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A reimagined bioethics agenda should be comprehensive, complete, and whole. It should move from a more “heady” philosophical space” to a more “hearty” everyday space. It should intentionally seek out diverse perspectives and audiences. Indeed, it should even re-imagine how we communicate the role and work of bioethics in everyday language. I argue that our bioethics agenda must evolve if we are to properly do the “work of bioethics.” While an all-encompassing or “whole” approach may seem ambitious, a sincere reflection on where we are in the field of bioethics and where we ought to be calls for a bold reimagination. Assuming we share an interest in a comprehensive bioethics agenda, how can we guide bioethics toward this goal? I suggest that we consider three foundational building blocks for reimagination: collaboration and trust-building, solidarity and the fair alignment of priorities, and sustainable funding for bioethics research, education, and practice.

Collaboration

First, collaboration is a crucial component in addressing urgent, globally relevant bioethics issues. Attempts at collaboration often fail if they do not include “listening well,” understanding, and effective communication. However, when we expand our ability to see, accept, and interpret different perspectives and strive to understand what matters to various communities, we become more effective collaborators and more impactful bioethicists. Reimaging bioethics could include forming regional and international coalitions, convening meetings, and updating bioethics curricula to include “listening labs” for students and practitioners.

Arguably, “listening well” is both an art and a skill, and it might be the linchpin to more effective collaboration, so we must learn to listen well. Our reimagined bioethics agenda can educate and train us to listen well. This skill can be nurtured in a “listening lab” within a framework that helps us understand how to listen and how we can humbly learn from other cultures. Listening well can lead to empathy and an understanding of how diverse core values and principles shape decision-making, and consequently to how we might become better collaborators as we tackle 21st-century problems together.

Solidarity

The second issue to grapple with is solidarity. Yes, but “what do you mean by solidarity?” I was once asked. My initial attempt to respond eloquently was surprisingly difficult, and I quickly realized that solidarity is easier to recognize than to define. For example, it might look like a child writing holiday notes to people without families, or neighbors helping each other during disasters. The common thread in solidarity is empathetic, caring action: one person sees another suffering and feels an obligation to relieve that suffering. Usually, the action is time-limited, but perhaps it shouldn’t be.  I suggest a comprehensive view of solidarity—one that starts with a call for a genuine reflection on our interconnectedness and on how humanity flourishes when we live with a consistent, continuous sense of "what happens to you matters to me, and therefore, I will stand with you.” We have an opportunity to center interconnectedness in our reimagined bioethics agenda.

Notably, solidarity can be easily misinterpreted. It does not mean collective thinking or groupthink, nor does it mean the absence of disagreements or differing perspectives. To those who may be skeptical of this concept of solidarity, I suggest that we let it be open to rigorous examination. We can start by convening meetings with diverse perspectives to discuss solidarity and develop an acceptable definition. It is essential to capture cultural and geographical perspectives, as well as the use cases of solidarity, to create a more comprehensive bioethics agenda. Regardless of our positions, I hope we can agree that bioethics has a role in supporting the continuity of life, and that together we are more effective and complete when addressing shared global bioethics issues such as emergencies, disasters, and the unintended consequences of innovation.

Funding

The third foundational building block in our reimagined bioethics agenda is sustainable funding. We have significant research opportunities in bioethics, and we also have the enormous task of asking tough, vexing questions about obligations, responsibilities, trade-offs, distribution, and accountability. This new bioethics agenda will require funding models that nurture collaboration, solidarity, and community-centeredness, which may mean stepping out of our comfort zone to create private-public partnerships.

For bioethics to be more relevant and impactful in today’s world, it will need to evolve and adapt. As difficult as it is to admit, moral arguments and justifications alone no longer suffice. Our role as bioethicists needs to be louder, bolder, and more ambitious. Our arguments need to exit the hallowed academic hallways and enter the economic and political highways. And yes, we can co-exist!

Bioethics has much to offer difficult, everyday situations. Avoiding hard conversations means we accept an incomplete bioethics narrative. Instead, we ought to wholeheartedly lean into complex and challenging areas of society so that, under our careful, critical, and moral guidance, we can contribute to more complete, ethically supported solutions. I sense that, if humanity is to thrive, we ought to reimagine bioethics by intentionally focusing on how we build our work on the foundational blocks of collaboration, solidarity, and sustainable funding for the essential work of bioethics.

Unini Odama, MD, MPH, MBE, FASN, graduated from Harvard Medical School with a Master of Science in Bioethics (MBE) in 2023 and remains connected to the Center for Bioethics through her work as an instructor for Global Health Ethics. She is also a nephrologist with an interest in health policy.

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For this month's Bioethics Blog, we feature an interview conducted by Carolyn Baker Ringel, JD, MBE with MBE alum Dr. Roger Chung, PhD, MBE, MHS. Roger is currently the Co-Director of the The Chinese University of Hong Kong CUHK Centre for Bioethics, an Associate Professor of the School of Public Health and Primary Care (SPHPC) of CUHK and the Associate Director of the CUHK Institute of Health Equity. He remains connected to the Harvard Medical School Center for Bioethics through events the CUHK Centre regularly hosts with the Center.

Roger, you became Co-Director of the CUHK Centre for Bioethics in 2022, and then came to Harvard for your degree. How did the degree change how you approach bioethical issues?

I feel more confident. The [MBE] program went through the history, the development, and the origin of bioethics. We read important works in the field. I have a more comprehensive picture. Also, over here in Hong Kong, everybody knows about the four principles. But what people don't usually know is how to use the four principles as part of a moral decision-making methodology to resolve moral dilemma. So that has been extremely helpful.

