Season 9 is off to an exceptionally strong start with our recent discussion with Dr. Nicholas Freudenberg, Distinguished Professor Emeritus of Public Health at the City University of New York (CUNY) School of Public Health. Dr. Freudenberg is Senior Faculty Fellow and co-founder of the CUNY Urban Food Policy Institute (www.cunyurbanfoodpolicy.org). He is a leading expert in Commercial Determinants of Health, authoring two key books in the field; At What Cost: Modern Capitalism and the Future of Health (Oxford, 2021) and Lethal but Legal: Corporations, Consumption, and Protecting Public Health (Oxford, 2014 and 2016). He was a contributor to the landmark Lancet series on the topic: https://www.thelancet.com/series-do/commercial-determinants-health.

Commercial Determinants of Health can be understood as the ways that market actors influence health and disease globally. Commercial Determinants of Health are related to Social Determinants of Health and Political Determinants of Health, which together form a system that influences patterns of human health and disease. The term developed in the early 2000s, emerging from an earlier concept of Corporate Determinants of Health, recognizing that a small number of multinational global corporations dominate the world economy. Dr. Freudenberg explains that changing behavior of businesses and corporations can achieve public health gains at a much greater scale that traditional individual behavioral change approaches, citing successful policies regulating the tobacco industry and smaller gains changing the business opportunities to favor alternatives to the fossil fuel industry. One of the largest commercial determinants of health is the food industry, where there are multiple opportunities for change. Dr. Freudenberg discusses the importance of coordination between activists and public health professionals to counterbalance the influence of corporations on policy. What is the role of bioethicists? Listen and find out!

Bibliography:

https://www.annualreviews.org/content/journals/10.1146/annurev-publhealth-052220-020447

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00011-9/abstract

https://global.oup.com/academic/product/at-what-cost-9780190078621?cc=us&lang=en&

https://global.oup.com/academic/product/lethal-but-legal-9780199937196?cc=us&lang=en&

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.org

https://unitedwedream.org

This month we are joined by Dr. Karen Meagher, Assistant Professor of Health Justice and Bioethics at the Lewis Katz School of Medicine at Temple University. Recently, Dr. Meagher was the Associate Director of public engagement in the Biomedical Ethics Research Program at the Mayo Clinic. Her research focuses on public health ethics and social implications of advances in microbial and human genetics. She has a PhD in philosophy from Michigan State University. From 2012-2016 she worked as a senior policy and research analyst on the staff of president Barak Obama’s Presidential Commission for the study of bioethical issues.

Listen in as Dr. Meagher shares her career journey starting with her undergraduate interest in the philosophy of science and social influences of how science gets done. She describes how she was drawn to the growing field of public health ethics, which blossomed in the early 2000s with increasing publications and dedicated journals. Dr. Meagher describes her Virtue Ethics orientation to public health ethics and shares the inside scoop on what it is like to serve on a Presidential Commission.

Later in her career, embedded with Mayo clinic biobank, Dr. Meagher describes her experiences with public engagement with community and how bioethicists can be a bridge between basic scientists and the community when grappling with difficult ethical dilemmas like those dealing with broad consent for future research with banked specimens.

Finally, we delve into a discussion of how Dr. Meagher’s work on antimicrobial resistance led her to engage in concepts of One Health Policy, which recognizes the interdependence of people, animals and the environment. She highlights the importance of breaking down silos between researchers in different sectors and how bioethics can bridge disciplines and create shared moral language, while also centering engagement of communities to help define these problems from different perspectives.

Selected publications of Dr. Meagher’s which were referenced in the podcast can be found here:

Meagher KM. Can One Health Policy Help Us Expand an Ethics of Interconnection and Interdependence? AMA J Ethics. 2024 Feb 1;26(2):E162-170. doi: 10.1001/amajethics.2024.162. PMID: 38306206.

https://pubmed.ncbi.nlm.nih.gov/38306206/

Meagher KM, Curtis SH, Gamm KO, Sutton EJ, McCormick JB, Sharp RR. At a Moment's Notice: Community Advisory Board Perspectives on Biobank Communication to Supplement Broad Consent. Public Health Genomics. 2020;23(3-4):77-89. doi: 10.1159/000507057. Epub 2020 May 12. PMID: 32396907.

https://pubmed.ncbi.nlm.nih.gov/32396907/

Meagher KM. Considering virtue: public health and clinical ethics. J Eval Clin Pract. 2011 Oct;17(5):888-93. doi: 10.1111/j.1365-2753.2011.01721.x. Epub 2011 Aug 11. PMID: 21834841.

https://pubmed.ncbi.nlm.nih.gov/21834841/

Meagher KM, Lee LM. Integrating Public Health and Deliberative Public Bioethics: Lessons from the Human Genome Project Ethical, Legal, and Social Implications Program. Public Health Rep. 2016 Jan-Feb;131(1):44-51. doi: 10.1177/003335491613100110. PMID: 26843669; PMCID: PMC4716471.

https://pubmed.ncbi.nlm.nih.gov/26843669/

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.

