Faculty Spotlight: Laura Bothwell

Ethics in Public Health explores critical concepts and issues in public health ethics to help students navigate the work of public health in a reflective, ethical way and to discuss ethics as part of our professional practices.

Laura Bothwell is an ethicist and historian of public health. Her research examines social, historical, and ethical dimensions of epidemiology with a particular focus on randomized controlled trials (RCTs). Her work examines how international and national policies have influenced trial rigor and ethics, protections of vulnerable trial subjects, and participant diversity in RCTs. She also does work at the intersection of climate change, epidemiology, and ethics.

Bothwell completed a PhD in the History and Ethics of Public Health and Medicine from the Department of Sociomedical Sciences at Columbia University followed by a postdoctoral fellowship in Health Policy, Law, and Ethics in the Division of Pharmacoepidemiology and Pharmacoeconomics at Harvard Medical School and the Brigham and Women’s Hospital. She has had visiting appointments at Oxford University, Foundation Brocher, the Karolinska Institutet, and National Taiwan University.

So much of what we do in public health has ethical roots; if we carefully attend to ethics and articulate our ethical motives in our public health work, it helps to build trust in communities. I am passionate about helping students to explore and articulate the language of ethics in their own work, to help their success, connection, and collaboration with the communities we serve. How can we come together to support the common good, to protect the vulnerable and give voice to those on the margins? How can we be stewards of humanity and our planet? These have always been the questions that motivate me.

My path to public health was circuitous, starting with an interest in bioethics and finding my way “upstream” to the distal causes of health and the “big picture” questions, much as clinicians treating patients often find their way to public health when trying to address the root causes of health inequalities and adverse outcomes. The unique vantage point of public health draws together awareness and solutions across disciplines that can really address the “fundamental causes” of health and disease, to borrow the term from Link and Phelan.

I think the greatest barrier to ethics in achieving healthy communities and a healthy planet is the common misperception that we are not deeply connected to one another; the pervasive (but I think misguided) notion that the path to fulfillment is through individualism. The values of empathy and mutuality have been part of wisdom traditions around the world throughout recorded history, but in the face of suffering and indifference, we can start to question humanity and wonder whether these are merely aspirational goals.

In thinking about this, I’ve been fascinated by the work of cognitive neuroscientists such as Matthew Lieberman who experimentally demonstrated through fMRI research that at the most basic level, when people have chosen cooperative actions that are more likely to be mutually beneficial rather than simply privileging their own self-interest, the brain’s reward center had more activity. It is quite powerful to apprehend that we are indeed wired to find happiness in caring for others and in mutuality more than through selfishness.

The question then becomes one of breaking down the barriers to living out our full, authentic humanity, and I think this starts in how we care for and create programs for the development of children of the world—to be loved and to love. So if the greatest challenge to ethics is perceived individualism, the solution is building awareness of the value (and indeed joy) of caring for others, a process that begins in the earliest stages of life.