Grady, Christine (2025)

BA: Good morning. Today is September 25, 2025. My name is Brittany Acors. I am a postdoctoral fellow in the Department of Bioethics in the Clinical Center. Today I have the pleasure of speaking with Christine Grady. Dr. Grady is a nurse-bioethicist who has worked at NIH since 1983 and recently retired from her role as chief of the Clinical Center Department of Bioethics. She has written widely on such topics as ethical issues in clinical research and clinical care, HIV research, nursing, and moral distress. Thank you for taking the time to talk with me today, Dr. Grady.

CG: It’s my pleasure.

BA: In your 1997 oral history with the Office of NIH History, you talked about your nursing education and your time working in Brazil. I don’t want to revisit those in detail, but I am wondering how those very early experiences in your career prompted some of your interest in bioethics.

CG: As you mentioned, Brittany, I am a nurse, and I had a number of different opportunities to work in nursing: in acute settings, in community settings, in international settings, in hospice, home hospice, a number of different things. In each of those very rewarding positions, there were issues that came up that I thought, I wish I knew how to address them. They were issues like: how do you think about allocating resources, and how do you help people at the end of their life, and how do you balance what’s good for this individual with maybe what the public health demands are?

Those were issues that came up in my nursing practice and in those days—I’m old enough—bioethics wasn’t really much of thing. I didn’t even know the word. There wasn’t much attention to it. So, as I went through many years of being a nurse in wonderful jobs, I constantly struggled with some of these questions and made some decisions based on them, but I wanted more background or a structured way to think about them. I ended up thinking, oh, I need to go back to school and learn more about what is now called bioethics, or what has been for a while, but was just new then.

BA: Before you went back to school—because we’ll get there—you started at the NIH as a Clinical Nurse Specialist in 1983, and then you transitioned into research roles as a Research Associate in the National Institute of Nursing Research [NINR] in 1989, and then eventually you became Assistant Director for Clinical Science there until 1996. What do you remember about those first years here at NIH?

CG: I had just recently returned from Brazil, where I spent a couple years with Project Hope working on a number of things, but one of the things that I learned in Brazil was about neglected and tropical diseases. Of note, some of the investigators at the NH were actually studying those diseases, so it was quite interesting to jump into that setting and learn more about the science of those particular disorders and how people were trying to address them. It also happened to be, as you alluded to before you know, that 1983 was really the beginning of HIV. The units that I worked on as a Clinical Nurse Specialist were doing work in immunological disorders and infectious diseases. HIV, of course fit right there as well, so I was learning along with the evolution of the disease and what people were learning about it across the world.

But we had a lot of really incredible experiences in those early ’80s with people with HIV, because they were very ill. They were very young. They were like, you know, my brothers, my friends. They were my age. They were full of life and then sort of stopped in their tracks with this terrible disorder. And they were very brave, just to come to the NIH and participate in clinical trials. Sometimes [the trials] helped them; sometimes they didn’t. But they helped us learn a lot about what HIV was and how to address it. So that was an amazing experience.

As I mentioned, there were all these tropical diseases and parasitic diseases. I was learning along with the staff about immunology, to the point where I got to teach immunology to some of the staff. That was very exciting. Immunology has also advanced a lot since those days, but in those days, there was a lot that was going on in terms of our understanding of how the immune system works. Those were very fascinating times.

In 1986-ish, I guess, there was an opportunity to work with Cliff Lane and some other people who were wanting to open an outpatient clinic for HIV and model it on a nurse-run, case-manager model. I thought, Wow, that’s great. So I helped set that up and spent a lot of time working with the nurses, the case managers, in that clinic, and helping to develop what that clinic would look like. It was really exciting and a model that worked really well at the time, and still does.

From that experience, I was able to connect with an investigator [Mary Ropka] who was creating the new intramural program in the National Institute of Nursing Research (NINR). What she wanted to focus on initially was HIV symptom management. She spent a lot of time in the clinic with me, and others in the clinic. She eventually hired me to go work at NINR, where I got to do some of my own research on fatigue and muscle wasting and some of the other symptoms that were plaguing people who had HIV.

BA: Had you done research work before, or had you largely been practicing as a nurse and had to learn different research skills as you took on that new role?

