Bioethics in the Margins

For this episode, we are joined by Kadija Ferryman, an anthropologist who studies equity and policy in health risk prediction technologies. Dr. Ferryman is Faculty at the Berman Institute of Bioethics and Assistant Professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.Dr. Ferryman traces her path into studying technology through a cultural anthropology lens, beginning with an early curiosity about how different cultures define illness and disease. She explains how the cultural anthropology focus on beliefs, values, and power structures shapes the way she examines modern health technologies. Using examples like the sequencing of the human genome, she highlights how different scientific communities drew strikingly different conclusions from the same discovery, revealing deeper tensions about race, biology, and social meaning that continue to influence biomedical research.Building on this foundation, Dr. Ferryman explores how bias becomes embedded in everyday health technologies, from pulse oximeters to clinical risk prediction algorithms. She describes how known inaccuracies of pulse oximeter readings for darker-skinned individuals persisted for decades and became especially visible during the COVID-19 pandemic. Extending these concerns to emerging areas like generative AI, she raises important questions about how biased data can shape both clinical care and healthcare systems more broadly. At the same time, she offers a more nuanced perspective: these flawed technologies can also serve as powerful windows into the inequities of our society and as opportunities to rethink how ethics is integrated into medicine and technological development.Ferryman K, Mackintosh M, Ghassemi M. Considering Biased Data as Informative Artifacts in AI-Assisted Health Care. N Engl J Med. 2023 Aug 31;389(9):833-838.Ethical Guidelines for AI:https://healthaipartnership.org/health-equity-across-the-ai-lifecycle-heaalhttps://www.chai.org/https://nam.edu/our-work/programs/leadership-consortium/health-care-artificial-intelligence-code-of-conduct/Select other publications by Dr. Ferryman:Collins BX, Bélisle-Pipon JC, Evans BJ, Ferryman K, Jiang X, Nebeker C, Novak L, Roberts K, Were M, Yin Z, Ravitsky V, Coco J, Hendricks-Sturrup R, Williams I, Clayton EW, Malin BA; Bridge2AI Ethics and Trustworthy AI Working Group. Addressing ethical issues in healthcare artificial intelligence using a lifecycle-informed process. JAMIA Open. 2024 Nov 15;7(4):ooae108.Shachar C, Drabo EF, Iwashyna TJ, Ferryman K. Addressing Racial and Ethnic Bias in Pulse Oximeters-A Wicked Problem. JAMA. 2025 Feb 18;333(7):563-564.Ferryman K, Crews DC, Drabo EF, Iwashyna TJ, Kane O, Jackson JW. Adherence to FDA Guidance on Pulse Oximetry Testing Among Diverse Individuals, 1996-2024. JAMA. 2025 Feb 18;333(7):631-632Also mentioned on the show: Joy Buolamwini Coded Bias

In this episode, our previous guest Dr. Daphne Martschenko returns with her co-author Dr. Sam Trejo to discuss their new book What We Inherit: How New Technologies and Old Myths Are Shaping Our Genomic Future.Dr. Martschenko is an Assistant Professor at the Stanford Center for Biomedical Ethics, where she studies how to promote ethical and socially responsible conduct in human genetics and engages the public around controversial science. Dr. Trejo is an Assistant Professor of Sociology at Princeton University whose work examines how social and biological factors jointly influence human development, with a focus on educational and health inequality.Their collaboration began in graduate school, where they approached genomic research from different intellectual traditions. Dr. Trejo, trained at Stanford, became involved with researchers studying polygenic scores, which are genetic indices linked to social and behavioral outcomes. A controversial talk and an unfortunate reply‑all email situation sparked debate about whether this work risked echoing eugenic ideas. His advisor encouraged him to connect with Dr. Martschenko.Dr. Martschenko, who earned her PhD at Cambridge, was studying how genomic scientists understood their motivations, responsibilities, and the risks of their work. More skeptical of the field’s claims and concerned about premature industry applications, she, like Dr. Trejo, was frustrated by polarized academic debates in which opposing sides rarely engaged productively. Their shared desire for more constructive dialogue shaped their collaboration and ultimately their book. In this work, they discovered more common ground than expected. Although disagreements remained, that didn’t hinder their ability to think together about regulatory frameworks that should be in place.They highlight two myths that distort public understanding of genomics: • The Destiny Myth—the belief that genes unilaterally determine life outcomes, historically used to justify harms such as involuntary sterilization. • The Race Myth—the false idea that humanity is divided into discrete biological races whose genetic differences explain behavioral or social outcomes, a misconception that has fueled discriminatory policies and continues to underlie white supremacist ideologies.Their work aims to help the public interpret genomic data and understand both its promise and limits. They note that polygenic scores remain a “black box”: even when predictive in certain contexts, their biological pathways are unclear and may operate differently across environments. Their remaining differences center on how scientific advances might counter—or inadvertently reinforce—social harms, and where scientific effort should be focused to meaningfully reduce health disparities.Find their book here: https://press.princeton.edu/books/hardcover/9780691237756/what-we-inherit?srsltid=AfmBOoppBsKJ5iKykfO2MzqGseQw_3EF028_8tMTrAB9G0trgMdqIUSeOther joint publications: https://pubmed.ncbi.nlm.nih.gov/35047864/https://pubmed.ncbi.nlm.nih.gov/37695009/https://pubmed.ncbi.nlm.nih.gov/34493865/

