Miller, Frank (2025)

BA: Good afternoon. Today is December 23rd, 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 Frank Miller. Dr. Miller retired in 2015 as a member of the Senior Faculty of the Clinical Center Department of Bioethics. He has written widely on such topics as placebo-controlled trials and clinical equipoise, the determination of death and organ donation, and, more recently, reflective pieces on what it means to be a bioethicist and how to do it well. Thank you for taking the time to talk with me today, Dr. Miller.

FM: Sure. Pleasure to be here.

BA: I want to start with some background and see if you could tell me a little bit about your upbringing and your family, and if you feel that put you on the path to study philosophy at Columbia College.

FM: I grew up in the Washington area and, somewhat unusually, both my parents were born in Washington, DC. Our background is Jewish, although not very religious. I originally went to a private elementary school in Rockville, MD, called Green Acres. Actually, my two children went there too. And then I transitioned into the public system. I can’t point to very much about my life prior to college that put me in the direction of philosophy, and certainly not bioethics. That was a much later development. However, I do recall reading about Socrates in my 9th grade world history class and being fascinated by his critical stance about ethical issues.

BA: Thank you. It’s interesting that you’ve got three generations here in DC when it’s usually such a transitional community.

FM: Right.

BA: After college, you earned a Ph.D. in philosophy from Columbia and then spent your early career in a few different roles: at the Vera Institute of Justice in New York City, planning programs and conducting research related to child welfare and juvenile justice and as a family investment manager. Can you tell me about those years and what those roles were like?y

FM: When I defended my dissertation, on the topic of whether there is a moral obligation to obey the law, and got my Ph.D. in fall of 1976, it was a particularly difficult time to find teaching jobs in philosophy. I applied for a few places, got some interviews, wasn’t accepted anywhere. Looking back, I actually count myself lucky for that. I could have ended up in some obscure little college out in the middle of nowhere and most likely would never have pursued the career that I did subsequently.

I got a job at Vera Institute of Justice, and it was through a family connection. My father-in-law is the first cousin of Herb Sturz, who founded the Vera Institute. Herb was quite an extraordinary man, sort of a nonprofit entrepreneur. I got an interview with Herb and some other people there, and I’m not sure exactly why, but they hired me. It was a really stimulating environment to work in. I was hired as a program planner. I helped develop some projects in child welfare, particularly relating to foster care and juvenile justice. One of the things I attribute to that period of time was that I had to do a great deal of writing, often under time pressure. I think that helped me in developing the habits so I could become a productive scholar down the road.

My father died in 1982, and I felt the need to assume his role in the family real estate investment business, so I came down to Washington, DC. I had no background for that, but I had no background for what I did at the Vera Institute either. It was just another effort in learning by doing, which I strongly believe in.

Taking on that role, I had a good deal of free time, and it allowed me to reengage on my own with my interest in philosophy. I did a lot of reading. I did a fair amount of informal writing, not for publication. I wrote some dialogues; I wrote some essays; and I actually wrote an unpublished book which I called The Philosophical Life, which looked at some of my favorite philosophers with a general theme: what does philosophy have to tell us about a guide to how to live well? I still have that sitting on a shelf somewhere, but I haven’t gone back to visit it, nor have I revisited my dissertation. But I’m thinking now, coming up to 2026, it’ll be 50 years since I did my dissertation, so maybe I’ll try to read it, I don’t know.

BA: Time to revisit it and get it off the shelf, maybe.

FM: Right, right.

BA: Have you revisited any of the other writing that you did during that time, like those dialogues?

FM: Not really. Actually, as we’ve recently moved to an apartment, I did a major purge of documents—probably more radical than I should have—but I don’t have access to any of that anymore.

BA: But it shows how you were still engaged in philosophy and thinking about that. Recently you wrote in your article, “Challenging the Conventional Wisdom” (2017), that you, “saw moral philosophy in the Anglo-American world as largely isolated from practical issues of moral concern.” Can you tell me more about what you meant by that and your thinking on this?