CG: Yeah, great question. I had always been interested in research. One of the earlier jobs that I had had was at Tufts New England Medical Center in an NIH-funded clinical studies unit, so I was very familiar with what research was. At that time, my role was not doing the research, but facilitating the research and taking care of the patients who were part of the research. When I was in Brazil, I didn’t have any funds or resources to rely on, but I tried to do a couple of really small studies that I thought would help us in the clinic. For example, there was a very large pediatric clinic. I remember thinking it would be really interesting to find out whether taking the weight of the children with their clothes on versus without their clothes on really made a difference, because in terms of moving people through the clinic, taking clothes off and putting them back on was a big deal. And in those climates, they didn’t really have a lot of clothes on, so I didn’t think it would really make a huge amount of difference. So I did a little study like that in Brazil, but without really knowing what I was doing. But I learned some things, and I enjoyed it. Then when I was working at the NIH, of course, I was surrounded by research, and so I felt like I understood how research was being done. I understood some of the issues that I thought should be researched, and I had resources around me to help me figure out how to make sure that it was done and done well.

BA: So that that brings me to your going-back-to-school period. By the mid-1990s, you’d been a nurse for a long time, a nurse educator, and then you were doing research for a few years. Then you went for a Ph.D. in philosophy back at Georgetown, where you did your undergraduate education. In your previous oral history, you talked about how Dr. [John] Fletcher helped inspire that decision and what your dissertation focused on, the ethics of HIV vaccine trials. But I’m interested in your motivations and what you felt the philosophy degree would offer you, and then looking in retrospect on your career, what do you think about that decision?

CG: It was a time that I wanted doors opened. I wanted to be able to do things that I wasn’t allowed to do because of my credentials. And I thought, well, the best way to do that is get more credentials, go back to school. I was interested in learning things. As I mentioned before, there were a lot of things that I came to realize were bioethics when I was working as a nurse. But also, because I had been working in HIV and in other kinds of infectious diseases, I was very interested in infectious disease epidemiology, so I thought, well, maybe I’ll do a PhD in that. It wasn’t like I was hell-bent on philosophy.

But when I talked to people like John Fletcher and some of the other people that I knew in the world who were working on these kinds of issues, it seemed like, well, bioethics was a really good avenue for me. It made sense given my background, given my interests, given my approach to life. And Georgetown, at that point and still now, had a good reputation for being a really wonderful place to learn bioethics, because of the Kennedy Institute of Ethics that was already there, and the relationship between that, and the philosophy department, and Dr. [Edmund] Pellegrino, who was at the Medical Center. So, it seemed like a good choice for me, and that’s where I went.

BA: The Kennedy Institute was one of the first institutes of bioethics in the 1970s. Did you have a sense of how the field had developed by the time you got there in the ’90s, or was it still kind of early stages?

CG: It was still early stages, and actually I started the PhD program in the ’80s, so it was even earlier. Surprisingly to me, because I was a nursing student in the ’70s, I never heard of the Kennedy Institute at that point, but it made an impact in the world because it was, as you just described, one of the first, and people were paying attention. A lot of people in health care were very interested in the kinds of issues that the Kennedy Institute was thinking about and focusing on and studying. So, it had already made an impact, and it has continued to evolve in different directions and grow since then. But I think places like the Kennedy Institute and the Hastings Center and places that all started in the ’70s really have created the opportunity for a field that we call bioethics that has flourished, I think, since then.

BA: You finished the Ph.D. in 1993, and then in 1996, you took on a new role using a lot of those skills.

CG: Yes.

BA: You joined the Clinical Center Department of Bioethics, which was brand new, and you had the role of Senior Staff Bioethicist. What did the department look like then?

CG: First, I’m going to give you two background pieces of information. When I finished my degree, I was thinking I was going to stay at NINR. The then-director of NINR [Dr. Ada Sue Hinshaw] was thinking about starting an ethics laboratory as part of the NINR portfolio—which never actually happened, but I think she was in good faith and really wanted to do that. At the same time, the then-director of the Clinical Center [Dr. John Gallin] was interested in creating a Department of Bioethics that had “national visibility,” as he described it. He organized a meeting, I think in 1995-ish, where he brought together a bunch of bioethicists from around the country to talk about what we could do if we did have a department of bioethics. I helped organize that meeting, because he knew I was interested, and there was a person from [the Genome Institute] who helped. There were a couple of people from different institutes who helped organize it [including Dr. Kate Berg, and others]. It was quite exciting to meet some of the people that I had been reading about and hearing about.

