If you read the text books of the time, at least the way I read them, that seemed to be the field that was trying to address racism, injustice, prejudice; it attempts to persuade people, so that's the field I thought I wanted to go into. Swazey: What did you see yourself doing as a PhD social psychologist, as you were getting your 7 degree? 8 9 Murray: As I said, I had been extremely fortunate to have had some really inspiring teachers. 0 They made a big difference in my life and I thought what could be better than to become a teacher. Quite frankly, I've never had a reason to regret that choice. So I wanted to be a teacher and I thought I could say some useful things, learn some useful things about what struck me as the things that diminished or pinched people's lives. So I wanted to get a PhD in social psychology and then go on. My idea, I guess, was to do research and teaching. Of course then I went to Princeton to graduate school and unfortunately the image of social psychology which I had garnered from the text books 7 only had a vague resemblance to social psychology as I learned to do it at graduate 8 school. You've probably heard the story. I did a research project around the end of my 9 first year or the beginning of my second year in graduate school. It's what one did at 0 Princeton in social psychology in those days to sort of qualify for the PhD level and you could get a masters. When you finished that, you could pay bucks and get a

8 page masters. I didn't have the bucks so I never got the masters. It was either have the piece of paper or buy food, so I bought food. I had a child at that point, a wife and child. The research involved deception, creating a phony accident and varying the conditions under which people witness this and then seeing if the responses were measurably different as a function of the differences in the situations. My job was to meet the people, set everything up, and then debrief them afterwards. This was a searing experience for me. The experiment was very well defined, it was in a very highly regarded tradition in my field, done by very fine people. My professors were wonderful people, I remain very fond of them to this day, but I couldn't do this work. I mean, I did it, I finished the study but I found that I couldn't do it anymore. It seemed to me I couldn't defend what we were putting these, basically 8, 9, 0 year olds through, without, of course, telling them what we were going to put them through. We mislead them about what they were going to witness. Swazey: Hence, some of your first papers on deception research. 7 Murray: My very first paper, the very first thing I ever published was on deception research. I 8 wrote it in a day. It had been building for how many years? About 0 years and it just 9 kind of poured out when the time came to write it. But it was rather remarkable 0 because if you had taken transcripts of what the subjects of this study said to me, and you had simply read the transcripts, you could have said, "hey, there were no ill effects.

9 page 9 These people expressed great satisfaction and admiration for the study. They claimed no ill effects." A very prominent social psychologist, the author of probably the most famous deception study in the history of social psychology, the obedience to authority studies, in fact had reported on his own transcripts of interviews with subjects... Swazey: I remember reading Milgran's justifications. 7 8 Murray: And I had read that, at some point, I guess I had read it many years later when I got to 9 Hastings. But I had the experience of actually being with these people. I saw 9 year 0 olds who were shaking, whose faces were pale, who were telling me how wonderful the study is. You didn't have to be the world's most perceptive person to recognize that they were shaken and desperate for someone to say, "you're not a complete jerk as a human being, you're not a complete failure, because you didn't help, you didn't come to the aid of somebody who might be in danger." They were looking for reassurance and I was the only possibility. 7 Swazey: Pretty scary, as a grad student, to be in that Murray: I was maybe, not particularly world-wise and I felt just such compassion for 0 these young people who were only a few years younger than I was and a considerable amount of guilt that I had put them in this situation. I went and talked to my professors

10 page about it. They saw that I was unsettled by it and they were supportive of me but just really didn't get it. When I tried to explain what was troubling me, the questions I would get were, "is there something wrong with the design ofthe experiment?" I'd say, "no, the experiment works fine, I just don't think we should be doing this to people." So in a way, my questions had to do, at this point, with the conduct of science. Could science be conducted in a way that was respectful? I became aware that you could actually do harm to people, possibly, in the conduct of research. I don't think I'd ever thought of that possibility. So I had these questions. I left Princeton after years without having done a dissertation. I had another classic graduate student experience where I'd worked for quite awhile, it might have been months, only to find out that one of the junior faculty who had been called in on a meeting to help sort of design my dissertation research, had told my advisor that in his view, I should not be allowed to use this as my dissertation topic because he had contributed to the design of it, but nobody told me. Of course I didn't know any better so I basically abandoned that topic. There were personal issues at the time, too. A child was born, who died. I had one child already and I needed to make some money so we left. 7 8 Swazey: Bad confluence. 9 0 Murray: Right. Those were not the happiest years of my life.