FM: I think if I were to rewrite it, I would qualify that somewhat. My point had to do with academic philosophy operating in abstraction from particular contexts. The kind of philosophy I was trained in, moral philosophy, had a great deal to do with the analysis of basic moral concepts and the logic of moral reasoning, and also the study of some very basic moral theories like utilitarianism and the type of philosophy that emanates from Immanuel Kant, as a sense of strict duties that one has to fulfill that are universal for everyone. One can’t get very far from any of that to how to analyze ethical issues that arise in the context of clinical practice and research, or health policy, or public health. As I tried to point out, I think philosophy is a very good general educational background, but it certainly is far from sufficient for being able to do competent work in bioethics.

BA: It makes sense that you were thinking about these more practical applications and pragmatism, and that led to this turn to bioethics. In the 1980s, you started several roles related to bioethics that you have said were fostered by your connection with John Fletcher. Can you tell me about your relationship with him and what he was like?

FM: Sure. I’ve had several points in my life where things happen, the doors opened, and I went down a certain path that, if it hadn’t happened contingently, my life would have been totally different. One of them was meeting John Fletcher. John Fletcher was an old friend of my stepfather. I met him, and he took an interest in me and my background. At that point, John was the first bioethicist hired by the NIH. Previously, in the 1960s, he actually did some pioneering scholarship on the ethics of clinical research. He wrote his dissertation on informed consent in clinical research at a time when there was very, very little that anyone had written on a topic like that. He did other things, too. His background was as a Protestant minister, but he didn’t practice in that role for a very long time. He was a very charismatic and dynamic person.

One of his roles as the bioethicist at the NIH—and he was the sole bioethicist there at the time—was to select people to be the so-called lay members of Institutional Review Boards (IRBs) at the intramural research program. Every program has to have an independent committee that reviews proposals for doing research, with an eye to protecting human subjects. It’s a requirement of the federal regulations that there be a member of that IRB who is not a scientist. I got appointed in that role to the National Institute of Child Health and Human Development (NICHD). That was a really interesting thing for me to be doing, getting access first-hand to clinical research studies. I didn’t really have any background for how to understand what was going on. Basically, in order to get some sense of what was going on in the scientific research, I would first read the consent forms. Over time, I got the ability to really read research protocols and understand the science well enough to be able to focus on the ethical questions. That got me interested in research and ethical issues in research.

John Fletcher left the NIH to take a position at the University of Virginia in 1987, and it was to set up a biomedical ethics program there. Prior to his developing that program, there was important work in bioethics being done in the religious studies department, particularly with Jim Childress, but there wasn’t a separate department [of bioethics]. Interestingly enough, the philosophy department had no interest at all in bioethics. So actually the biomedical ethics program that Fletcher started was affiliated with the Department of Religious Studies, but not the philosophy department. I think it was a joint program of religious studies and the medical school.

John asked me to help him out, basically as a consultant in how to develop a program. I was drawing not on bioethics, because I hadn’t become a bioethicist yet, but on my experience as a program planner that I had had at the Vera Institute. I made regular visits to Charlottesville to spend time with John and people who he was affiliating with. Through that, I got really interested in the issues that he was dealing with, and thought to myself, well, maybe I should explore bioethics.

I did my one and only formal training in bioethics with a one-week course at the Kennedy Institute of Ethics at Georgetown. It was a very good course that had been going on for quite some time; I think it’s probably still going on. After doing that, I thought, maybe I should try my hand at actually writing something. So that’s how I got initially launched.

BA: Great. I was wondering if the choice to join the IRB for the National Institute of Child Health and Human Development had anything to do with your history at the Vera Institute working on juvenile justice.

FM: I don’t think it actually did. It was just a matter of fact that there was a vacancy. I can’t say there was much of any connection. No doubt, some of what I learned and thought about at the Vera Institute was relevant to my thinking about research involving children. But that wasn’t the reason why I was sent there.

BA: Yeah, just a vacancy, and that was the beginning of your break into bioethics.

FM: Right.

BA: Then in 1999, you officially joined the Clinical Center Department of Bioethics at NIH as a senior faculty member. What led to that role?

