Our Woman of the Week is Ana Iltis, nominated for her work as a bioethicist and her role as a trustee at St. Vladimir’s Seminary. You see her here speaking at Rice University’s Baker Institute Science and Technology Policy Program in 2020. We asked her to tell you how she found herself here, working in a relatively new field like bioethics:
“I am not always sure where ‘here’ is, but it includes being a wife, a mother, daughter, daughter-in-law, sister, aunt, friend, member of Holy Cross Orthodox Church in North Carolina, and a philosophy professor who specializes in bioethics, wears various administrative hats at the university, and is quite active in the field. In recent years, I have become involved with St. Vladimir’s Orthodox Theological Seminary as a member of the Board of Trustees and through the DMin program. I’ve been blessed to have my faith and professional lives intersect through my involvement with the seminary. Had I been born much earlier, being a ‘philosophy professor’ would have been unthinkable. I am grateful to both the women who were trailblazers and the men who were in positions of power, recognized their talents, and created space for them. I have been blessed with a supportive husband (Steve), daughter (Sophia), and parents. I cannot count how many conferences my mother traveled to with me and Sophia so that she could care for our young daughter while I built my career. I credit teachers and professors who were incredible mentors and early career colleagues who trusted me and gave me opportunities. All of them were instrumental in shaping my ‘here.’
“I am first-generation American. My family is Cuban, and I grew up in New York, New Jersey, and Pennsylvania, never in communities with other Cubans or with many immigrants in general. I learned Spanish at home and English outside the home. I grew up profoundly aware of sameness and difference. I experienced first-hand how quickly we all can make assumptions about others, condemn difference as inferiority, and fail to recognize what we share in common. Today, these experiences shape how I analyze controversial questions and how I teach. I often find myself encouraging students to consider alternative explanations and interpretations so as to avoid premature judgment and false dichotomies. My family’s experience leaving a comfortable life in Cuba with nothing but their faith, integrity, education, and a few changes of clothes made me profoundly aware of the importance of education and the willingness to take responsibility for oneself and one’s family. I am now approximately the age my grandparents were when they left successful and fulfilling professional and personal lives in Cuba along with every material possession they had and began anew to be freed from Communism. I have reflected over and over again on the enormity of their decision, the incredible effort they put into rebuilding lives, and the humility with which they accomplished this– taking jobs that hardly matched their education or what they had accomplished to begin their lives as Americans. I grew up constantly being reminded of the fact that they left Cuba with nothing but their education, their faith, and their work ethic. Your money and possessions can disappear overnight, but the rest cannot be taken away. I took the message to heart and suspect it influenced my decision to pursue life as an educator.
“Looking back, I see how a series of positive and negative experiences shaped my interest in bioethics, a field I had not heard of until I was a senior in high school. I grew up surrounded by health care. My maternal grandmother, born in 1918, was a physician. She had many medical school classmates and physician friends who were women, something that was rare in the US at that time but was not so unusual in Cuba. My father is a medical physicist who, though long-retired, continues to be active in his profession. I grew up surrounded by discussions about health and health care. These were not limited to the ‘why you should never smoke’ images my father produced from time to time, or to the anatomy lessons my grandmother imparted while cutting chicken in her kitchen, explaining how joints, ligaments, and tendons work. These also included discussions about how different payment structures affected patients and shaped medical decisions as well as tales of how far medicine had come and how treatment had improved or changed over time. I remember wondering as a child how the proverbial ‘they’ had figured out which treatments work better than others and when ‘they’ could be confident saying so. When, why, and how did something everyone thought was good for patients become bad for patients? When, why, and how did something go from ‘maybe this is good for patients’ to ‘this is a good treatment’? Who decided what was good and bad, right and wrong? How did they decide? What started as childhood ‘wonderings’ turned into a lifetime of inquiry regarding biomedical research involving humans.
“One negative experience in particular stands out as formative in shaping my thinking about difference, power, and how we treat others and use others. I have a ‘heart murmur’ and, as a child, I visited a pediatric cardiologist for check-ups twice a year. When I was in 6th grade, the exam room filled with more people than usual. There was a group of medical students – at least six, though maybe more - visiting from Germany. Someone thought it would be great for each and every one of them to listen to my heart, and to practice placing leads and doing an EKG. I was turned into the ‘teaching dummy.’ No one asked whether this was okay with me. No one seemed concerned that this made my appointment far longer than it needed to be, which was a burden to me and to my parents. No one cared that I might not want all of these strangers touching me or that I was freezing. I was powerless and I was being used. I remember being outraged. And silent. I had no idea what bioethics was at the time, but I think that, unbeknownst to me or anyone else, my career trajectory was set that day.”
Axia!
Ana Iltis is our Woman of the Week, nominated for her work in bioethics. You see her here speaking as the co-director of the bioethics center at Wake Forest University and at a workshop in pediatric bioethics and decision making for children at Saint Louis University. As many of us may be unsure about what falls under the heading of bioethics, we asked her to tell you about it:
“I’ve been fascinated by health and health care for as long as I can remember. For many years, I thought that I wanted to be a physician. As I made my way through college, completing my pre-med requirements, volunteering in hospitals, and shadowing physicians, I realized that I was much more interested in asking questions about what I was seeing than doing what I was observing. How were decisions made about what to do and not do, about what treatments to offer and when to withdraw treatment? Why were some people eligible for more aggressive care, such as an organ transplant, and others not? How did doctors know they were recommending the best care for each patient? These and many other questions led me to what was then a relatively new area, bioethics. I had two wonderful mentors at Villanova University who encouraged me to listen to myself and to pursue what I was passionate about, studying ethics rather than medicine. I am grateful for their help in opening my eyes to new possibilities, for a rare moment of humility on my part to see that I should accept that I had been wrong about what I said I wanted to do, and for parents who supported me in making what many people thought was a bad career move. After college, I earned a PhD in philosophy at Rice University rather than going to medical school.