11 page Swazey: But you went back and finished, obviously. Murray: I finished from a distance. Swazey: What did you do when you left Princeton? I assume this was before Hastings. 7 Murray: Yes, well before. I applied for jobs. I didn't have a PhD at that point but I was fortunate 8 enough to be offered a couple of positions. One at a place called New College in 9 Sarasota Florida. 0 Swazey: With Ron Carson. Murray: I arrived at what seemed to me at that time, a pretty far out place in Florida, as a Philadelphia boy who didn't know anything about Florida. This was, in some ways, at the height of the drug culture and God knows New College was not exempt from that. This young faculty comes up to me, one of the first people to actually make an effort to 7 just welcome and befriend me, and it was this guy named Ron Carson. I taught there 8 for years. Toward the end of that time, I decided I really needed to finish my 9 dissertation. I wanted to get my dissertation done, I wanted to perhaps prove to myself 0 that I could do it, I'm not sure, a lot of factors there. But I wanted to do it and I did it. I did it without any deception in the protocol. In fact, I was able to show that in some

12 page other studies that had used deception, some apparently irreconcilable results could be reconciled if you assumed that the people you were asking the questions to were not idiots but in fact understood questions differently depending on the context. So I was able to show that people did, in fact, understand the questions differently, that they gave answers that were completely sensible in light of those differences of understandings and that was my dissertation. 7 8 Swazey: Were you teaching social psychology when you were at New College? 9 0 Murray: I've never been in a psychology department. I was in, what was it called there? The title was something like the Division of Social Sciences. Yes, I taught courses in social psychology but at New College, you were not only permitted but encouraged to branch out and teach what needed to be taught, whatever you were interested in. There was even one time there that Ron and I taught a course together on Camus and Sartre. Swazey: He told me about that. That is wonderful. He said you had the best time with the 7 students as you figured out things with them in your discussions about the issues. 8 9 Murray: I pretty much read the available corpus of Camus' work as well as a lot of interpretive 0 work on him. I knew Sartre less well. Ron knew Sartre very well. He'd been writing a book on Sartre as I recall. We had become very close friends. There weren't very many

13 page students at New College. It feels like maybe 0% of the student body took this course! It was a great course and it was great fun to teach. Interesting. Swazey: What then led you to bioethics? Obviously the deception research experience led you into an interest in what we now call ethical issues in research. 7 Murray: I knew what my questions were, I just didn't know what the labels were for them. I 8 didn't know of a community of folks who were also taking those questions seriously. I 9 certainly didn't know there was a nascent field. One of the ironies is I did this research 0 around 99, which of course is the same year the Hastings Center was founded. But I'd never heard of it. I'd never even heard the term bioethics. Well, I left New College after years there, and in 97 went to a place called the Western College. It was part ofmiami University in Oxford, Ohio, the far comer of the state from where I now live. I thought about that always as a second generation experimental college, one that learned from both the successes and the mistakes from the first generation. It had all the intellectual energy of some of its predecessors and less of the pathology, substantially 7 less of the pathology. The kids who came to the Western College program tended to be 8 very smart and they were a tad more adventurous than the kids who would go to other 9 programs in the state system, more tolerant of ambiguity. I was at Western College 0 years, I guess. I got an NEH scholarship to Yale. It was one of the year-long fellowships hosted by the Department of Religious Studies and a professor named Gene Outka.

14 page Twelve of us received the fellowship that year. Most of them were philosophers and so I spent that year reading mainly philosophy, a little theology, reading it for the first time in a systematic way in the company of some very gifted people who became my mentors as well as colleagues, who gave me enormous encouragement. I came away from that year convinced that there really was a kind of discipline in philosophy, that systematic, responsible inquiry was really possible and you could actually make progress. I don't know ifl really believed that before that year. So that year was critical in acquiring some skills and knowledge in philosophical reasoning and method, but probably the feeling I developed that discourse in ethics also was possible was crucial too. Swazey: What kind of philosophy were you doing, primarily? Analytic? Murray: Who were we reading that year? Lots of analytic philosophy. Most of the philosophers there were what I would call analytic philosophers. We did read a bit more broadly than that, in part because it was in the department of religious studies, but it was very 7 philosophically oriented. I had a year there, went back to Western College, saw a notice 8 in the professional papers about the Hastings Center fellowships in bioethics. Well, 9 what was bioethics? I didn't know. The little, small paragraph description, what struck 0 me is this is what I've been looking for the past 0 years. It seemed exactly on point with the questions that had been so burning inside me. So I applied to the Hastings