FM: Well, maybe I should back up a little bit. After taking that course at the Kennedy Institute, John Fletcher invited me to join him to teach at the University of Virginia, so I had an appointment there as a part-time faculty member. I taught there for nine years. It was during a period where I was doing a good deal of bioethics scholarship as well teaching. Over time, I got tired of commuting between Washington, DC, and Charlottesville. At first I would go back and forth in a day when I was only teaching one course, but then I was teaching two, so I went and spent the night. And I thought it’d be better if I could find something closer to home. I did actually apply for a position in what was then the early stage of the bioethics department at the NIH, but they weren’t interested in me at that stage. I didn’t get an interview. [laughs]

BA: Not yet.

FM: Not yet. So, I kind of came in through the back door, if you will. We’ll probably have to back up a little bit in time. I think around 1991 there was a decision made at the NIH that there should be a bioethicist appointed to each of the IRBs. I had gotten to know some of the people in the Bioethics Department in its early phase before then, so I was appointed to play that role for the intramural program of the National Institute of Mental Health. That was a really interesting experience for me. I served on that IRB or its successor for I think about 12 years or so. I got deeply exposed to psychiatric research, and I got interested in ethical issues relating to that.

One of the investigators who came before that committee and later chaired that IRB is a psychiatrist named Don Rosenstein. I got interested in a particular form of psychiatric research known as psychiatric challenge studies or symptom-provoking studies. We had some studies like this that came before the IRB. At least on the surface they look quite controversial, because they involve researchers giving drugs or other stimuli to psychiatric patients who are in the research hospital in order to provoke their symptoms and study them in a controlled way. And I thought, well, how can you really do that? How can these people in the white coats make people sick for the sake of science? I was kind of troubled by it when I saw these studies. Don was then a psychiatric research fellow. Don was about 10 years younger than me. He came before the committee a few times [as a researcher]. I liked him and got to know him a little bit, and then I came to him with my concerns about this particular type of research. It led to our having long conversations about it and writing a paper together. It’s one of my very first papers in the ethics of clinical research.

I did a good deal of collaborating with Don in subsequent years. He had a relationship with Zeke Emanuel, who took over and really established the bioethics department as it is now. Don persuaded Zeke that it would be a good idea to hire me, with an affiliation to the National Institute of Mental Health (NIMH) as well. I joined the Department of Bioethics in 1999.
I continued to serve on that IRB; also Don wanted to develop a seminar on research ethics for psychiatric research fellows in NIMH. He and I developed it together, and we taught the course together. That was one of my responsibilities for the next nine or ten years.

BA: Right, lots of good connections, hard work, and asking the right questions led to a new path. What did the department look like when you joined in 1999?

FM: Well, I guess it had been going on for a couple years. Zeke was and is a very dynamic guy, so he created a lot of energy in terms of the work of the department. And although I thought I was fairly productive as a scholar when I was at UVA, I really ramped things up when I got to the bioethics department. That was in part because I didn’t have the teaching responsibilities that I had had before, but more than that, I think it was the culture that Zeke created.

One of the things that I think is a really special element of the NIH Bioethics Department is the fellowship program. It was in a very embryonic stage when I joined. Years before I got there, the department hired its first fellow who was a pre-doc fellow, Neal Dickert, who has gone on to be a distinguished bioethicist at Emory now and a cardiologist. One of the tasks was to have fellows go along with the bioethics members to the IRBs, so Neal was designated to come along with me to NIMH, and I got to know him. I don’t remember whether there were any post-doc fellows at that time or if that later developed. At any rate, I think the fellowship program is quite a valuable educational experience for the fellows, but also it’s an opportunity for the senior faculty members to provide mentored research and to collaborate with these people who are learning bioethics. It expands the scholarship focus to have that element of the department.

BA: So, it sounds like some of the benefits from joining the department were increased research productivity and the support of fellows and faculty in the department. Were there any challenges to adjusting to the new role?

FM: Well, there are always challenges. I can’t point to too much that I can think of, looking back. I didn’t have much experience doing mentored research with younger people, but it seemed to be a pretty easy thing to do. I really enjoyed it. I got a lot out of it. I hope my mentees got a lot out of it, too.

One of the challenges always was that you were in a culture where people were being very productive all the time, and one doesn’t always have good ideas of what to do next. There could be periods where I could be wondering, hmm, what am I going to work on next? But that kind of tension, I think, sort of helps.