“Bioethics is still relatively new. Depending on which version of its history you read, you might see it dated to post-World War Two and the Nuremberg Trials, or to the 1960s and 1970s with significant technological developments in medicine and revelation of the United States Public Health Service study at Tuskegee. But long before any of this, there was a tradition of medical ethics that focused strictly on physician behavior. And, many early Christians wrote on topics that remain important for contemporary bioethics. I admit that this has been a great surprise to me. From abortion to euthanasia, and from embryo research to cloning, there is much wisdom in the early Church.
“Much of my work focuses on the ethical questions that arise in human research, a practice that necessarily involves using human beings to advance the interests of others. In order to do good, medicine must not only aim at good ends but the interventions themselves must be safe and effective. Hence, the need to conduct research on human beings. Such research includes randomized controlled trials in which some participants receive a new medication, vaccine, or other product and some receive a substance that is inert and has no known therapeutic value (placebos). Some trials even compare sham surgeries to real procedures. In other trials, some participants receive new interventions while others receive existing treatments. Human research involves much more than clinical trials, though these are familiar to many people and raise numerous ethical questions. What risks is it appropriate to ask people to take to generate knowledge to improve the care of future patients? What risks are permissible when the participants themselves might benefit? At first, one might think that it is never appropriate to put people at risk in research, and that it is especially problematic to run placebo-controlled trials. How could one withhold a possible new treatment from any patient? The difficulty is that without such research, people may be treated with interventions that are not safe or effective for them, possibly causing great harm. In other cases, a lack of research means that people will face situations in which there are no treatments available at all. The importance of clinical research is undeniable and conducting such research ethically can be challenging.
“The pandemic we’ve all been living through has brought into sharp relief the importance of rigorous research. In the face of great uncertainty about the SARS-COV-2 virus, including how and why it affects different people differently, what might be effective in treating people who are mildly, moderately, and severely ill, how many people actually have had it and recovered, what it means to have antibodies to the virus, how to prevent transmission, and so on, physicians and others felt immense pressure to ‘do something’ new and even bold in an attempt to make progress. Decisions that might appear to advance individual and community interests might not do so in the long run, but it can feel not only permissible but obligatory to try something and to react quickly to every new piece of information. You might remember a time in 2020 when many physicians and politicians declared that hydroxychloroquine was or could be effective in treating COVID-19. The rush to get access to this anti-malarial drug was spectacular even though the evidence supporting this claim was paltry, at best. Some preliminary case reports and poorly run ‘trials’ led to a rush to judgment that turned out to be deeply misguided. Not only was the drug ineffective in treating COVID-19, but its use was linked to cardiac arrhythmias and deaths. There are countless examples in the history of medicine of situations in which what was thought to be good or at least worth the chance turned out to cause more harm than good. Rigorous biomedical research is essential to achieving the ends of medicine and avoiding harm, and conducting research ethically involves a series of trade-offs and value judgments that are not always simple.
“Research ethics involves many questions beyond the kinds of potential benefits that justify risks to which people may be exposed for potential benefit to themselves or others. They include questions of privacy and confidentiality, when and how to secure individual permission for inclusion in research, when to terminate studies early, how to demonstrate respect for participants and communities at all stages of research, and which populations to include and exclude from research, among others. I work on many other topics in bioethics, but these are among the questions with which I love to grapple. I have the privilege of working through them theoretically in my teaching and in my writing as well as practically, working with investigators and on various types of oversight committees. It is energizing work that is never boring.”
As usual, we asked our Woman of the Week, Ana Iltis, about her morning routine. You see here here with her family in her happy place, Hilton Head Island in South Carolina, and engaging in one of her favorite activities, bike riding with her dog at the beach in the fall (“beach time in the fall is far better than summer, in my mind, especially in the land of hot and humid weather”):
“My mornings have changed over the years based on my family’s needs. When Sophia was an infant, I learned to wake up extra early to work before she awoke so that I could spend more time with her later in the day. My early mornings have served me well. As Sophia got older, my early hours allowed me to be available after school some days of the week, and to watch her play sports. My 4 am wake up time – without an alarm clock – has been the source of much amusement among colleagues, students, and friends over the years. I’ve heard students compare the earliest timestamp on emails they’ve received from me. Only recently have I discovered the ‘Schedule Send’ feature, which conceals just how early I’ve been working! My mornings typically start a little later now, but not much later. I’m routinely out of bed by 4:30 am, with our fluffy dog following me around. (I’m his favorite human, and he loves to be wherever I am.) I take the dog out and feed him, work for about two hours and then, ideally, take a long walk. Walking time is also prayer time for me – uninterrupted and peaceful. Only then do I begin what I jokingly refer to as ‘second morning’ – showering, having breakfast, and going to the office. I keep a copy of the Akathist to the Mother of God, Nurturer of Children on my desk at the university. I try to pray part of it when I arrive, and then, throughout the day, I stop periodically and try to work my way through it.”
Thank you, Ana!