15 page Center and wonder of wonders, I got another NEH fellowship for a year. That's how I got to the Hastings Center. Swazey: When you went to Case, did you go as Director of the Center? Murray: Yes. There had been at least people there who had been doing work in bioethics: 7 Stuart Youngner and Mary Mahowald. Stuart's a psychiatrist. Mary's a philosopher. 8 The dean of the school had decided that it was time to have an actual center, an actual 9 program with a budget, with a reality to it, so they had a search and they ended up 0 making me their first choice and they were my first choice. Swazey: I gather from Stuart that one of your competitors was Jack Kevorkian. END SIDE, END OF TAPE Swazey: What were your goals for Case when you took the job? What did you want the Center 7 to become? 8 9 Murray: I don't know that I had any grand goals but I had a sense of.. I knew why I went there. 0 Swazey: Why?

16 page Murray: Well, I remembered as an adolescent, reading about the medical school at Case Western Reserve University and its efforts to keep alive whatever humane impulses draw people into medicine by giving them a patient when they arrive, usually a pregnant woman. I knew a little bit also about the new curriculum that Case had pioneered in the 90s, which they called the organ system curriculum. What they 7 meant was they didn't want to have things chopped up into new disciplinary chunks, 8 but rather to see the body, see the patient as an entity, as a whole. Now of course all 9 these things sound better in theory than they often work out in practice. 0 Swazey: They tried, though. Murray: We still try and it still remains a part of the normative structure at that institution. The difference is not that they do everything right at Case Western Reserve in medical education but that when you go in and say, "we're losing touch with" and you talk about the patient as person, it means something at Case Western. It taps into years, 7 pretty much, in history in that institution, a history that remains pretty prominent. So it 8 still matters. As a place I thought it would be very congenial to ethics. As a university, 9 it happens to be one physical unit. Everything is on that campus: the law school, the 0 medical school, the undergraduate colleges, everything is there. And I thought that was a real advantage over many of the elite medical schools on the east coast, which are

17 page physically separated from the rest of the university. It kind of struck me that it is unlikely that you'd ever get enough resources at a medical school to create your own liberal arts program, but if you had all the people within a minutes or 0 minutes walk, as we do at Case, and if you built a program on the idea that you're going to use the whole campus as a resource that you could do good things with modest resources. We also had a family reason for moving. We wanted a community that we thought would be a really good place for our children to finish their schooling, so we moved to Shaker Heights and it actually is an excellent place to raise a family. So that was why I went there. Also I hadn't known Stuart Youngner before, and I enjoyed him immensely and he helped persuade me to come. I remember the negotiations with the Dean at the time. We were talking about what this Center ought to be like, which is what I was interested in talking about, and I said, "look, this is an academic medical center with a first rate research program. If you have an ethics program that isn't a first rate, scholarly program, no one will respect it. I can tell you that I'm not interested into coming to such a program. So only if you are committed to making this program work and recognizing that this needs to be a first rate intellectual enterprise, will it thrive here. And it's only under that circumstance that I will come here. So it's got to have research, it's got to be involved 9 in the education of medical students." I think the scholarly piece surprised him. But he 0 immediately grasped it; he was very savvy and said yes. The education piece, we obviously both agreed upon. Then he said, "look, we're a medical school that doesn't

18 page own our hospitals. A lot of what we do is difficult to explain to this community, basic research. People can't immediately grasp the value of a lot of what goes on here. People understand ethics, they are taken with it." I guess he'd seen this from the early efforts there. "So I want you to remain involved with the communities." So I said, "well, then our mission will be three parts: research, education, and community dialogue." And that's how the Center's three part mission was decided upon and we've really lived by that ever since. I think they were good choices. If you ask what I envisioned, I envisioned a place that would really do terrific work in each of those three missions, in some ways figuring out what those missions meant as we went along. But I also... I call it the atomic theory of center organization. The atomic theory of center organization: you use your money to hire an attractive nucleus and if you do it right, they end up attracting the electrons, the other faculty at the university, the clinicians at the medical school whose salaries you cannot afford to pay but who love to work with, and love to be part of, the intellectual community that is your center. Swazey: Great image. 7 8 Murray: It's worked awfully well for us. 9 0 Swazey: What did you all decide at the faculty retreat in September about a PhD program?