We close out Season 8 with a very special episode that is particularly poignant in this holiday season when people of many faiths are called to reflect on our core values. We are joined by Reverend Jackson who is currently the Associate Conference Minister for Justice and Witness Ministries in the Central Atlantic Conference in the United Church of Christ. Reverend Jackson has been the pastor at the United Church of Christ of Seneca Valley in Germantown, Maryland since 2016. She earned her Master of Divinity degree in 2012 from Wesley Theological Seminary. She also holds a Master of Social Work from Fordham University and a Bachelor's in Social Relations and Public Policy from Michigan State University.In this conversation, Reverend Jackson discusses the evolving role of sanctuary churches in the context of immigration and the legal risks they face. Since the withdrawal of federal guidance designating protected locations such as churches went into effect, it is more difficult for churches to provide sanctuary for refugees at risk for being deported to dangerous and life-threatening situations. A coalition of religious organizations has since brought a lawsuit against the Department of Homeland Security arguing that this policy violates the right to expression of faith and freedom of religion.Reverend Jackson discusses the theological and moral imperative to support immigrants that arises from multiple biblical texts, and the calling on Christians to take risks for their faith. Reverend Jackson advocates for a proactive approach to community involvement and the need for churches to educate themselves about local laws and the realities of immigration. Churches must advocate for their rights to practice their faith without government interference. She reminds us that love for one's neighbor is a core tenant of Christian faith. The biblical texts clearly demonstrate that this imperative applies to all people around us, regardless of status.Links to organizations proving support to immigrants:https://www.ilrc.orghttps://unitedwedream.org

We are thrilled that this podcast is airing right after the 2025 American Society for Bioethics and Humanities meeting. It is based on a 2024 ASBH workshop “Remaking Bioethics Together.” Our guests are Stephen Molldrem, PhD, assistant professor and the research program director in Bioethics and Health Humanities at the University of Texas Medical Branch School of Public and Population Health, Krishna Chokshi, MD, associate professor of medicine in the division of hospital medicine at the Mount Sinai Hospital in NYC, Jonathan Shaffer, PhD, assistant professor in the department of sociology at the University of Vermont and Zackary Berger, MD, PhD, associate professor at the Johns Hopkins Bloomberg School of Public Health and in the division of general internal medicine at the Johns Hopkins School of Medicine. Our guests discuss what led them to organize that workshop, beginning with an appreciation of how the principlist, individualist approach of bioethics falls short in addressing systemic challenges to equitable healthcare. Dr. Shaffer shared how his interest in remaking bioethics stems from observations of the focus on “fringe science” in ASBH meetings and the relative absence of more politically oriented moral theorizing. He discusses how sociological frames can help think about the production of shared norms and moral values. Drs. Berger and Chokshi discuss clinical systems ethics failures and what it would mean for Bioethics to think of Capitalism as an object of moral inquiry and to consider organizational ethics in relationships between Academic Medical Centers and communities. We discuss how the “imagined neutrality” of the field of Bioethics has evaporated in the recent overlapping crises of academic medicine. Dr. Molldrem discussed political organizing and the need to take power and its functioning seriously. At the 2025 ASBH meeting last week, this group took the next steps to begin organizing the field by recognizing threats and opportunities and considering resources at our disposal to effect change. Next steps include fostering scholarship around these ideas, considering methods of institutional change within bioethics institutions and collaborating within and across disciplines to foster change. Please reach out to us or our guests if you are inspired to join this crucial work.