BA: Yeah, it gives you time to be creative and a little more flexible. I want to move to thinking about some of your research. Even before you joined the department, some of your earlier publications and presentations were focused on euthanasia and assisted dying. Can you talk about some of your main contributions to that topic, and what got you thinking about it?

FM: Sure. I had a long-standing interest in mortality, death, and dying. I think it really stemmed from the death of my father in 1982, when I was 34 years old, and it’s a topic I thought about and read a lot about from a philosophical point of view. This interest prepared the way for having an interest in end-of-life decision-making that patients undergo. In 1990, when I made the transition into bioethics, euthanasia was a big topic in the news because of the activities of Jack Kevorkian, who was a retired pathologist who recruited people who wanted to end their lives. A lot of these cases were quite controversial, especially the people who were not terminally ill. I should qualify: it wasn’t technically euthanasia, but [Kevorkian] rigged up this machine in which he could start an IV infusion in a patient’s arm, and the patient could push a button that would make the lethal medications flow. [Kevorkian] didn’t push the button, so in that sense, it wasn’t technically active euthanasia, although very close to it.

One of his first patients was a woman in the relatively early stages of Alzheimer’s disease—certainly not terminally ill and still functioning at a reasonable level. That was quite controversial, but I thought that there definitely were some cases in which it could be justifiable for a physician to help a patient end his or her life, beyond simply a decision to stop life sustaining treatment which will lead to someone’s death—which is sometimes called allowing to die rather than killing the patient. So I searched around for what I thought would be a good case, kind of a paradigm case, of active euthanasia or assisted suicide. I guess not long before that, I had read a biography of Sigmund Freud. He had terminal cancer, and endured it for quite a while, with several operations, but at a certain point he just didn’t want to go on anymore. He talked to his personal physician, and he said he wanted to end his life. Now, whether or not the way he died was actually euthanasia or not, I’m not really so sure anymore. I interpreted it that way. I wrote a paper about it, as I thought it was a paradigm case: here’s somebody who really knows his own mind very well, he’s terminally ill, he’s suffering a great deal, he doesn’t have any kind of life sustaining treatment he could stop, but he has good reason not to want to go on living. His physician gave him, over a few days, high doses of morphine that produced sedation to unconsciousness. I’m not sure that technically qualifies as euthanasia, but at any rate, I wrote it up that way. I probably wouldn’t, going back today.

Not long after, there was a case study published in the New England Journal of Medicine by Timothy Quill, a physician in Rochester, NY. He described providing a lethal medication, barbiturates, to a patient suffering from leukemia who wanted to end her life. This is certainly against the law—he did it sub rosa, but he wanted to write about it. He published it in the New England Journal, which is quite an accomplishment for that kind of case to be published there. I thought, here’s somebody who was a hospice physician, somebody who was really involved with death and dying, but he was prepared to take it one step beyond what was legal. It seemed justified to me, and I got interested in that. I subsequently met him, and we started a collaboration together, at first relating to the topic of how you could regulate a legal practice of physician assisted death, whether it is prescribing lethal medications or a physician actually administering a lethal medication. This was before it had become legal. I teamed up with him, and together we thought of some other colleagues who would be good to have on board. There were two physicians, John Fletcher, a legal scholar, and myself. I took the lead in drafting our paper.

That led to my first publication in a medical journal [Miller, Quill, Brody, Fletcher, Gostin, & Meier, (1994), “Regulating physician-assisted death,” New England Journal of Medicine, doi: 10.1056/NEJM199407143310211]. I just got really interested in the topic. I explored it from lots of different angles. Although I was finished with that topic by the time I joined the bioethics department, I came back to it again later, particularly after I retired, because there had been new developments that stimulated me to want to continue to work on it. So that’s been one of my major interests.

BA: I feel like a related theme to this interest in mortality and death and how to do it well runs through your work on the determination of death as it relates to organ donation. Can you tell me more about that?

FM: Sure. This was an issue that I had some familiarity with, just by virtue of reading the bioethics literature, but hadn’t particularly worked on. I read a paper—this might be 2006, 2007, 2008, I’m not sure—by Robert Truog, who is a pediatric anesthesiologist and bioethicist, who I had met a couple times through my UVA connection. He wrote a paper on brain death and organ transplantation that was published in the “Hastings Center Report.”