19 page 9 Murray: Well, we came in with various levels of skepticism whether a PhD program was at all desirable; certainly whether it was feasible or not, we weren't sure. We carne out enthusiastic about trying to develop a PhD program. I'll give you a quick description of what our rationale was. I certainly believe, and I believe it was shared by the faculty who participated in the retreat, that bioethics is a very interdisciplinary field and that it makes particularly central use of two different families of methodologies: the methodologies ofthe social sciences, and the methodologies of the humanities, especially the analytic methods of philosophers. A great majority of people who call themselves bioethicists and do work that is respected in the field tend to do one or the other of those two, work in one or the other of those two families. Law counts in the humanities pile, as it does for NEH. It's relatively rare, though, to find an individual scholar who is proficient in one of those but also at least understands, at a critical level, work in the other half I remember going to an early meeting of the Society for Health and Human Values and getting the abstracts and being appalled because what struck me was that I was looking at third rate social science. Humanists doing surveys with no idea of what a sample was or how to write a question, and I thought "what in hell am I doing in a field that doesn't even know what it wants to do, doesn't do it well?" I think that's improved somewhat, I think it's improved actually quite a bit, but there still is this lack of any sort of critical mass of people who understand both methodologies. The model was this, very simply: to give people a background in bioethics rather like the one we give our masters students but then to teach them to make them critical

20 page consumers of methodologies both in the social sciences... I think it wouldn't be that difficult to identify some core sets of methods... and core methodologies in humanities, particularly those of philosophy. Now, after that, they would, I assume, go on to specialize in one or the other of those. So some would go on and do conceptual and normative work, philosophical type work; others would go on and do empirical work. They would be mentored by one or the other Center faculty, first rate people who do each of those kinds of work. They would graduate with a PhD quite expert in one of those families of methods but be able to critically evaluate and creatively use work in the other family. And that, I think, is extremely uncommon among people in bioethics and I thought we could do that. When our faculty began to reflect on this, people immediately began to think of places where those folks could work. It was like a light had gone on, lots of folks were saying, "this sounds really exciting." We could do it, we could do it particularly well with our group in that environment and intellectually it made sense and we felt those people could actually do something with that PhD, they could find interesting work. 7 Swazey: Did you know at that point, in September, which was months ago, that you were 8 leaving? 9 0 Murray: I knew it was a possibility but no, I didn't know for sure.

21 page Swazey: Did your colleagues know you might be? Murray: Most of them did not. Swazey: Because I was wondering if that would have made any difference in their decisions. 7 Murray: Ifl had... I didn't know it... I can't remember when we actually turned the corner. The 8 corner was probably turned more in October than in September. But I didn't want 9 people to pull their punches, I wanted them to think as creatively and positively as 0 possible about this program. And quite frankly, I hope that in time, this PhD program happens. It may take a slightly different form because it will have to be somebody else who leads it. Swazey: I want to get back to the social sciences. But are you going to have an interim director for the Center? 7 Murray: I don't want to give you an answer on the record because I haven't talked to the Dean 8 yet about who that would be. 9 0 Swazey: Ok. Let me come back to... I'm fascinated by your perspective that social sciences has been one of the two major methodologies...

22 page Murray: You want to argue with that? Swazey:...in bioethics. Well, I think, and this is partly out ofrenee's and my personal experiences in bioethics over the years, but we have certainly sensed that bioethicists, and I'm talking primarily about analytic philosophers, have not been that interested in 7 thinking socially, and that to me is a broader term than social science; but using social 8 science knowledge and expertise to think socially. That's been one of the primary areas 9 oftension in bioethics. We've certainly encountered it personally on many levels, but 0 also find it in just reading social science and bioethics literature and being involved in bioethics for a long time. So I'm intrigued by your perspective, and wonder how much it is affected by your being a social psychologist who has become a central figure in bioethics? Murray: Not in social psychology. 7 Swazey: No, but I can't think of anyone else with a social science training. 8 9 Murray: Ruth Faden and Adrienne Arch. We're the that I know ofthat have a background, I 0 think all of us have backgrounds in social psychology, actually. I know Adrienne's PhD is in that. I think Ruth's is as well.

