Q: How has your personal journey influenced your approach in building moral communities in healthcare?

I stumbled into bioethics and healthcare ethics as a graduate student doing analytic philosophy. Bioethics awakened me from my analytic dogmatic slumbers by giving me real context in the work that I find myself doing now. I started working at a hospice care center directing the ethics office. I had the privilege and pleasure of working with a deeply ingrained interdisciplinary team, which brought together social workers, medical doctors, chaplains, and nurses. This is where I first encountered the deep significance of the nurse perspective, providing quality healthcare to patients, to families and communities. I was spoiled in a way, because there was a kind of egalitarian approach, recognizing that all these perspectives equally matter.
When I worked in the hospital and on hospital ethics committees, I began to see a hierarchical structure that was quite alarming to me. Nurses on these committees and myself really leaned in to make sure that there was agency, to give voice from that sector of professional healthcare service. From there I ended up working in academic spaces as well as clinical spaces, trying to do work in bioethics and clinical ethics. It all involved working with others. Community building is inherent to how I came into the field to begin with.

Q: When you think about the conference theme “Building Moral Community,” what comes to mind? How do you go about building a moral community?

Building a moral community is being deeply attentive to others and being present in ways that are not superficial. I had an uncle who was a civil rights leader for many years in the city of Birmingham, Alabama, and he was deeply engaged in community work and activism. He would ask us often what we were reading, studying, and doing. When we started getting to academic spaces, we would share a little about it, probably thinking it was really impressive. He would pause, and it would only be maybe 6 seconds, but it felt like 5 minutes. Then he would just kind of nod, and say, “Just don’t forget about the people.” That phrase has stuck in my mind. How does the work I’m doing relate to real people in real context who have real issues and real problems that I am also a part of? “Don’t forget about the people” shapes how I engage and build community.
I also come from an intellectual and spiritual tradition of African American thought that really emphasizes the notion that it’s not just individualism or just communitarianism, but rather persons in community. This idea toggles between the tension of the individual being of utmost importance – we are particular people with particular life experiences – and people that are never detached from larger communities. We have to be able to deal with the tension, the messiness, and the dissonance of that. That’s a necessary part of what it means to be human.

Q: In the broader social context but also in the clinical setting, people seem to have a harder time communicating with one another and holding different opinions and ideas. What is your experience in bridging some of those gaps?

My experience is clumsily bumping along like other people are clumsily bumping along. We have to acknowledge that it’s hard. The discord and polarization may be amplified higher than we have experienced in our recent history, but I try to take a deep breath and ask myself, “Have we been here before?” It may be a difference in degree and not necessarily difference in kind. So can some of the historical context in dealing with conflict still be a part of the apparatus to help us navigate current spaces well?
When I have the tendency to be a little more judgmental or wonder, “How could people think that?” I think about something my dad used to say that I didn’t appreciate until I got much older. He’d pause, smile and have this phrase of “Keep living,” meaning a lot of initial opinions we have may shift as we get more life experience. He would also say, “We’re just all trying to make it.” There’s something there that resonates deeply. We’re just all trying to make it, right? We’re all on a journey; we didn’t arrive overnight. How do we continue to shape our conversations, our dispositions, our outlooks, so that we can recognize that at the end of the day, even if operationalized differently, we may want the same things for ourselves, our families, our loved ones, and those in our community?
It’s a challenge because while we’re a part of a larger community, we are also part of sub-communities. As individuals, we may be part of multiple communities, where the values of each of those communities might conflict. What are those inherent internal values? How do we think about this in our own lives, and then expanding to life in proximity with each other? We have to cultivate this value and virtue of solidarity. This has been a hallmark of social ethics for many years. What does it mean to think about our common life together? To think about the sharing of resources, both as a value that should guide how we think about larger configurations of our health systems, but also
as a kind of virtue, internalizing the right to make notions of solidarity part of our disposition?

Q: What are some steps that healthcare workers can take to build trust among communities that may not trust the systems that are in place?