Then when Dr. Gallin decided to start this Department of Bioethics in the Clinical Center, I—having missed patient contact, which is something I had done a lot in nursing work—I thought, Oh, that’s for me. I want to go there. So I applied, and he hired me.

It was a very different department in those days. There were two people there: Dave Wendler, who was a fellow, and an assistant. There was one other part-time fellow there [Evan DeRenzo]. They were in this little closet in a corner. And then there were the three of us.

It was exciting, but we were on top of each other and trying to learn things. At the same time, the Genome Institute had a little focus of bioethics in their portfolio, and they brought in a person who sat near us [Ronald Green from Dartmouth], so we got to talk to them. From there, it just grew. Several things happened. We were able to start a fellowship program through the department and bring in fellows—first one, then two, and it grew over time like that. We were able to hire more people. Zeke Emanuel was hired to be the director of the program, or the chair of the department. And it just grew from there.

Now, as you know, Brittany, because you’re part of it, we have a very vibrant group of people. It’s still small by many standards, but by bioethics standards, it’s pretty big. We have eight faculty, and twelve fellows, or something like that, and some support staff. It’s a great program, a great department, that has grown and thrived.

BA: Do you have a sense of how the Clinical Center at large first received the department in 1996?

CG: I think they were curious but didn’t know what bioethics really was. So, some of our work, which still continues today, is to try to help people understand how bioethics fits into science and clinical care, and how it can be helpful. I think, in the early days, there was a lot of skepticism, but people were sort of like, OK, whatever, it doesn’t bother me if it doesn’t bother me. But right away, we had a consult service that grew. Prior to the creation of the department, there was a little bit of a consult service in the program that existed before, but it was quite different than the way it got set up in the new department. I think people who asked for help through the consult service began to see it as very useful and began to spread the word. In the beginning, and it’s probably still true, there were people who asked for consults and who kept coming back. They found them useful and would repeatedly ask for them. I think they also talked to their friends and colleagues, and so it grew that way.

In addition to the consult service, which still is very active and important, we were beginning to do our own research, and some of that got a lot of attention. In those days, of course, people, especially people who knew a little bit about bioethics, were like, “Research? How do you do research in bioethics?” It was a proving ground, in a certain way, to show that there actually is really important research that can be done, and done rigorously, and that can provide some useful guidance for how we think about things. That was a really wonderful opportunity for us.

And then the third piece is, as I’ve mentioned before, the fellowship program. It was one or two fellows in the first few years and then grew and grew. It’s gotten to be a program that is very competitive and has brought in people from a variety of backgrounds with a variety of skills, but all really cream-of-the-crop people. And they end up going on to be leaders in their field. Many of them are leaders in bioethics. Some of them are leaders in fields adjacent to bioethics. It’s been a really rewarding part of the department.

BA: Did you feel that your background in nursing made your approach to bioethics any different from others in the department? We had several philosophers, and then Marion Danis as a physician, but nursing is its own kind of empathetic career.

CG: Yes, I do. I used to compare myself mostly to the philosophers, because I have a PhD in philosophy. At some level, I was described as a philosopher, and I would say, well, I am a philosopher, but I’m a different kind of philosopher, because I have this clinical background. It gives me some insights that people who don’t have a clinical background probably don’t have, and also an approach to working with people that I think comes with being a clinician. I used to say that I have an advantage because I have those two things that some of my philosopher colleagues don’t. I have continued to identify myself as a nurse. I feel like the things that made me want to be a nurse, and the things that made me the nurse that I was, I have continued to thread through my work as a bioethicist. I think it is an approach to people and a recognition of some of the complexity of what happens in a clinical situation, which is almost always very complex.

BA: After many years here, you became chief of the department in 2012. What additional responsibilities did that entail? And did you have any kind of vision for what the department might look like under your leadership?

CG: I worked very closely with Zeke [Emanuel] throughout the whole time that he was the chair of the department. There were a couple of times very early on, and when President Obama was elected and Zeke was detailed to the White House, where I was the Acting Chief, so I had that experience in my portfolio already. When he decided to leave, I thought, well, I should apply for this job for two reasons: I thought I knew more about the department than anybody else, and I could continue the strong things about the department and build other things that would make it even stronger. And so that’s the way I presented it to the search committee. To be perfectly honest, my understanding is that they almost didn’t give it to me because I was not a physician. But they ended up giving it to me, and one of the things that I told the search committee that I wanted to do, and I think I did do afterwards, was emphasize some of the scientific areas that we, as bioethicists, could really contribute to, because they were moving fast and there was a lot going on. One of those was neuroethics. Prior to that, we hadn’t done much in neuroethics. Another area was genetic ethics. Although we had been doing some stuff in that, I thought we could expand and work with some of the really fascinating and fast-moving science that was happening in those two areas at least. And as you probably know, being at the NIH, you learn about all kinds of science when it is in very early stages. I think it’s really important to think about some of the ethical implications of the science as early as possible, and the only way you can really do it is if you understand some of that science. So, my focus was, let’s get people really immersed in the science that they’re going to be working in, so that they understand enough to be able to make reasonable contributions to understanding the ethical issues involved in that science. That’s really how I tried to steer us in the last 12–13 years.