23 page Swazey: So, what, when you say social science methods... Murray: Your question makes me realize I need to make a distinction. Virtually everyone in bioethics today, I think, would admit that you need to have good empirical information for lots and lots of questions and so I don't think there is any deep hostility or deep 7 discontinuity between being interested in practical moral issues and recognizing the 8 importance of facts. But there's a deeper sense in which the social sciences may have 9 things to contribute, and I think there you're right. There is probably still more 0 resistance to thinking socially, as you said, to think in terms of institutional forces, in terms of how culture is shaping our perceptions as well as our values, questions like that. That's a harder thing, I think, for many people, in analytic philosophy particularly, to grapple with. But I think the field has changed. You and Renee were pioneers in this and I think the lack of understanding ofthe social sciences was profound. I think both sides have to take some credit here. 7 Swazey: I agree. 8 9 Murray: Both sides need to learn to communicate with each other. Learn to value what each 0 other does and to see that they don't, in fact, necessarily take away from each other's... to think socially does not mean that you can't also think about what is right and wrong.

24 page To think about what's morally permissible and morally impermissible doesn't mean that you should put aside the cultural influences that shape our moral perceptions. In fact they can work together and will find increasingly people who are recognizing the intellectual contributions of both kinds of thinking. Swazey: I certainly have seen that with the younger generations coming into bioethics and social 7 science. 8 9 Murray: I think there are new cohorts and the battle lines were drawn 0 or 0 years ago, there's 0 still remnants of those but I think many of this newer generation would be mystified by some of the battles that were fought. I haven't tested that hypothesis but I think it is probably true. Swazey: You're right. There has certainly been sort of bad efforts by social scientists who think they can be bioethicists and vice versa. 7 Murray: And vice versa. It's not that the work was intrinsically invalid, it more often failed to 8 appreciate what could be said... quite frankly, even in the social science tradition I was 9 raised in, one was very uncomfortable thinking in normative terms. Psychology was 0 born in an effort to distance itself from philosophy; it came out of philosophy, studies of perceptions. Instead of thinking about perceptions, people began to do literally

25 page "introspection." That was the research around the turn of the century, the early research in psychology. So psychology, in particular, was uncomfortable getting what they would see as bogged down in conceptual or normative kinds of dialogue. They wanted facts. They wanted data. They wanted to be like the natural sciences. I guess people have matured a bit now. They don't have to deny the intellectual validity of other forms of inquiry in order to be comfortable. 7 8 Swazey: And certainly, I think, the fact that the philosophy which practically all of you were 9 trained in was analytic philosophy fostered a particularly deep cleavage with a lot of the 0 social sciences. Murray: I guess I should admit that I wasn'tjust reading analytic philosophy. Swazey: No, you said you had broader readings. Murray: I was reading much more broadly. I was reading some European, some Continental 7 philosophy, though not much. In the end, I find much of phenomenology 8 unintelligible. I find a lot of insight in reading certain types of literature; I have a lot of 9 respect for the folks who do literature. I don't think everything can be reduced to 0 propositional logic, which is a parody of analytic philosophy, but it wasn't far off..

26 page Swazey: I've talked to a lot of people who got a PhD in analytic philosophy. The stereotype sort of fits a lot of what actually went on and a lot of them are very uncomfortable with that now. When you were at Yale on your NEH, did you take any religious study courses? Murray: No, there were no courses. We had a seminar and Gene Outka gave us some of the readings, but we chose lots of the readings. We read some Kierkegaard, whom I had 7 read on my own before then. I just can't recall what we read. Most of the stuff! was 8 most involved in was very philosophical in its tone and in its methods. 9 0 Swazey: Let me pick up on your decision to head Hastings. What prompted you to decide you would move? You may be too close to it to come up with an answer. I guess partly that is a question of what role do you see Hastings and you playing in, say, the next decade in bioethics? Murray: I can answer the first. I'm not sure I can answer the second. Well, I can give you some sort of answer. I've been at the Center for Medical Ethics for a little over years now. 7 It's been terrific. We love Cleveland, we've become great proponents for living in 8 Cleveland. The thought of leaving is wrenching. It was a concatenation of personal and 9 professional reasons. We sent our youngest child to college this fall. We were 0 unwilling to rip her out of her high school previously, when people had made inquiries, so Hastings' timing was impeccable. And our extended families are all on the East