His basic thesis was that, if you really look at the status of people who are diagnosed as brain dead, these are patients who have had a severe brain trauma, maybe from like a motorcycle accident or an overdose of some drugs. They’re being sustained in the intensive care unit with mechanical ventilation, all kinds of intensive care interventions. Their brains have basically ceased to function—but they’re still breathing, they’re still excreting waste, their metabolism is still going on. They’re performing a whole array of biological functions that are characteristic of living beings, but they are declared dead, and their organs are now suitable for transplantation. And that’s ideal, because the heart is still beating and so blood is circulating through the organs, and they’re ideal candidates. There’s a basic norm of organ transplantation known as the dead donor rule, which is that you are not permitted to procure vital organs—the heart, liver, both kidneys—from a donor unless that donor has previously been declared dead. But the conundrum here is that you have people who are biologically alive, but they are legally considered to be dead. How do you make any sense out of that?

So I read Bob’s piece. I thought it was really interesting, but I thought the ethical rationale for continuing to do organ transplantation for these brain-dead donors needed to be further developed, because it seemed clear to me that the dead donor rule was being violated all the time. These are people who are not really dead. Indeed, the fact that they’re not dead is the reason why their organs are such good candidates for transplantation. I went up to visit Bob in Boston and had to kind of twist his arm a little bit because he thought he was finished with this topic. He had been writing about it for years. He actually did a master’s dissertation on it, quite a number of years previously. But I persuaded him that there was more to be done, and we started collaborating. We had a very rich collaboration, with multiple published articles, over several years that ended up in our writing a book that we published together, my one and only monograph book. Basically, I’m an essay writer, but it gave me a lot of satisfaction to actually have one published book to my name, and I did maybe three-quarters of the work for the book. It was largely based on several published papers that we had done before, some of Bob’s previous work on his master’s dissertation about brain death, and a more detailed ethical rationale for procuring vital organs from donors who were (not yet) biologically dead.

That was a major research focus for me. I was particularly interested in what I saw as the incoherence between the norms that govern the practice and the actual practice itself. I wanted to work on how to make sense of that. My conclusion, basically, was that we should give up the dead donor rule because it’s being violated. Now the chance of that happening was and still is pretty remote, but I thought that it ought to happen. The thrust of our work was to explain the incoherence in the practice and come up with an acceptable rationale for procuring organs from these patients. The upshot, in a simple way, is that they’re in a state of permanent, irreversible unconsciousness, and nothing will ever restore consciousness to them. So they’re not dead, but we contended that they’re really as good as dead in terms of having any kind of personally meaningful life anymore. After organ transplantation, the ventilator is going to be stopped. They’re going to die anyway, so they’re in no way harmed by procuring organs from them, even though they’re still alive, if this is done with adequate consent. Now, typically you’re not going to get informed consent from the donor themselves. I mean, maybe they’ve signed up for organ donation on their driver’s license, but they certainly haven’t faced the particular situation that they’re in. The consent is provided typically by family members giving proxy consent for the patient. So if there’s adequate consent, there’s a situation where no harm is done to the patient who’s going to die anyway. But a lot of good can come out of the transplantation, and that seems to be a justifiable practice. We just needed to lay that out in a systematic way.

BA: That shows some of your thinking about the norms and solving incoherences in clinical care and practice. You’ve also worked on those themes in research ethics. Can you tell me a little bit about the ethical considerations that shaped your ideas about placebo-controlled trials, which you believe can be justified even when there’s a standard of care; and clinical equipoise, which you don’t find to be a useful concept?

FM: Right. I think this stems back to the work I was doing during my first exposure to research ethics, back in the 1980s, on the IRB at NICHD. It seemed to be clear that clinical research is not the same as medical care, but there’s a tendency to conflate the two. It was pretty pervasive at the NIH, and in some sense, maybe symbolically, it still is. You go into the garage, and it says, “Patient Parking.” Well, these are research subjects. [laughs] Yes, they’re also patients, but they’re research subjects. There was a guide for research subjects coming into the Clinical Center that was called “The Patient Handbook.” So there was a conflation of the patient role and the research subject role.