BA: I think that’s been really successful. We certainly have a lot of neuroethics publications out of the department and genetic ethics, and you’ve led a lot of those too. I’ve noticed throughout this history project that one of the other things that a lot of our faculty members have done is public service work, not just at NIH, but often as Commissioners. You were a Commissioner on the President’s Commission for the Study of Bioethical Issues from 2010 to 2017, which is pretty long period of service. Can you tell me about that role?

CG: Sure. It was a privilege to be invited to be a Commissioner. I had, earlier in my career, actually worked on the staff of one of the HIV Commissions, so I understood a little bit what Commissions do, and it was kind of amazing that they invited me to be a Commissioner, not a staff member. It was a really incredible experience. We had a lot of very important topics that we spent time researching and trying to understand and trying to say something about the ethics of. Some of it was a little bit overwhelming. I remember, for example, the first project we had was synthetic biology, and President Obama himself asked, could the Commission say something about the ethics of synthetic biology? This was maybe in the summer of 2010-ish, and our report was due by December. We had mountains of things to read. We had at least three, or maybe more, hearings to learn from experts in the field, and then lots of meetings to try to synthesize: how do we think about this? What can we build on that’s already been done? What’s new here? That kind of stuff. We came out with a report in December of that year, and I was like, wow, that’s really fast work. And I don’t mean by that that it wasn’t good work. I think it was actually very good work, and that’s been validated by the usefulness that it has shown since—that report in particular, but others as well.

A couple other things about being on the Commission were really great. Prior to that Commission—I don’t know if it was all Commissions or just Bioethics Commissions—but government employees were not allowed to be Commissioners. I think Zeke had a lot to do with changing that. But I was [a government employee and Bioethics Commissioner]. And so was Nelson Michael. There were other federal government employees who were part of the Commission, and that was good because we had some inside knowledge that others didn’t have, which was also quite useful for some of the topics that we were discussing. Two other things were that I was a nurse, and I was the only nurse on that committee. There were other bioethicists, and so I was in good company in that regard. But a question you asked me a few minutes ago, did my nursing perspective bring something different? I think it did. I think that was a good thing too.

I really learned a lot from that experience as a Commissioner, and I feel like I contributed a lot to the work of the Commission. We have a number of reports out there that sort of, I think, stand for themselves in terms of usefulness for certain topics.

BA: Moving into some of your research: one of your most cited articles was the 2000 publication, “What Makes Clinical Research Ethical?,” co-authored with Zeke Emanuel and Dave Wendler. How did that article come about?

CG: I had been thinking about the ethics of clinical research for a long time, since I had been at the NIH, and sort of talking about it, thinking about it, giving lectures about it, things like that. I remember one day Zeke came to me and he said, there’s a lecture you give where you give these different points, and I’ve never seen that put all together in a synthesis. And I said, oh, well, OK, let’s do it.

So, we did. The ethics of clinical research can be complicated. There are a lot of really detailed issues that are hard to address. Some of the guidance that existed was helpful, but also the different guidances that existed and the different regulations sometimes had different interpretations, and there were some conflicts and things like that. So it was important to try to think of what we could do that would be a step-back opportunity to frame how clinical research could be ethical, and what are the important pieces you look at in order to figure that out. We were thinking investigators, reviewers, people like that were the main “customers” or readers of the article. Not surprisingly, in a certain way, it has resonated quite a bit. It’s a very well-cited paper. It’s been adopted in some national regulations. It’s part of a lot of academic discussions. People still write papers about how it applies to other specific kinds of research. So it has stood on its own for a long time.