27 page 7 Coast. My wife's, about Y hour north of the Center's location and mine in the Philadelphia area. And our children are not scattered yet, but all of them indicated that they thought it was unlikely that they would settle in Cleveland. They would probably end up, more likely, on one coast or the other and most likely the East Coast. So for family reasons, a move east was attractive. 7 Swazey: Those I can sure understand because my kids both live in Colorado and it's a long 8 ways from me. 9 0 Murray: I don't want to think about it. My oldest daughter got married last spring and she and her husband live in Michigan now. They told us recently that they are looking at jobs in the New York-Connecticut area, so I'm rooting for them whole heartedly and enthusiastically. Swazey: What about professional reasons? 7 Murray: It began, really... I thought I owed it to the Hastings Center to think seriously about it as 8 a possibility. Hastings had provided a first community that had taken my questions 9 seriously, and actually offered me intellectually useful ways of trying to answer them. It 0 was wonderful. So I had enormous gratitude for that. But I'm not so nice a person that gratitude alone would have taken me much further than just looking at it. I began to

28 page 8 think about the role of Hastings in relation to other institutions involved in bioethics. As a pioneer, its value can not be over estimated, it was enormous. As a courageous gamble by its founders and by its staff there, the many people who came before me, in its first 0 years or so, it was an amazing act of courage by those folks. But the world had changed. Hastings had actually seeded a number of outstanding programs around the country. Now some of them weren't direct descendants ofhastings or its former 7 staff but there were outstanding and notable programs at places like Hershey, 8 Pennsylvania; Seattle, Washington; Cleveland, Ohio. I don't want to leave anybody 9 else out; there are many others like that. Even if Hastings was doing work exactly of the 0 same quality it did 0 years ago, the fact is it now has lots of competition. Some of those centers, including my own, do certain kinds of projects better than Hastings. After all, I had doctors and scientists at my own post who would come to me wanting to do projects, with great ideas about questions that they felt a need to answer, complexities that they needed to sort out. Case is a wonderful place. So a question I spent a long time thinking about is what should Hastings' role be now that the world has changed around it? Is there a role? Or is it just a wonderful institution that has 7 simply run its course? There would be nothing dishonorable in that. In fact, in some 8 ways, if its useful life had ceased, the right thing to do would be to celebrate it and then 9 to bury it. Well obviously, I've convinced myself that life hadn't ended yet at the 0 Hastings Center. I've got a number of ideas about where it might go. What Hastings did 0 years ago, through its early life, was... I have a variety of metaphors to describe it...

29 page 9 you could say they went out and they cleared underbrush, they mapped terrain, they identified questions, they established the intellectual legitimacy and the feasibility of taking on certain classes of issues. They made it an intellectually respectable field. The people at Hastings were just brilliant and they were thinking about the kinds of questions that nobody else was really asking in a very disciplined way at the time, even if now there might be hundreds of scholars writing about those questions. Now there 7 are lots of good people out there so I expect that many of the best questions, lots of 8 different places are going to investigate and be able to do that. It struck me that 9 Hastings could still play that role in a kind of new vein. Most funders, like the National 0 Institutes of Health, are, in an important and valuable way, conservative. They'll take one big step with you but you've got to be pretty sure you're going to be successful when you take that step. Hastings, I think, has the ability to go or steps ahead of the field, to figure out where the questions are going to be and years from now, in part because they have the intellectual energy and the people there: the fellows, these 00 plus people who are leaders in their respective fields. I've always sought a greater role for the fellows in the Center's life. I am a fellow and one of the perennial criticisms is 7 "you're not using the fellows properly." Nobody's figured out how the hell you should 8 use the fellows properly. I have some ideas about that, we'll see if they work. But one 9 of those ideas is to say, "look, there are things that you, as a fellow, would love to be 0 able to do but you can't get anybody to fund you right now because it's out there, it's steps ahead." NIH is going to say it's a wild idea and we don't fund wild ideas. But