We welcome everyone back from a beautiful summer to kick off Season 8 with Julia O'Brien, the "grandmother" of geographic information systems (GIS). O'Brien was the Federal Emergency Management Agency (FEMA) Region II Special Geospacial Coordinator before her retirement in 2023. She worked in remote sensing and GIS for over 30 years. Before that she was the Senior Project Manager for a New York City project to complete an accurate GIS dataset for NYC, culminating in the Citywide Street Centerlines (CSCL) database.

O'Brien walks us through the importance of GIS in disaster management and how it allows leaders to understand what infrastructure may be in the path of storms or flooding in order to prepare adequately for natural disasters. She discusses the role that FEMA plays to support states and localities during manmade and natural disasters. We delve into how proposed cuts to federal funding will affect institutional knowledge that is critical for disaster relief during this time of increased frequency and severity of disasters due to climate change. O'Brien highlights the importance of diversity in planning for disaster response needs. Finally, she discusses the importance of aid services provided by agencies like FEMA and USAID, noting that when a government does not meet the needs of the people, it will not be supported.

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/10.1080/15265161.2024.2323869

Dougherty 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/

Dr. Carlos Smith, a general dentist and ethicist, is the Associate Dean of Ethics and Community Engagement and an Associate Professor in the Department of Dental Public Health and Policy at Virginia Commonwealth University School of Dentistry. His work focuses on professional identity formation, dental ethics, and oral health justice. In this episode, Dr. Smith discusses his unique path blending dentistry, theology, and bioethics. He begins by discussing the importance of seeing other Black health professionals in his community and observing the professional contentment of dentists while exploring career options. He also cites the crucial piece of advice of one mentor who encouraged him to see the paths of dental school and seminary as not an either/or, but a both/and. Dr. Smith encourages us to think about some of the basic principles in bioethics – beneficence and maleficence – with a broader lens. For example, he talks about the professional duty to understand the reality of racism of all forms in order to think about harms and benefits more systematically and wholistically. He also pushes the envelope on the long-standing medical ethical imperative to place patients’ interests above physicians’ interests by pointing out that the political interests of patients should also be placed above the political interests of health professionals in order to uphold that principle with integrity and trustworthiness. Dr. Carlos provides some clear-headed definitions of diversity and equity and engages with Kirk and Amelia on a must-listen discussion of the ethical dilemmas institutions are facing regarding the precise use of language in this political climate and the critical need to engage with communities and to advocate during these times.

Works cited in the podcast can be found here:

Teeth, by Mary Otto https://a.co/d/j68ePPQ

Smith, C. S., Kennedy, E., Quick, K., Carrico, C. K., & Saeed, S. (2021). Dental faculty well-being amid COVID-19 in fall 2020: A multi-site measure of burnout, loneliness, and resilience. Journal of Dental Education, 85(12), 1956-1965. https://pubmed.ncbi.nlm.nih.gov/34780060/

Smith, C. S. (2023). Applying a systems oriented ethical decision making framework to mitigating social and structural determinants of health. Frontiers in Oral Health, 4, 1031574. https://pubmed.ncbi.nlm.nih.gov/37521174/

Smith, C. S., & Simon, L. E. (2025). To do good and refrain from harm: Combating racism as an ethical and professional duty. The Journal of the American Dental Association, 156(2), 91-94. https://pubmed.ncbi.nlm.nih.gov/39269381/

Smith, C. S. (Guest Editor). (2021). A Clarion Call to Leaders in Dentistry - A Professionalism Ethic for Diversity, Equity, and Inclusion. Journal of the American College of Dentists, 88(2), 1-48. https://issuu.com/college1920/docs/ejacd_vol88-2_2021-07-22_f/s/12896517

Smith, C. S. (Guest Editor). (2021). The Beauty of Many Voices: Unlocking A Growth Mindset Towards Diversity and Inclusion. Journal of the American College of Dentists, 88(3), 1-48. https://issuu.com/college1920/docs/ejacd_vol88-3_10-21_f4/s/13713999

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 Network

The 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

Our first ever repeat guest is 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 had previously joined us in September of 2023, on Season 5 Episode 2 of Bioethics in the Margins. She joins again today to discuss the timely topic of the effect of recent Executive Orders rescinding the 2021 guidance designating schools, churches and healthcare institutions as "safe zones" exempt from immigration enforcement. Dr. Fabi outlines specific strategies that institutions can adopt to protect students and patients, particularly designating areas clearly as private spaces, which require a judicial warrant for ICE agents to enter. She highlights the importance of proactive planning on the part of institutions. Kirk, Amelia and Dr. Fabi reflect on our moral obligations towards immigrants as a society and the specific obligations of ethicists in practice and discuss the importance of immigrant communities to the fabric of our society. Several resources that were mentioned in the episode are linked below:

1. Toolkit for healthcare institutions curated by Mark Kuczewski

2. Link to “red cards” to inform people of their rights

3. Immigration Policy Tracking Project

4. The Health of Newcomers by Patricia Illingworth and Wendy E. Parmet

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/28922206

https://pubmed.ncbi.nlm.nih.gov/30484899/

https://pubmed.ncbi.nlm.nih.gov/35300858/

Link to Practical Radicals: https://thenewpress.com/books/practical-radicals