It’s 25 years old now, so the question is, is it still the right framework? I think it is. I think there are a couple things that could use more work—some of the specific elements of the framework have had some academic inquiry but could use more, because of disagreement about what they mean or how they apply. And then I think there’s a question that I haven’t had enough time to spend thinking about, and that is, with all the new methods of research that we are now using, how does it apply now? I think it probably still does, but I think somebody looking at that application would be a very interesting exercise.

BA: Can you give an example of one of the aspects that you think could use some more research?

CG: Sure, I can give a couple. One, social value probably has had, maybe not the most attention, but a lot of pretty serious attention, in terms of is it really required? What does it mean? How do you measure it? How do you know if you’ve got it? Does it change over time? There are a lot of questions that people are still struggling with, and I am a firm believer that it is actually a very important part of doing ethical research. Clinical research involves people, and even if there aren’t risks, there are discomforts or burdens or requests of people to do things. It also requires resources, and resources should be used wisely. So why do a study if it doesn’t have any utility? It seems like that’s wrong, and therefore we should be sure that research has some social value before it’s done. That’s the way I always used to think about it.

Some people disagree with that and say that there are other reasons to do research, like finding products that will make stakeholders happy, things like that. I still think there’s a way in which even that kind of research should have social value. I’m describing social value, in my mind, as some utility for the people whom you’re studying. So if it’s finding a better way to deliver a drug, that has social value if it’s really a better way. Some of the challenges are: how do you know in advance whether something’s going to have social value? And what counts? Is it benefit to people or benefit to groups? Is it health benefits only? Could it be the speed of doing the trial? There are a lot of unanswered questions about how one should think about what social value is and how you figure out whether a study or a proposal has it before you start.

There are lots of things that need more in-depth exploration, but I’ll mention two others. One is fair subject selection. I think it is critically important, but it’s also complicated. It’s complicated because what’s “fair” is one question that needs to be answered, and certainly there’s a balance between getting the right people who will help you scientifically answer a question and paying attention to who’s burdened by research and who’s benefiting from research and who’s vulnerable. With all of those things, it’s not an easy task. [Fair subject selection] gets attention, but it needs more normative unpacking, if that’s the right way to think about it.

And then the third one I’d say [needs more attention] is respect for enrolled participants and respect for enrolled communities. It’s loaded, because as we said in the paper, or I’ve said many times in presentations, prior to this framework people we talked to and some of the regulations and guidance that we had available to us said, OK, you get external review of your research by an IRB [Institutional Review Board] or an REC [Research Ethics Committee], you get informed consent of the participants, and you’re done with your ethics. That has never made sense to me, because I think you’re just beginning. By collaborating with the participants in the study, there are ethical obligations that you have to them throughout the study and when the study is over. Those kinds of things need more unpacking as well. Some of them are getting it, but some of them aren’t.

BA: So, bioethics isn’t done yet.

CG: No, it’s not done yet.

BA: I think what I heard in a lot of your answer, particularly the social value one, is a focus on the pragmatic effects of clinical research on patients and communities and society more broadly. I think that reflects a lot of the nursing clinical care background that you have.

CG: Yes, yes.

BA: In 2004, a couple years after that article, the three of you plus Jack Killen teamed up for a follow-up article, “What Makes Clinical Research in Developing Countries Ethical? The Benchmarks of Ethical Research.” What led to that expansion in that project, and how did it add on to those previous principles?

CG: When we first put out the framework in 2000, we took it on the road. We went not only to the courses that we taught at the NIH, but we also had the opportunity to do courses in other parts of the world. We would present the framework and ask people, does this make sense to you? What’s missing? What’s good about it? Over time, we realized there was something missing. It was about partnership—the partnership with the people that were in the study, but also the communities of people that cared about research. It might be a geographic community. It might be a disease community. It might be the funders. It might be the investigators. But there’s a lot of people [who care]. Clinical research is, I always say, a team sport. There’s a lot of people involved. So having some partnership with those people that’s a collaborative partnership, which means respecting the contributions that they bring to the table so that it’s satisfying the needs of all of the partners, seems like a really important ethical requirement. So we decided to add it. And that’s another one that could use a little more digging into.

BA: Another one of your primary areas of research has been moral distress. What got you interested in that topic, and what have your contributions been to that field?

CG: Moral distress is a term that came about in the nursing literature in the ’80s. It was a description of basically the distress that nurses felt when they thought something should be done a certain way when they’re taking care of patients, but the constraints of the organization basically made it impossible for them to do that. It had to do with both hierarchies within institutions, but also the status of nurses.