This episode of Bioethics in the Margins features a panel of bioethicists: Danielle Pacia of The Hastings Center, Sana Baban of UMass Chan Medical School, J. Wesley Boyd of Harvard Medical School, and Ryan Dougherty of Kaiser Permanente. They are the co-authors of a national survey exploring the role of social justice in their field, published in the American Journal of Bioethics: Empirical Bioethics. In this conversation, the authors discuss their key findings on what social justice obligations bioethicists feel they have, the concept of "social bioethics," and the duty of the field to address systemic injustice. We start by defining the term "social justice" and discussing how it relates to the four principles of bioethics. We spend some time unpacking the methods of the study including strengths and limitations. The main finding - that >80% of bioethicists surveyed believe that social justice should be part of their work - is contextualized by exploring how social justice can add information and objectivity to our work. The episode ends with some reflections by the authors on how we can move forward in the field with these important tools.Work cited in this episode: Pacia DM, Baban SS, Fletcher FE, Mithani Aziz Z, Cooper JF, Boyd JW, Dougherty RJ. A Survey of Attitudes Toward Social Justice Obligations in the Field of Bioethics. AJOB Empir Bioeth. 2025 Apr 17:1-12. doi: 10.1080/23294515.2025.2474915. https://pubmed.ncbi.nlm.nih.gov/40244571/Fletcher, F. E., Ray, K. S., Brown, V. A., & Smith, P. T. (Eds.). (2022). A critical moment in bioethics: Reckoning with anti-black racism through intergenerational dialogue. Hastings Center Report, 52(S2), S1-S68. https://doi.org/10.1002/hast.1363 Pierson, L., Gibert, S., Orszag, L., Sullivan, H. K., Fei, R. Y., Persad, G., & Largent, E. A. (2024). Bioethicists today: Results of the views in bioethics survey. The American Journal of Bioethics, 24(5), 4-22. https://doi.org/10.1080/15265161.2024.2323869Dougherty RJ, Fins JJ. Toward a Social Bioethics Through Interpretivism: A Framework for Healthcare Ethics. Camb Q Healthc Ethics. 2024 Jan;33(1):6-16. doi: 10.1017/S0963180123000452. Epub 2023 Aug 25. PMID: 37622652. https://pubmed.ncbi.nlm.nih.gov/37622652/

In this episode of Bioethics in the Margins, we delve into the topic of capital punishment by nitrogen gas. Dr. Robert Glatter is Editor at Large for Medscape Emergency Medicine and Assistant Professor of Emergency Medicine at Zucker School of Medicine at Hofstra/Northwell. Dr. Peter Papadakos is Professor of Anesthesiology, Surgery, Neurology and Neurosurgery at the University of Rochester, and a Professor of Internal Medicine at Mercer University School of Medicine. Drs. Papadakos and Glatter dissect the harsh realities of suffering and injustice surrounding the execution of Kenneth Smith in Alabama, the first person executed using nitrogen gas. They explore what nitrogen is and its physiological effects and reflect on the inhumane nature of nitrogen hypoxia. The conversation also touches upon the broader issues of botched executions, delayed executions as psychological torture, the absence of definitive DNA evidence in some death row cases. They highlight the point that both the American Medical Association and the American Society of Anesthesiologists as well as many nursing associations state that participating in executions is not the practice of medicine and is prohibited by their members. This means that executions are conducted by non-medical personnel. They also point out that delaying executions, sometimes for decades, falls under the definition of torture under the Geneva conventions. This conversation poses the question; if our society continues to condone these practices, are we civilized?The JAMA editorial mentioned during the podcast can be found here: Evidence Against Use of Nitrogen for the Death Penalty | Neurology | JAMA | JAMA NetworkThe editorial authored by Drs. Glatter and Papadakos can be found here: https://www.anesthesiologynews.com/Commentary/Article/02-25/Capital-Punishment-by-Nitrogen-Gas-The-Harsh-Reality-of-Suffering-and-Injustice/76074

In this episode, we are joined by Dr. Tanya Zakrison, MD, PhD, Professor of Trauma and Acute Care Surgery and Director of Critical Trauma Research at the University of Chicago Medical Center. Her work focuses on the connection between interpersonal trauma, critical race theory and racial capitalism. In this podcast, Dr. Zakrison shares how her personal experiences in young adulthood helped her make connections between violence experienced in the United States and global patterns of violence resulting from capitalism and colonial histories. She describes how structural, cultural and social violence causes the trauma-based violence we experience locally, nationally and globally. She describes the incessant gun violence in the U.S., especially affecting schoolchildren, as a critical problem that requires attention beyond making arrests and treating the physical wounds of the victims. Dr. Zakrison points out how we have normalized abnormality in the U.S. through the culture of individualism and social violence. She introduces the concept of “hate” as a public health disease and discusses the importance of deep understanding of history as a means to disrupt cycles of hate. In this broad-ranging discussion, we also explore the importance of medical-legal partnerships and their role in supporting victims of violence, framing them as one methodology for violence prevention as well.In discussing her work on firearm violence, Dr. Zakrison shared a poignant experience of being told as a scientist in the United States that she was not allowed to ask a particular question, highlighting the contrast between legislation such as the Dickey Amendment and our national ideals of freedom. She recommended building bridges of solidarity, joy, love and communal support systems to counteract the effects of discrimination, exclusion, and hate. At personal level, she encouraged us to use our power to help people develop their human potential so that we can all benefit from the genius that everyone holds inside themselves.Some of Dr. Zakrison's work can be found here:https://pubmed.ncbi.nlm.nih.gov/28922206https://pubmed.ncbi.nlm.nih.gov/30484899/https://pubmed.ncbi.nlm.nih.gov/35300858/Link to Practical Radicals: https://thenewpress.com/books/practical-radicals