That seemed problematic to me, from an ethical point of view. These are two different activities, and investigators do things in research that could never be justified in medical care. I got interested in placebo-controlled trials, because there were a lot of them being reviewed at the NIMH IRB. This involved patients with severe mental illness who would come into the hospital and be taken off their medications to be studied without medication. That in itself was a radical departure from clinical practice, and then various novel agents would be tested in those patients. They could be suffering from severe depression, bipolar disorder, schizophrenia, panic disorder, or other psychiatric conditions. There are proven effective—although often not highly effective—treatments for these conditions; however, they are only symptomatic treatments, there aren’t any cures for these conditions. But these new agents would be tested against placebo, even though there were standard drugs available.

That ran up against another basic norm in clinical research, under the title (not necessarily a good title) of “clinical equipoise.” This is a concept that was put on the map by a philosopher-bioethicist named Benjamin Friedman, and he published a paper on this. I think it was in “New England Journal” around 1987 or so. The basic idea is that there should be a state of uncertainty among experts in order to do a clinical trial, such that it’s uncertain whether the experimental treatment is better than nothing or better than the standard of care. No patient should be randomized to a treatment that’s known to be inferior to standard of care, because that would be going against medical ethics. Doctors are supposed to provide, if not optimal medical care, at least professionally standard medical care, so it wouldn’t be justifiable to randomize a patient/research subject to a placebo if they’re suffering from depression or schizophrenia or bipolar disorder. But these studies were going on: they were going on at the NIMH; they were going on sponsored by drug companies. In fact, the FDA [Food and Drug Administration] was typically requiring that there be a placebo control in order to have a rigorous test of these treatments, because these are treatments of symptomatic conditions, of subjective symptoms. Basically, there’s a high propensity to have a placebo response; that is, people will get better and improve even though they’re getting an agent that has no medication in it, provided—at least it was thought—that they don’t know that that’s what they’re getting, that they’re under a blinded condition. They don’t know whether they’re getting a drug or a placebo.

I saw here a situation of incoherence between a basic bioethics' norm and the actual practice of clinical research. This was before my work on death and organ transplantation. But in both of those cases, it might seem odd in a way, I thought the problem was with the norm, not with the practice. I thought that you could justify these studies on methodological grounds to have a rigorous test of efficacy of a novel agent, without exposing people to undue risks of harm. I thought this basic norm of clinical equipoise was flawed. It became a mission of mine to try to point it out and to get other people to see it. Now, to some extent, I was beating my head against the wall in terms of doing that. I was getting articles published, but it wasn’t getting a lot of traction, particularly in the medical literature. Eventually I broke through there in collaboration with physician-ethicist Steve Joffe. It was one of my ambitions, to be able to attack this norm within a medical research journal. I guess that’s a long-winded answer to your question.

BA: That’s great—it shows a lot of connections and how you’re not afraid to challenge those norms. Since you’ve been retired, you’ve been doing a lot more personally reflective writing, like an article on your experience during COVID and another on your sister’s death. What prompted this turn, and how has it felt to publish these more personally connected, vulnerable, and emotional materials?

FM: Sure. Well, the one about my sister’s death came before. It was back in 2008, I believe. That was obviously a very traumatic experience. My sister was a horse person and taught riding and horse show eventing. She was in a horse show, and she fell off her horse and hit her head on the ground. It was a hard helmet. She was resuscitated right away and flown to a hospital, but she suffered a cervical fracture that left her quadriplegic and ventilator-dependent. I got involved with her care right away, from the beginning. For a couple years, she was eager to go through rehabilitation, to see whether she could start a new life. But after a while, she just felt like it wasn’t worth it anymore. She was a very physically active person, so it was quite difficult to be so totally dependent. She wanted to end her life, and she asked me to help her figure out how to do it.

What I was able to do was to arrange for her to get admitted to the hospital for the sole purpose of stopping her mechanical ventilation. This was not a typical case at all. It’s certainly not euthanasia, but it can feel a little bit close to it, because she was certainly going to die when she did it. I was able to connect with a pulmonologist who had taken care of her for an earlier attack of sepsis. I was able to persuade him to admit her into the hospital for this purpose. He was a bit reluctant to do it, but he did.

At any rate, I got very much involved in her case, and I wanted to write about it, because here was a case of a family trauma that tapped right into my work as a bioethicist, so that seemed like an interesting challenge to write about. That was my first foray into writing a personal essay.