Because you got a degree at a US institution, do you find that what you learned doesn't always translate in Hong Kong? Or do you feel that the universality of what you're discussing transcends the fact that there might be different norms in different countries.

I think that some of the methodology is very universal. Let's use the methodology of principlism as an example. We had already been talking about these principles in Hong Kong - respect for autonomy, do no harm, benefit your patients and people, as well as justice.

At the same time, getting an education from a prominent Western institution, I think it really helped me to go deeper into the cultural aspect of bioethics. That's very important. How do you put different cultural priorities together, and somehow still respect both perspectives?

I also appreciate that the Master of Bioethics program at Harvard built into the modules non-Western ethical approaches.

The question always is, once you've seen an issue through many different lenses, ultimately you may have to decide which lens you're going to use.

I think it depends on the context, right? I know very clearly that when you're talking about public health policy making, then the utilitarian calculus would often stick out, that number matters for people. The net utility matters on a population level, but it doesn't mean that that must be THE most important lens there is. Pluralism, or "robust" pluralism as Becca [Brendel] and Kelsey [Berry] would call it, was very helpful for me.

You did your capstone work on euthanasia. Have you continued to do work on that issue?

The reason I undertook that research is because we [at the CUHK Centre] had already been studying end-of-life care in terms of advance medical directives, do-not-resuscitate, and withdrawal and withholding of life-sustaining treatment, and this seemed to be the natural next step to study as a scholar. We are very interested in what the public attitude is towards euthanasia. There is ongoing research right now in Hong Kong on that issue and I'm part of that team. There are two sides to my research on this. One is more of the normative side of things. One is more of the empirical side of things. We want to understand what people are actually thinking about and why they're against or for it.

Surprisingly, a lot of people in Hong Kong are inclined to the approval side rather than the rejection side. That is very interesting, right? People talk about Asian culture as being very conservative about these kinds of things, but it's the opposite. Our preliminary data told us one of the reasons people do not reject the idea of euthanasia is actually about family. They don't want to be a burden to their family. It's a huge thing in our culture.

We watched the movie The Farewell in the MBE Foundation class. It showed me it's very important to discern what is a fundamental moral difference versus a non-fundamental one. I realized, after really digging deep into how people arrived at their conclusions about end-of-life care, that a lot of the differences that we seem to have are actually not fundamental. If they [Chinese relatives] want to hide a fact from the grandma [the patient with terminal cancer] as in the movie, they weren't doing it because they were malicious. They were doing it because they don't want to harm. It’s a different specification of harm, because in Beauchamp and Childress’s framework, they would often talk about harm to the physical quality of life, rather than harm to the general well-being. But it is just a different specification of the same principle, leading to a different conclusion. Assuming that there can only be one single moral conclusion from a certain biomedical principle is a danger. That’s the danger of over-abstracting the overarching principles.

In the US, if you want to change policy, you might speak before Congress, or work as a lobbyist, or write letters. How do you find you can be most effective in advocating for the sort of regulatory or legal changes that you might want from an ethical perspective?

I helped contribute to the subsequent legislation of the Advance Decision on Life-sustaining Treatment Ordinance over here in Hong Kong as I was brought in as part of the commissioned research team at the School of Public Health and Primary Care at CUHK to study the policy direction for end-of-life care.

The Health Bureau during that time was looking into end-of-life care and laws on advance medical directives. The people chairing the Clinical Ethics Committee of the Hospital Authority told the government that we needed to have a new law, because the Fire Services Department was legally obligated to resuscitate. The commissioned study we did then led to a governmental public consultation, which collected opinions from the public, then put it to the Legislative Council, which is our law-making body.

The whole thing (from the initial conversation with the Fire Services Department to the passing of the law) took, I would say, about 10 years. The law was passed in late 2024. It'll be enacted by summer of this year.

What is an issue that sometimes comes up for you when doing health equity research?

When I first started doing health equity research, there were a lot of people challenging me, basically saying that, "Roger, this is life. The world is inherently unequal and unjust and I don't understand why you're doing this kind of research." At the very beginning, I said, but isn't it obvious that we should care about these kinds of things. What I realized by going through the MBE is, not everyone shares the same moral intuition. I started to appreciate this kind of questioning.

And so their philosophy was, because there's nothing you'll be able to do to fully right the wrongs, it's a waste of your time to be examining them?

That's right. Like we don't need to work so hard on this. But the [MBE] course and the module on ideal justice versus non-ideal justice really helped me to answer this question. If you look at it from the lens of a non-ideal justice, then we should do something. We want to do something about health inequity precisely because the world is not perfect. Justice isn't a static state. Justice as progress is how I actually see it now, because the world is not perfect, and every little step matters.

What do you think the biggest issues will be on your to-do list for the next year. What is going to require most of your attention?

At this point of my career, I have taken more administrative roles. To be honest, I did not really appreciate doing administrative work in the past, but now I realize it's so important to be able to oversee the operation of a center or a program. I'm also the director of the MPH program here at the School of Public Health and Primary Care. When you're looking at the program, you want to make sure that the education that the people are receiving is top-notch and is forward-looking. Since our students may have to make tough medical decisions, clinical decisions, or public health policy decisions in their professions, you want to give them the education where they can learn how to arrive at the ethical decision so that they can do the "right" thing. I want them to have that appreciation and understanding. That is very important, but that's a lot of work behind the scene.

In terms of the CUHK Centre for Bioethics that I'm running with my co-director, we have basically three big directions: education, research, and public engagement. You want people to understand that bioethics is not something in an ivory tower. It is not something that only the philosophers can talk about. It concerns them and their everyday lives. So, yeah, there are a lot of things on my plate.