Happy holidays from BITM! We are delighted to share this episode with you this week. Kirk and Amelia sat down with Dr. Donald Carter III, assistant professor at Mercer School of Medicine. Dr. Carter earned his Doctorate in Bioethics from Loyola University after earning a Masters in Divinity from Vanderbilt and an MBA from Tennessee State. He is a Sadler Scholar with the Hastings Center and the co-chair of the Race and Culture and Ethnicity (RACE) affinity group of the American Society for Bioethics and Humanities (ASBH). Dr. Carter began his career as a musician after earning a BA in music from Fisk University, one of the many Historically Black Colleges and Universities (HBCUs) in the United States. This episode is a great one for those who are curious about pursuing a career in Bioethics. Dr. Carter shared how he explored several career paths before ultimately finding his professional home in Bioethics. Dr. Carted discussed his work exploring the impacts of the 1910 Flexner report, which, while contributing to creating uniform standards for medical education, also resulted in the closing of 5 of the 7 medical schools within HBCUs. This is one of the reasons for the shortage of Black physicians that persists today. He discussed the importance of diversifying the field of Bioethics and the positive changes he has observed within ASBH over the past few years. He shared how he views HBCUs as an important resource to tap to help diversify the field. He recommends building up bioethics education at HBCUs as a way of fostering lasting change. He also discussed the importance of humanities in medical education, sharing his experiences using visual training strategies (VTS) in medical education, reminding us that the arts have a way of returning us to a place where we can see each other as full humans again. Dr. Carter pointed out that one of the superpowers of the field of Bioethics is that we have a large tent. He examined specific ways in which racial, cultural and professional diversity can enhance the value our field brings to patients and communities.

We are back with season 7, chatting with Brian Tuohy, PhD, a sociologist of immigration and health, assistant professor of bioethics, and co-director of education at the Lewis Katz School of of Medicine at Temple University. We use the lens of immigrant health to delve into some deeper questions like "What does bioethics mean?" Dr. Tuohy generously shares his own personal and professional journey into the field, highlighting the interdisciplinary nature of bioethics. He discusses his own family's immigration story and research with Mexican immigrants to the United States to bring out contrasts and nuances in the experiences of different groups based on language, age at immigration and a multiplicity of immigration status categories. We touch on some issues in ethical conduct of research with immigrant communities and conclude with a deep reflection on the power that bioethicists have as insiders in the healthcare industry and the importance, joys and responsibility of teaching the next generation of physicians. Some of Dr. Tuohy's work can be found here:Brian Tuohy, Health Without Papers: Immigrants, Citizenship, and Health in the 21st Century, Social Forces, Volume 98, Issue 3, March 2020, Pages 1052–1073, https://doi.org/10.1093/sf/soz048Rocco, P., & Tuohy, B. (2021). A New Dawn of Bioethics: Advocacy and Social Justice. The American Journal of Bioethics, 22(1), 23–25. https://doi.org/10.1080/15265161.2021.2001105Tuohy B, Jatres J. Researching Those in the Shadows: Undocumented Immigrants, Vulnerability, and the Significance of Research. Am J Bioeth. 2023 Jun;23(6):106-109. doi: 10.1080/15265161.2023.2204053. PMID: 37220350.