Once I retired, I decided I wanted to write personal essays in general. I took a personal essay writing course, and I’ve actually written a little self-published book about lots of different topics. At the same time, I saw the opportunity to do some bioethics essays that had a personal dimension to them by virtue of my involvement with the interdisciplinary journal known as “Perspectives in Biology and Medicine.” It’s a journal I really liked. I’d had a few things published there over the years. I was asked to become the deputy editor of that journal, and it gave me an inside track to be able to write these pieces. Now, they were peer reviewed, but the editor liked what I was doing, and the journal liked to encourage people to put personal reflections into their work.

I enjoyed it. There’s really a challenge, I think, to incorporate two very different styles of writing: the impersonal, objective voice of the scholar, and the personal voice of someone who’s writing about their experience. I like doing that and was able to keep it up over several essays.

BA: It’s nice to be able to hear your voice a little more. I’ve enjoyed reading those more personal, reflective essays. This comes after a very long career of fruitful collaborations, and you reflected on the value of these in your article, “On Collaboration in Bioethics Scholarship.” That made me wonder if there’s anyone, past or present, who you wish you had the opportunity to work with, or who you’d like to work with again.

FM: In a number of my collaborations, I became friends with people who I collaborated with. I certainly would welcome other opportunities. I’m pretty much in deep retirement right now. [laughs] I’ve only got one project going on, might be my last one, you never know about these things. But I also like to find new people, too. One of the things I’ve done over the years is read something by someone and cold-call e-mail them to say that I’m interested in what they’re doing. Getting into an e-mail discussion about it can lead to a collaboration. I also collaborated a good deal with my colleagues in the Department of Bioethics.

I especially valued collaborating with Alan Wertheimer, who joined the Bioethics Department late in his career. We wrote several essays together, and we edited a book together [The Ethics of Consent: Theory and Practice (2009)]. We actually became good friends. He lived in Vermont and would travel back and forth to the NIH. We would talk on the phone a few times a week about issues that we were interested in, departmental gossip, that sort of thing. Unfortunately, Alan died in 2015. I guess he was in his early 70s. That was a big loss for me, and I certainly would have wanted to collaborate more with him, but that couldn’t happen.

BA: That’s a wonderful tribute and definitely reflects what I’ve heard about him in the department and the influence he had here. Thinking about the department, from when you began in 1999 to when you retired and became a special volunteer in 2015, what has changed and what has stayed the same?

FM: Well, I don’t know how to answer that exactly. Certainly, once Zeke left and Christine [Grady] took over, that was a big change—very different personalities. It wasn’t quite the same exciting environment after Zeke left. That had its good elements and its maybe not-so-good elements. [laughs] Nothing wrong, it’s just that there was so much energy created by him and what he was doing. He came up with ideas for a lot of projects. He had some ideas for some that he asked me to take over.

But as far as the basic life in the department, I think it pretty much stayed the same. It may have changed recently in light of Trump 2.0, but I’m not really up on that; I can’t really speak for anything that’s happened after I retired. It seemed to me a pretty similar pattern throughout. Zeke created a very good model of a fellowship program, of mentored research, and also having senior people come as visiting scholars. We haven’t talked about that part, but that’s a very good program. I collaborated with a few people who came in that way. So, I think it was a great deal of continuity.

BA: That’s great to hear. Thinking more big picture now, what do you see as some of the greatest challenges and opportunities confronting bioethics in the next five to ten years?

FM: I need to preface this by saying I’m a little out of the loop these days. I used to be a really avid reader of the bioethics literature, and since I’ve retired, that’s dwindled more and more. But I did have a very big surge of scholarship during the COVID-19 pandemic. For about a year or so, I was probably as busy, although not being paid, as I was when I was in the bioethics department. It was a really interesting transition to me, because I got interested in ethical issues relating to public health. I do think there has been a greater interest in public health and health policy within bioethics over the last 15–20 years. I think that’s a really important area. I’d like to see bioethicists engaging to a greater extent in those domains rather than focusing on the more traditional topics of clinical practice and biomedical research.

BA: That’s really helpful, learning some of those lessons.