The idea really expanded after that by many other authors who thought, OK, there are other kinds of constraints on whether people in the healthcare field are able to do what they think is right in a certain situation. It’s not just nurses—it’s all kinds of health professionals. It makes perfect sense, because healthcare is, as I said, a team sport. People work collaboratively with others. And others, especially in this world that we live in, sometimes have different views on what’s right. They might have different values. They might have different priorities. There are institutional rules. There are legal rules. There are financial constraints. There are so many complex things that go into a health system that it’s just not surprising at all to me that sometimes healthcare providers are going to be in a situation where they think, I think we should do this, but I can’t or we can’t. That is what I think of as moral distress.

I think it’s real. I think it’s gotten a lot of attention, but there’s a lot of confusion about the terms. There are a million terms that have been substituted for it or used in similar ways and not with clarity about the distinction between some of these terms.

One of the things that I’ve been thinking about a lot, and trying to write about but haven’t written too much yet, is an idea that I’ve been calling “moral strength.” It’s not an antidote to moral distress. It’s not that we have distress and, therefore, we have to be strong. It’s not that at all. It’s a descriptor of the way I have viewed healthcare professionals throughout my lifetime of working with them—that is, that many of them are strong. They are morally strong. They make decisions on a daily basis that do have ethical ramifications, and they do so more often than not without distress. They do so because they’re committed. They go, and they make a decision, and they sometimes are supported by their colleagues. They can still experience distress. They can still get burned out. I mean, all that’s still true. But their day-to-day work has a foundation of what I’m calling moral strength, which I think is really important, needs to be better recognized, and needs to be cultivated. That’s what I’m trying to talk about these days and write about these days a little bit. And again, it’s not just nurses. It’s all the way across every healthcare profession.

BA: Well, a lot of your work in the last couple of years has focused on moral distress and maybe moral strength in the COVID-19 pandemic. How has your research grown or changed given that development?

CG: As many people know, COVID sort of brought the world to its knees, and healthcare professionals really carried a lot of that burden. People worked under extraordinary circumstances, sometimes without protective resources for themselves, with more patients than they could carefully attend to, with many, many deaths—and they were lonely deaths, and isolated deaths, and really hard circumstances. People have written extensively about the moral distress and the moral injury that resulted from some of those experiences that people working in COVID had. I think that’s true.

Connie Ulrich and I did a study a few years ago interviewing clinical ethicists around the country and asking them about how their lives changed under COVID. Basically, what they learned, what they struggled with, etc. Almost without exception, every one of them mentioned moral distress as a sort of ubiquitous and problematic reality in healthcare institutions. I also think some of the ideas that I have about moral strength came through during COVID as well, because there were healthcare providers who showed up every day despite those pretty awful circumstances, who wore garbage bags because they didn’t have protective equipment, who reused their N-95 [masks] to the extent that they bled from them, who gave incredibly compassionate care to people who were dying without their families there, who stood up to institutional policies that seemed wrong. That story needs to be told too. COVID brought out both [moral distress and moral strength] in the world of healthcare professionals. It was a very important time for us to think about what are the strengths and where are the weaknesses and how do we help address them.

BA: Moving into some more big-picture focus on the Department of Bioethics, what changes have you observed either in the Department of Bioethics or at NIH more broadly throughout your tenure here? And what has stayed the same?

CG: With respect to the department, as we mentioned earlier, one obvious thing is the growth, just the size of it. But I think along with the size of it came visibility. It’s been very visible both internally at the NIH but also externally. Impact and influence—I think the research that we’ve done, the fellows that we’ve trained, the consults that we provided have all had an impact and a positive influence on the field of bioethics and the kinds of topics and the kinds of thinking that people do about bioethical issues.

I also think what has grown is respect: respect for the department in many ways, but also respect for the field of bioethics, and how it can make a difference in terms of how we do science, and how we do clinical work, and how we do public health. When you take those ethical considerations into account early on and address them along the way, it makes all of those things stronger. I think the department had some role in that as well, so that’s all been good.

What has stayed the same? There are still struggles for people who say bioethics, what is that? That still occurs. It always surprises me, but it does. But much less than it used to, that’s for sure. And people are actually, more often than not, asking, can you help me think about the ethics of this? Sometimes through a consult, but sometimes just stopping you in the hallway or calling on the phone. Overall, the growth and the increase in visibility, stature, and impact have been great.

BA: What do you see as some of the greatest challenges and opportunities for bioethics in the next 5–10 years?

