Meet Lori Bruce, the New Director of Yale’s Bioethics Center

Rick Harrison
Lori Bruce speaks to a an off-camera gathering at Yale School of Medicine

Lori Bruce is the third director of the Yale Interdisciplinary Center for Bioethics.

Lori Bruce first joined Yale’s Interdisciplinary Center for Bioethics in 2011 as assistant director of its summer program. She became director of the program and associate director of the center in 2016. 

In recent years, she has successfully spurred The U.S. Department of Health and Human Services to issue new guidance to teaching hospitals and medical schools requiring that providers obtain consent before performing sensitive examinations, particularly on patients under anesthesia; worked with states to improve their infant abandonment laws and increase support and confidentiality for pregnant and postpartum women; and called for caution, consent, and long-term support for patients as states have begun to legalize forms of psychedelic medicine.

In July, Bruce succeeded Stephen Latham as director of the center, which is supported by the Institution for Social and Policy Studies, following his retirement from the position after 15 years. Now, as the center’s third director, Bruce hopes to strengthen its role in ethical policymaking, expand its global reach, and help bring the tools of bioethics into more professions and communities.

In a recent conversation, Bruce reflected on her introduction to bioethics, the lessons she brought from neuroscience and crisis counseling, and the importance of approaching ethical questions with collaboration and humility. The interview has been edited and condensed.

How did you first become involved in bioethics?

I was running a social neurosciences lab at Harvard, and I was also providing rape crisis counseling in the Boston area. I would meet with survivors when they came to the hospital for post-assault care. I would not know their name or anything about them. I just knew they were showing up for care.

My role was to help create a buffer between the survivors and the hospital system because the emergency departments were not equipped to address their unique needs alone. We helped survivors understand the forensic and medical services available to them and the implications of their choices within the justice system. The survivors’ control had just been ripped from them, so we were there to help them reclaim their power and get connected to support services.

You are describing a delicate situation with much complexity and many ethical considerations.

Yes, and because of that work, I was asked to join the first community ethics committee at Harvard. The committee leaders wanted to amplify the voices and values of community members in health policy across the Harvard system.

Was that a logical transition for you?

I first asked the committee’s founder, Carol Powers, “Whose ethics matter to you?” I was skeptical of how community views would be gathered, for whose purpose, and whether we would have a say in how our voices were represented. She and I engaged in a series of discussions around consent, power, goodness, authority, and what “care” really means within health care. I was impressed by how carefully she listened and how her responses were influenced by both her own personal experiences within hospitals and her understanding of broader social and economic factors. That was my introduction to bioethics.

“Whose voices matter?” is a question I continue to pose throughout my work and frequently discuss with my students. More importantly, whose voices ought to matter? There is often a distinction between those questions. As bioethicists, we can sometimes help smooth out power imbalances, helping physicians or patients and families ensure that their voices are articulated and integrated within solutions.

What did you think of bioethics when you first encountered it?

I had no idea what they were talking about. I was wary of this idea of bioethics because I thought, “Who is anyone to say what is ethical? 

I had no familiarity with modern bioethics as a social movement that arose in the 1960s, in part from the civil rights movement. Carol Powers invited me to be part of the community ethics group, and that opened doors for me to attend bioethics training programs at Harvard while I was still working in social neuroscience.

What was that training like?

At the time, bioethics education was often delivered through short courses in which people reflected on principles — including dignity, justice, and autonomy — and then applied those principles to bedside consults or policies. I kept asking, “How are you getting from here to there?”

My previous experience was very methodological and structured. I came from a computer science and neuroscience background, and when you analyze computer code — or the brain — you follow a process to ensure you are not making mistakes. I was baffled at the lack of structure within bioethical deliberations. There were these ethereal values and principles, and somehow we were supposed to jump from them to policy recommendations.

Much of my work has been influenced by those early days, when I was always seeking a process.

‘Whose voices matter?’ is a question I continue to pose throughout my work and frequently discuss with my students. More importantly, whose voices ought to matter?

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Lori Bruce

How have you brought that more structured approach into your work?

I have created frameworks to help ethicists, physicians, and other clinicians add ethics to hospital policies and programs. The greatest gap I found was in the analysis or creation of health policies and programs within institutions such as hospitals. These tools can also be applied when writing health legislation, especially at the state level.

My frameworks are very collaborative, which helps stakeholders think deliberately about several questions: What ought this policy value? What kinds of values should guide this policy or program? Who and what ought we include during the design phase? What are the long-term and short-term goals we wish to achieve? And what actions should we take to achieve those outcomes?

Why ask those types of questions?

Most often, policy designers jump directly to thinking about what a policy or program should do, instead of what it should accomplish. They may say, “We’ll encourage the social worker to meet with the patient earlier to make the discharge process smoother.” But the policy goal may only be understood implicitly, when it ought to be defined explicitly.

Instead, you want to identify quantitative or qualitative measures that can later help you ask, “Are we succeeding?” You also need to ask whether you want a policy to be used — and how frequently. Certain policies address intractable disputes involving clinicians, hospital systems, patients, and families. I might say, “Yes, let’s work on a policy for this issue. But let’s also look at the policies further upstream in the patient’s experience that may need improvement so that we are not using this conflict-resolution policy so frequently.”

We should try to get in front of the intractable dispute. I refer to that as preventive bioethics. As opposed to responsive bioethics, where a major ethical conflict arises and we then have to solve it.

Why is it important to include stakeholders in ethical policymaking?