30 page 0 Hastings might be able to find the risk taking small foundation who, because of their... END OF SIDE, TAPE Murray: That is one of the ideas. How to involve the fellows and, in a way, revivify the role Hastings has historically played in the field, again to try to figure out what's just over 7 the horizon, bring it into good view so the whole field can then do excellent work. The 8 Center will continue to do, I hope, work with stuff that's in view today... will take the 9 one step... do the one step work... I'd love to see us make a concerted effort, though, to 0 do more of the step work. Those are all metaphors. It could be a crock, but I don't think so. Swazey: You sound excited about it. You're beaming as you speak. Murray: Not because I think I'm going to have all those ideas, by any means, but because there's a real rich, intellectual resource in the community of people. The thing is, 7 they're not competing against themselves if they help Hastings do this. In fact, they are 8 also helping themselves because if we can help establish the intellectual bonafidies, 9 then they can walk in and do wonderful work. 0 Swazey: Well, it will be fun to track your progress over the next couple of years and as you said,

31 page I don't think an institution necessarily should live forever, but if it's going to go on, it needs an infusion. Murray: Yes. It needs to look at how the world has changed around it. A lot of institutions, I suspect, die not because they don't continue to do well what they've always done, but because they've failed to be responsive to how the world changes. 7 8 Swazey: And it can be very hard when you're in the midst of an institution, an d part of its 9 founding history, to step back and take that outside look. 0 Murray: I've been away for about years, lived in the world, seen it through different eyes, so I just hope I can bring whatever I've learned to the Hastings Center. In the end, it struck me that there were wonderful assets there, including the Board, including the fellows, including the associates and the senior people associated with it. I've met a number of the senior members of the board and I've been very impressed with their commitment and their intelligence. In the end, they convinced me. 7 8 Swazey: Did they search for a new president by contacting people? 9 0 Murray: Yes. This time they didn't hire a search firm.

32 page Swazey: Right, because I don't remember seeing any ads or letters... Murray: What I was told was that they knew some people they thought would be viable candidates and were going to try them first rather than go through the time and expense of a search. 7 Swazey: Obviously worked. Let me use that as an entre to ask you to define or characterize 8 bioethics. What is this animal that you've gotten involved in? 9 0 Murray: God, you can do this so many different ways, as you know. It's a set of questions and a community of inquirers and practitioners who believe those questions are really important. Many of the issues identified in bioethics are ones the public policy makers think are terribly important as well. And you can give one of your standard definitions. I don't think I could improve on ones that I'm sure you've written. Dealing with ethical issues in science, medicine, especially the biomedical sciences, health care, etc. But bioethics can never cordon itself off from the rest of the wo rld so it must be concerned 7 about the environment of the natural world. It must be concerned about human 8 wellbeing and human flourishing, more generally. 9 0 Swazey: What sorts of phase movements, or major changes, have you've seen it go through? I'd assume you'd say it's not the same today as it was when you first went to Hastings.

33 page Murray: For me it covers about 0 years. Again, I hate triteness, so I don't want to repeat what I'm sure you've heard from other people who are better placed than I am to make those... Swazey: I think everybody has their different perspectives on what's happened, depending on 7 where they came from and where they Murray: Let me distinguish between things: one is the questions that are being dealt with and 0 how we've dealt with them; the other is what's happening to the field, as a profession. The questions evolve over time. I think there's more interest now in not just in dividual issues, physician-patient issues, but in policy issues and health care as a system, the whole realm of health services delivery, HMOs, different ways of organizing health services, different ways of payin g for it. That had always been an interest, it just wasn't one that many people spent a lot of time writing about, but it's more so today. Genetics is obviously a much more central issue today than it was 0 years ago. But I was 7 working on genetics about 0 years ago so fo r me, nothing's changed! 8 9 Swazey: People kept asking me and some other people if we were going to apply for ELSI 0 money, and I said, you know frankly, I can't think of that much that we weren't studying and talking about 0 years ago that I suddenly want to write a grant. So,