CG: I do think that part of what we’re dealing with in the country right now is skepticism about science and skepticism about institutions. I think bioethics will be caught in that, because we’re part of both of those in some ways. That’s going to be a challenge and, along with it, misinformation and disinformation and how you deal with those. I think bioethics has to maybe be a leader in terms of thinking about how to do that. I think we can be a model for how you can have debates and disagreement with civility and without demonizing the people who disagree with you. So I think those are all really important things that bioethics needs to do.

I am a little worried about resources and funding for bioethics. That’s going to be a problem across a lot of areas of science, but it’s going to be true for bioethics as well. That, unfortunately, could discourage people from wanting to do bioethics in the future if they can’t see a pathway. So that concerns me, the funding.

BA: In light of those challenges, or just based on your own experience, what advice do you have for aspiring bioethicists early in their careers or in their education?

CG: I think the most important thing is to find a niche that you feel strongly about, because I do think that bioethics is strongest when it’s very knowledgeable about the area in which it’s opining, if that’s the right way to think about it. So science or clinical care or public health or whatever it is, pick it and then focus on what you think you can contribute to that area. Learn as much as you can, and be persistent, and don’t get discouraged. Remember that you can have an impact and have an influence in a positive way on the way people think about science and the way people contend with some of the really important issues that we are all going to be facing, and are all facing, in the health arena, in our country, and in our world. I think there’s a huge need for people who can do bioethics and do it well, and who can do it with patience and civility and focus.

BA: Do you have tips from your current research on cultivating moral strength?

CG: Yeah, I think so. I do think that some of the motivation for getting into fields like bioethics and healthcare professions is an important start, and we should be recognizing that and cultivating that early on in people. You know, why do you want to be a bioethicist?

What do you care about? Those kinds of things are really important, but once you get into the fields, [you should be] educating yourself about everything that you need to know for your jobs and your profession and working together. The model of moral strength that I think works the best in everything that I read and think about and see is being part of a moral community: having others who you can talk to, and work together with, and support you, and want to hear what you have to say. Working towards a common goal seems critically important. And then having some imagination about what can be done and what can’t be done and why, and also working within the institutions that you work within to make them supportive of all of that. Those are the things that are going to make moral strength possible and sustain it.

BA: Great. I think those are really helpful tips. Do you have any particular memories or funny anecdotes that stand out from your time in the Department of Bioethics?

CG: Perhaps others have spoken about this, but one of the things that’s been wonderful about the Department of Bioethics for me is the camaraderie, that people do support each other.

It is a community of people. It is a moral community, and also a social community. We have a lot of fun having potluck dinners and going out after work and having tea together. Those are things that stand out as things that I will always remember as an important part of the Clinical Center Department of Bioethics. Even during COVID, we did some pretty creative things to keep our social life going, our social community going. We played games on Zoom at certain times, and we met in Rock Creek Park, six feet apart, and that kind of thing. We tried to maintain the social community even when it was hard and not everybody was able to do it. Those are maybe not funny, but I think they’re important things about the community in this department.

BA: Having been here for more than 40 years, you know the Clinical Center and the NIH campus better than probably anyone. What’s your favorite secret of the Clinical Center that you’re willing to give away?

CG: I have two things to say. One is probably not a secret, but it should be shouted from the rooftops, and that is that the people that work at the Clinical Center and across the clinical programs at the NIH are some of the most dedicated, smart, incredible public servants that exist, and they should be recognized for that. And they have. There’s been a lot of incredibly important discoveries that have been made at the Clinical Center, too. I think the, not really a secret, but the factoid that I always loved to talk about is that the Clinical Center is a really big place. It is the largest brick building in the world, with more than 3 million square feet of area. And even after 40 years, there were places I couldn’t find. [laughs] So it’s a maze of interesting things going on that you can get lost in.

BA: Anything else you’d like to add, or any questions you wish I’d asked you?

CG: I do think that one of the things that bioethics is going to have to contend with going forward—and has contended with historically—is inequality, that is, problematic inequality. That affects health, and it affects how we treat each other. Right now is kind of a difficult time to be talking about that, but it’s absolutely critical to both our healthiness, but also our future.

BA: A great note to end on, and something we’ll continue to think about for many years, I’m sure. Thank you again so much for taking the time to speak with me. I really appreciate it.

CG: Thank you for taking the time to speak with me. It’s always a pleasure. Nice to see you.