When you bring in people affected by a policy, they can review what you are proposing and say, “You’re off here by a mile, and here’s why.”

We all have different interests, success criteria, and objectives. When a patient walks into a hospital, the main thing they are likely thinking about is, “I want to get better.” They are there for medical care.

A clinician is certainly thinking about caring for patients, but they are also rightly thinking about training students, conducting research, complying with policy, and meeting other responsibilities. Hospitals also have many goals including the generation of funds and protecting themselves from financial and reputational harm. All of these goals are important. But they are all actualized through the administration of medicine on patients’ bodies.

I imagine these same principles apply to your work with legislators.

Correct. Legislators need a specific kind of information. I need nuanced, careful data to publish manuscripts. But legislators need a subset of that data, they need it yesterday, and they need it in plain language so that others can understand it.

There is complexity that everyone brings to the party. As bioethicists, it behooves us not to say, “I know the solution,” but rather: “Tell me what your problem is.”

I have been encouraging more bioethicists to flip the script in this way and listen to the problem as it is articulated by the public or by the community we are trying to serve. We cannot go into a setting and say, “I can solve this for you,” until we understand how the people in that setting view the issue we are exploring together.

What makes Yale’s approach to bioethics distinctive?

Through the summer program, we have created a collaborative, sustained community that continues to draw on its alumni. This community is helping to change the face of bioethics.

One of my goals since taking over the summer institute has been to help ensure that the people working in bioethics reflect those we are serving when we develop policies or treat patients in hospital settings. Through the center, we have been able to offer a remarkable number of scholarships, and even our highest rates for a seven-week program are often less than the cost of one-week programs at other institutions.

We also work very hard to provide a thoughtful infrastructure. I am not just providing knowledge. People can obtain bioethics knowledge in many places.  We fill them with knowledge, but we also give them community. We help them realize that good bioethics cannot occur in isolation. Our alumni contribute enormously through the mentorship of newer members.

What do you mean by community?

At its best, bioethics works with a broad range of stakeholders, including philosophers, legal scholars, clinicians, technology ethicists, allied health workers, and scholars of religious studies. Bioethicists need to be willing to stop and listen. Through authentic collaborations, you can learn about other methods of inquiry, other frameworks, and other ways of being. That helps create work grounded in practical, effective methods.

How has the summer program helped extend Yale’s influence beyond campus?

Every year, people come to the summer program from several other countries. They may be younger professionals or quite senior professionals, sometimes chiefs of medicine in prominent cities who want to bring bioethics to their regions.

That also happens within the United States. The head of a biology department at a university in Virginia came to the program because she wanted to create a bioethics course for biology majors. She spent two years working on it, and it is now a successful and popular annual course that gives science students a forum to discuss moral dilemmas within gene editing and other biological topics.

The summer program is intensive, but not a final destination.

Exactly. The summer program provides a framework to launch people into this work. It usually takes a couple of years of additional mentoring and growth to contribute because bioethics cannot be learned in just one summer. We link participants with resources and with other people — including summer program alumni — doing related work.

For example, we have had senior professionals from the Pakistan Institute of Living and Learning attend the summer program. They went back and added to the structure they already had there. For a while, I taught in their bioethics fundamentals program, but now they are running with it on their own. We have similar success stories in Spain, Australia, and the Czech Republic. I would love to replicate these successes in more places around the world. 

What are some of your priorities as director?

I want to bring ethics and policymaking methodologies more closely together and help formalize the field of ethical policymaking. I want to further develop the policy model I have created and help more people learn about it and use it in both institutional and public policy.

I am also continuing to partner with legislators across the US on policy responses for crisis births, including confidential birth, to help families in crisis learn about their options and have a safe, in-hospital labor and delivery.

What, if anything, concerns you about your work?

Whenever I create a health policy, I am aware that providing access to a health solution may also mean I am deprioritizing someone else’s access. I am aware of how the work I do could be detrimental. I am always asking: What are the potential unintended consequences? How can we mitigate them early? How can we monitor the policy and pivot when needed?

You have also launched an initiative in rural health, right?

That’s right. We are helping policymakers and hospital leaders, along with clinicians, allied health workers, and students, think carefully about how to introduce AI and health technologies to vulnerable areas across Connecticut to promote healthier outcomes while minimizing unintended consequences. Our topics include maternal health, care for older people, end-of-life care, and emergency care.

Why focus your career on bioethics?

Bioethics is vitally important because it gives us tools to examine how we can — in practical ways — promote goodness, reduce harms, and build community across differences. 

Whether we are working in a hospital setting or with legislators, our solutions tap into the creativity that bioethicists are known for to promote human flourishing.

Sounds like a rapidly moving target, particularly at the pace of current technological evolution.

Ethics changes all the time. Its fluctuation is one of the biggest misconceptions about my field. What is ethical today may not be ethical tomorrow. What is considered ethical in one ZIP code may not be considered ethical in another because ethics is nuanced, based on context, and contingent upon culture, technologies, and resources.

What do you hope people take away from studying bioethics?

I hope that some students are inspired to become bioethicists, but I also find joy when my students bring bioethical principles and frameworks into other fields. Bioethics solutions are best when cultivated in an interdisciplinary, collaborative environment. 

When done well, bioethics education should also promote inquisitiveness and humility.

Humility?

Humility is absolutely necessary. When we do this work, we are imparting values into policy and practice. This can impact choices within health care. We must be mindful of how our perceptions and beliefs may influence well-being across all impacted communities.