34 page organizing health services, different ways of paying fo r it. That had always been an interest, it just wasn't one that many people spent a lot oftime writing about, but it's more so today. Genetics is obviously a much more central issue today than it was 0 years ago. But I was working on genetics about 0 years ago so fo r me, nothing's changed! 7 Swazey: People kept asking me and some other people if we were going to apply fo r ELSI 8 money, and I said, you know frankly, I can't think of that much that we weren't 9 studying and talking about 0 years ago that I suddenly want to write a grant. So, 0 you're right. It's been there. Magnified now, but it's been there. Murray: I think the questions have not changed dramatically. I'm sure I'm just not being very thoughtful this morning, but I'd say there's more continuity than there is discontinuity in the kinds of questions that are being asked. They've gotten broader, we are more concerned with issues about social systems, especially the health care system, more willing to ask some of the harder questions about things like rationing health care. 7 8 Swazey: Why do you think that was only being dealt with by a very small number of people, 9 say 0 years ago, even 0 years ago? I mean, was it sort of deselected or... 0 Murray: Well, I think some questions are easier to answer, or you could feel better about the

35 Thomas Murray, PhD, 0/98 page answers you come up with, feel more confident, feel more righteous. There are folks who see the history of bioethics in terms of protecting the helpless but autonomous patient against the paternalistic, powerful physician. You are campaigning for the good and the true; that's your vision ofbioethics. It's not so easy to figure out exactly what the right thing to do is about, say, rationing of health care, dealing with scarce resources, all the kinds of issues you and Renee wrote about in Courage To Fail. 7 8 Swazey: You know, I was thinking yesterday in the organizational ethics session that we used 9 to have the poor vulnerable patient and the paternalistic, controlling doctor; now the 0 doctor is the knight in shining armor and the controlling, possibly evil corporation... Murray: There you go, some things change. Swazey: That's right. It's not a great dichotomy to set up but we 've done it. Murray: So the questions change. Maybe it's so now you can feel righteous again if you think 7 about organizations. Maybe ethicists like to feel righteous, I'm not sure. 8 9 Swazey: Right there on the side of the good and the true. 0 Murray: Absolutely! And that's not a bad thing. We just have to be careful not to let it lead us

36 Thomas Murray, PhD, 0/98 page to easy answers when the world's more complicated. I had to give a talk yesterday about international health research and the reflexively easy thing is just to say, "oh, you could never do anything that you couldn't do exactly the same in the U.S." But the closer you look at it, you realize that circumstances are different. If a country is responsibly trying to figure out how it could save the lives of its people with a public health intervention and they can't remotely afford what we can provide in the U.S. 7 but they want to test out a slightly different method that may not be quite as good and 8 they're not even sure will work in that population, is it obviously wrong? 9 0 Swazey: I heard you gave a very good talk. Murray: Did you? I haven't had any reviews of it. Swazey: That's the first one, second hand. But from somebody with strong convictions. Murray: I wasn't sure how I thought about that. What I'm finding is, the more you learn, the 7 world can get more complicated. 8 9 Swazey: That type of issue, the one you addressed yesterday, is one that I hope will erode this 0 destructive divisiveness of cultural relativism versus universalism or "objectivism," which has not served anybody well.

37 Thomas Murray, PhD, 0/98 page 7 Murray: No, it can become a kind of convenient way of saying, "we can't think about that kind of problem in any of the normal ways because it's a different culture." We put it aside. That doesn't appeal to me. The intellectually convenient option is not often the best option. The other piece is what happened to the profession. I have to think about that. 7 Swazey: Let me pick up on how you described bioethics: you called bioethics a profession. 8 9 Murray: Yes. Sure. 0 Swazey: Why? What makes it a profession? Murray: Because we say it is. It's the velveteen rabbit principle. You know that, don't you? You treat it as if it' s real and eventually it becomes real. Enough people treat bioethics as a real profession and it has all the marks of a real profession. I'm not up on the sociology of professions these days, I've read a little bit of it. It seems in every respect 7 I can think of to be a profession. It's an unusual one, it doesn't license its providers. It 8 does have some providers and today, in fact, there's going to be a session about 9 standards in bioethics consultation. So in that sense, it's becoming professionalized in 0 the way certain service-providing professions become institutionalized, with great caution, I think appropriately great caution. But it is a profession in the way an