Building trust is tricky. The question isn’t only how do we build trust amongst these communities, but also what does it mean to be a trustworthy institution or trustworthy healthcare professional? When healthcare professionals and institutions are a part of that distrust, we have to be honest with our histories and interactions with various communities. We have to own the missteps and the mistakes. That goes a long way in terms of credibility. As kids, many of us were taught that if we do something wrong or if we wrong someone, either intentionally or unintentionally, we acknowledge it and we say we’re sorry. We try to figure out ways that we can repair and continue to move on. It can be something as as basic as that; when we wrong someone – people, groups or communities – we need to own up to it and not just say we’re sorry but find constructive ways to repair and move forward to have some type of restoration. My mom always said, “We can do better. Son, you can do better.” Collectively, we can do better. Are our institutions trustworthy? Asking this question will help reestablish trust.
As we move in this direction, we also have to be committed. It’s going to take a minute. We didn’t lost trust overnight. There are long histories here. So we’re also not going to get out of these problems overnight. We need patience, to stick with this for the long haul even when we don’t see results immediately. Africana philosopher Lewis R. Gordon said if we fail to remember that political struggle is for the next generation, we will falter and we will err. For those that know Gordon’s work, he’s saying this is going to take time and a kind of resilience, a “stick-to-itiveness” as one of my teachers would say. If we don’t have that, we will falter or err. We’ll give up too quickly because we don’t see the kind of change we want to see in the immediate proximity. We will make mistakes because we will begin to manipulate and circumvent the process of what it takes to really become trustworthy. We need to show that we are worthy of the trust we want patients, families and communities to have in us.

Q: What relationships have been important to you on your path to different roles as an ethicist, educator, and leader?

There’s a family background where I saw what it means to be attentive to other humans and to be present. Even if I didn’t master that in my own life, I saw it modeled. Then there are academic folks who helped me think about moral philosophy and ethical theory and then push me to think about praxis. What does it mean to allow our theory to inform the way we engage people and then how does that engagement help correct aspects of our theory? It’s not a one way street but a reciprocal attenuation of theory and practice in this notion of praxis. And there are healthcare professionals with whom I’ve worked with over the years, many nurses, who have been able to speak so directly as I sit in a place that’s very different from theirs. Their perspective is doing the day-to-day care. Lastly, there are people in my community who aren’t professional healthcare workers, people who are just trying to make it. As I have a tendency to make some issues more academic than perhaps they need to be, those relationships become meaningful because they have a way of recalibrating me and grounding me. The analysis that people in our communities bring to the table who aren’t professional healthcare workers is so invaluable. We have to listen more. At the end of the day, they’ll push you right to why it really matters.

Q: What advice would you give to a new healthcare professional about ethics and building moral community?

When I was a teenager, my elders would say you may go far if you remember that the sweetest sound to someone is the sound of their own name. What they meant by that is not just knowing names, but understanding this is an individual person who is part of our community. Even if I’m not overly familiar with them, knowing their name adds a deeper interpersonal level. Things like medical technology distances us from one another and from our humanity. It can be can be deeply impersonal at times if we’re not careful. Remember that the sweetest sound to someone is the sound of their own name, making sure that we attend to the person. Oftentimes in clinical ethics, we talk about person or
personhood and rational cognitive factors that are associated with questions of autonomy. Decision-making sometimes strays from the individual to “disembodied reasonable persons.” I’ve never seen a disembodied reasonable person before ever. In Greek philosophy, there is a word called prosopon, which is often translated to “person.” The etymological sense of the term is “to turn towards the face of the other.” It’s a very different connotation than when we just think of a person as an individual, rationalistic, autonomous agent or disembodied person. The Greek notion of prosopon reminds us that to be a person, it brings in both the individual as well as the community in an embodied engagement and interaction. My advice in a nutshell would be to remember that to be a person is to turn to the face of the other and that the wisdom from our elders tells us that the sweetest sound of a person is the sound of their own name.