In this episode, Amelia and Kirk speak with Lynette Martins who is co-leader of the ASBH immigration affinity group with Dr. Brian Tuohy and a recent graduate from Georgetown Law’s O’Neill Institute in national and global health law. Ms. Martins highlights the importance of Medical-Legal Partnerships in identifying and addressing both direct and indirect impacts that legal issues and policy have on health and healthcare access and outcomes. MLP’s are particularly helpful for addressing the Social Determinants of Health, the non-medical conditions in the environments in which we live, learn, work, and play that can negatively influence patient outcomes. MLP’s provide collaborative spaces for interdisciplinary dialogue, enhancing individual patient care while also helping healthcare institutions address recurrent issues that may be impacting specific patient populations.Further reading can be found here:https://medical-legalpartnership.org/wp-content/uploads/2019/04/Financing-MLPs-View-from-the-Field.pdfhttps://medical-legalpartnership.org/wp-content/uploads/2020/10/Health-Center-MLP-Toolkit-FINAL.pdf

Amelia and Kirk chat with Dr. Mark Kuczewski, Professor of Medical Ethics at Loyola University, Chicago. In this episode, they discuss his recent article https://www.healthaffairs.org/content/forefront/nonprofit-health-care-behaves-badly-case-mission-leaders-ombudsmen in which Dr. Kuczewski elucidates the challenges nonprofit healthcare employees face as workplace culture becomes increasingly corporatized and the importance of counterweights– in the form of ombudsmen, better-designed incentive structures, and virtuous local board members– who can potentially help promote the nonprofit mission for patients. They also discuss Dr. Kuczewski’s publication on organizational ethics and the importance of hiring for mission (https://www.researchgate.net/publication/6121839_Is_Organizational_Ethics_the_Remedy_for_Failure_to_Thrive_Toward_an_Understanding_of_Mission_Leadership).Dr. Kuczewski describes the “patchwork” of healthcare available to undocumented immigrants and the need to sever the tie between immigration status and healthcare access and talks about his work with Loyola University Chicago Stritch School of Medicine to accept DACA recipients into its program.Dr. Kuczewski is the Father Michael I. English S.J. Professor of Medical Ethics at Loyola University, Chicago, the director of the Neiswanger Institute for Bioethics and Health Policy, and a Fellow of the Hastings Center. His current interests include the bioethical issues related to immigration. He served as the project manager of the Loyola University Chicago Stritch School of Medicine effort to include Dreamers in medical education, wherein Stritch became the first medical school in the nation to welcome applications from Dreamers of DACA status. https://www.luc.edu/stritch/bioethics/aboutus/facultydirectory/profiles/kuczewskimark.shtml

Dr. Stephen Hargarten is a Professor of Emergency Medicine, Associate Dean for Global Health, Director of the Global Health Pathway, and Director of the Comprehensive Injury Center at the Medical College of Wisconsin. His research interests reflect an intersection of injury and violence prevention and health policy to address the burden of this biosocial disease. He was the founding President of the Society for the Advancement of Violence and Injury Research and has served on the Violence and Injury Prevention Mentoring Committee for the World Health Organization. In his conversation with Amelia and Kirk, he makes a compelling argument for considering firearm injury as a disease and a public health crisis. They discuss state and federal policies that can and do affect this primarily political disease. Dr. Hargarten also explains the use of a biopsychosocial model for healing from firearm injury and calls for medical educators to include firearm injury mechanisms, prevention and treatment in curricula. Selected publications are included below. Commentary: Moving Emergency Medicine Toward the Biopsychosocial Disease Model (Hargarten S.) Annals of Emergency Medicine. November 2019;74(5):S52-S54 SCOPUS ID: 2-s2.0-85073691318 11/01/2019 Gun Violence Education in Medical School: A Call to Action (Barron A, Hargarten S, Webb T.) Teaching and Learning in Medicine. 2022;34(3):295-300 SCOPUS ID: 2-s2.0-85104939062 01/01/2022 A scoping review of patterns, motives, and risk and protective factors for adolescent firearm carriage (Oliphant SN, Mouch CA, Rowhani-Rahbar A, Hargarten S, Jay J, Hemenway D, Zimmerman M, Carter PM.) Journal of Behavioral Medicine. 15 August 2019;42(4):763-810 SCOPUS ID: 2-s2.0-85069995818 08/15/2019

We are joined by Rachel Fabi, PhD, Associate Professor of Bioethics and Humanities at SUNY Upstate Medical University. She is a Faculty Research Affiliate at the Syracuse University Lerner Center for Public Health Promotion. She received her Ph.D. in Health Policy and Management, in the Bioethics and Health Policy track, at the Johns Hopkins Bloomberg School of Public Health, and served as the 2019-2021 National Academy of Medicine Greenwall Fellow in Bioethics.Dr. Fabi shares her insights on policies that affect the health of immigrants and refugees in the United States, and discusses her research on a broad range of topics such as access to care, reproductive health and treatment in ICE detention. Listen to the end for her insights into the role of physician advocacy.