When Patrick Smith, PhD, first began his academic training in bioethics, his uncle, who was a civil rights leader in Alabama for 53 years, taught Smith an important lesson: don't forget about the people. In this month’s spotlight, Smith shares how despite working in a field that can sometimes seem removed from the people, his uncle’s words have stayed with him, influencing his early work at a hospice care center in Michigan and later in his current role as director of the Program in Bioethics at the Trent Center for Bioethics, Humanities & History of Medicine. He also offers insight into what jazz, his favorite genre of music, can teach physicians about engaging with patients and their families.
Among your many roles at Duke, you serve as director of the Program in Bioethics at the Trent Center for Bioethics, Humanities & History of Medicine. What are your responsibilities in this role?
I bring faculty from across the university together who are interested in bioethics and engage our Trent Center faculty associates who are doing work in bioethics. My role is to promote their research and promote the mission of the Trent Center for Bioethics. A lot of the early programming in my first few years here involved highlighting the important role that racial justice will play in the practice of medicine and in the training of medical professionals.
In January you presented a lecture titled, “Jazz and Medical Ethics: Reflections from an Imperfect Art.” What were some of the highlights of that presentation? What can jazz teach us about health equity and justice?
My love of jazz informs how I teach and engage folks. I understand jazz as being more than music. There are certain motifs or themes of the music that emerged, particularly in the sociohistorical and political context, when jazz emerged at the turn the 20th century.
One was this notion of syncopation, which is the emphasis on the offbeat. It becomes part of the way we think about the world, listening to those voices that have not always been heard. Attention to syncopation can inform the way we see the world and allow us to be more attentive to the marginalized, the disenfranchised, the disempowered.
Two, the notion of improvisation plays a role in the practice of medicine in various ways. In jazz, some would say that you never play the same song twice. The same applies during encounters between physicians and patients. There's something very interesting about that notion of improvisation that requires a deep listening. It keeps us from being complacent. As clinicians engaging patients, the patient may present with symptoms that are very familiar. But in that moment, it is important to remember it is still a new encounter with a new person with a new story, with a new history, and you have to think about those issues in new ways, because this affects the trajectory of their life.
The third notion is call and response, where jazz musicians call out to their bandmates and the audience, and those bandmates and audiences respond in the moment. All of these areas require a deep listening that becomes important for the practice of medicine. So, what this points to in terms of clinical engagement is recognizing that this is a shared experience.
While clinicians have expertise that they bring to the table, patients, their families, and communities also bring something to this space that requires a kind of response. This notion of call and response is deeply communal and reminds us that while there are certain individuals who have expertise, patients and families bring expertise into this space as well.
How did you first become interested in bioethics?
I kind of stumbled into bioethics. As a graduate student, I was training as an analytic philosopher doing moral philosophy and epistemology. At the time, I was teaching at a small theological school in Michigan. I had breakfast with a mutual friend of a gentleman who was a medical director at a hospice care center just outside Detroit. After this meeting, the medical director asked if I'd be willing to sit in on their ethics committee meeting that they have once a month. Then I was asked if I would be willing to oversee the ethics office.
For me for a while, studying philosophy was very abstract, and very remote from the lives of people. So, being in that clinical space really provided a kind of traction for me to say, “Okay, these are real questions, real people, real issues.”
I had an uncle, Reverend Dr. Nelson H. Smith Jr., who was a civil rights leader in Birmingham, Alabama, for 53 years. He co-founded the Alabama Christian Movement for Human Rights, which was the local affiliate of the Southern Christian Leadership Conference (SCLC). They worked very closely with King and many other leaders in that space. As I was starting to do my academic training, my uncle asked, “What are you studying?” I would go through my highfalutin academic research. And he would just kind of sit there and look at me and nod. He'd have this long pause. And then he would, impressively unimpressed, say, “Well, that's good, but just don't forget about the people.”
For me, being in those clinical spaces was a way for me to finally feel like I was embracing that in my professional work and not forgetting about the people.
How are you and colleagues within your field working to address issues related to equity, diversity, and inclusion in bioethics?
Several years ago, a few of us who are Hastings Center fellows got together and created a report with the Hastings Center, which is an independent bioethics think tank. We generated a special report called, A Critical Moment in Bioethics: Reckoning with Anti-Black Racism Through Intergenerational Dialogue. We challenged our colleagues in bioethics to grapple more intensely with questions surrounding racial justice in our field. In other venues, we also encouraged those who serve on editorial boards for high impact journals to encourage those journals to have peer reviewers from other disciplines to evaluate scholarship in these areas. For example, folks in African American studies have been writing on questions of health justice for years, but they have not been part of the medical ethics community. What many of us have said is, “Look, you have to expand your scope and expand your canon.”
We are also working to develop mentoring programs with other centers of bioethics to generate a pipeline of younger scholars. We're introducing them to key players and organizations, so they can develop their voice get a little shine, too.
What passions or hobbies do you have outside of work?
I enjoy spending time with my family, including my wife and two kids, who are 18 and 16. I enjoy riding mountain bikes. Another hobby that I love is getting together with friends for bourbon tastings. And of course, I love listening to live music, whether it be going to jazz clubs or R&B clubs, just to listen to artists do their craft.