FM: Yeah, I’ve never been involved with it, but there are issues relating to climate change that certainly have a bioethics dimension, although it’s not primarily a bioethics issue. It’s a global survival issue that needs to be dealt with on the political level.

Another area that I actually got involved in late in my career, and I think we’re seeing more, is animal ethics and research ethics. I did a couple papers on research involving non-human primates that raised some interesting questions. My most recent published piece was with a philosophy postdoc fellow in the bioethics department [Jasmine Gunkel]. It was just published in the last issue of the “Hastings Center Report” on so-called xenotransplantation, which involves genetically modified pigs as a source of organs for transplantation into human beings in order to deal with the organ shortage. We approach that issue, in large measure, from an animal ethics point of view. And so animal ethics has been, I won’t say neglected, but not a primary focus of bioethicists, I think there’s certainly more worthwhile to be done there.

BA: Great. I also wanted to reflect on some of these themes of mentorship. In “Bioethics as a Vocation,” you offer some advice that reflects a lot of what other participants in this oral history project have talked about, like grounding yourself in a discipline that’s relevant to bioethics. Did you have any other advice that didn’t make it into that article that you would want to share with aspiring bioethicists who are early in their careers or education?

FM: I think I really covered my thinking on that on that particular topic. It was a really interesting piece for me to write, very different from anything else I’ve written before, much more didactic. I’m a real believer in the mentored research model. I never had that myself. Maybe there can be some virtues of being self-taught, too. I’m not sure my career would have turned out any differently had I had the mentorship route, but I think it’s a very fruitful way to become educated in bioethics.

I said what I had to say [in that article]. If I had written that earlier in my career, I might have done some things differently, but it was mostly looking back and then trying to find some kind of guidance for people thinking about it going forward. I have no idea to what extent anyone’s paid any attention to it, though.

BA: Just a couple questions to wrap up here. Do you have any particular memories that stand out from your time in the Department of Bioethics that you haven’t talked about yet?

FM: The Bioethics Department over the years has had a pretty rich international research ethics training component. It was overseen by Reidar Lie. I don’t know whether Reidar is still associated with the department or not, probably no longer as a faculty member, but he was the organizer. He’s a Norwegian physician-bioethicist. I went on a couple of these trips, and the travel afforded an opportunity for a lot of one-on-one contact with my colleagues, getting to know them better. Two of them that I have fond memories of: one was a trip to Zanzibar, off the coast of Tanzania. I remember taking a walk around sunset with Dave Wendler along the beach of the Indian Ocean. Quite delightful. I can’t remember what we talked about, but I really have a fond memory of that. And then there was a trip to South Korea where Reidar, Dave Wendler, and I went. The three of us spent a lot of time together. I insisted that if I was going to give a talk there, they’d have to send me business class, but Dave didn’t do that. [laughs] So here I was, sitting up in these very comfortable quarters, and there was an empty seat next to me. I tried to get the flight attendant to allow Dave to come up and sit next to me, but they said no, can’t do it, so I spent a lot of time walking into the back of the plane, standing up and talking to Dave. We gave talks in the late afternoon or early evening. Afterwards, we went out to dinner with our Korean colleagues and drank a lot of sake and just had a good time together. Those are some of my fond memories that involve the personal side of working in the department.

BA: That’s great, I love that personal and international collaboration and connection. Is there anything else you’d like to add or any questions you wish I’d asked you?

FM: I think obviously we could have talked a lot more, or more about certain areas. Let me just mention one thing because it’s been important to me. My work on placebo-controlled trials got me very interested in the placebo effect as a psychosocial phenomenon. It led me to get involved in a research program that was not ethics at all, but involved questions like, how do you understand this phenomenon? How do you think about it from a theoretical point of view? That’s an important path I went down in research, and it was one of the stories I talked about in “Bioethics as a Vocation.” It was one of these situations in which working on one topic leads you naturally to think about a really different topic, but it’s related, and then you go on to that. That’s at least one way of developing a research career. We could have talked about my work on deception too, but time is limited.

BA: I probably could have talked to you for three hours about your research and still not covered it, but I really appreciate you taking the time to talk about what we were able to cover. Thank you for your willingness to participate in this project.

FM: Sure, thanks. Bye now.