 I'm delighted now to welcome you to the McClean Center Prize in clinical medical ethics and health outcomes. Today will be the eighth annual presentation of that prize, which is one of the larger prizes in American bioethics. The previous winners of the prize have been extraordinary clinician ethicists who have changed the world of practice. The first was Jack Wenberg from Dartmouth and then Peter Singer, who is now the number two person at the World Health Organization. Susan Toll, who developed Pulse, Laura Roberts, the chair of psychiatry at Stanford, Paul Farmer, and his great work with partners, Bill Fagy, who eradicated smallpox from the world, Norman Faust, the great senior pediatric ethicist from Wisconsin. As usual, I'm delighted to welcome Kenneth Polanski, the dean of the Division of Biological Sciences and the Pritzker School of Medicine, the executive vice president of the University of Biology and Medicine to present the person who has won this year's award, Dean Polanski. Good morning. Thank you, Mark. So I'm delighted that we could all be here for the University of Chicago 31st annual Dorothy J. McClean Fellows Conference on clinical medical ethics. And this is always a wonderful conference and clearly a terrific group of speakers and important topics to discuss. So I'd particularly like to welcome the many former McClean Center Fellows. As I think you know, but I'll go over it again, the conference is named after Mrs. Dorothy Jean McClean, the matriarch of the McClean family, and a great supporter of educational programs at this university and at other universities in the United States, including Colorado College, Smith College, and Yale. Dorothy believed that education was the best way to improve the world. So the McClean Prize, as Mark has mentioned, is a $50,000 award. It's one of the largest prizes in bioethics in the United States. And it was established in 2010 by the McClean family to recognize physician scholars who had made transformative contributions to clinical medical ethics and to healthcare in general. And Mark has gone over the previous winners and it clearly is a who's who of people, not just in clinical medical ethics but in medicine in general with extraordinary contributions. So this year we are continuing the tradition and I have great honor in introducing Dr. Stephen Miles, who is the recipient of the 2019 McClean Center Prize. So Dr. Miles is currently professor emeritus of medicine in bioethics and is the former holder of the Mars family endowed chair in bioethics at the University of Minnesota Medical School in Minneapolis. He taught and practiced medicine at the University of Minnesota for almost 30 years prior to becoming an emeritus professor. He began his academic medical career at the University of Minnesota after spending three years from 1986 to 1989 as the associate director of the new and developing McClean Center. Dr. Miles' clinical career was in general medicine and geriatrics. He has published four books, more than 20 chapters and over 200 medical articles. His research work has focused on medical ethics, human rights, torture and end of life care. In one of his best known works, the Hippocratic Oath and the Ethics of Medicine that was published in 2004 by Oxford University Press, Dr. Miles reviewed the meaning of the Hippocratic Oath and wrote a modern vernacular version of the text. In his extensive work on torture and doctoring, Dr. Miles has pointed out that in the United States there are many torture survivors as persons with Parkinson's disease. Quite a stunning observation. In his 2006 book Oath Betrayed America's Torture Doctors, which was published by the University of California Press, Dr. Miles explains how during the mistreatment and torture of prisoners at Abu Ghraib, at Guantanamo Bay and at other war prisons he visited, some doctors, nurses and medics remained silent while prisoners were abused and tortured. Dr. Miles currently maintains two websites, the Doctors Who Torture Project as well as the Military Medicine and the War on Terror Project. The latter project, Military Medicine and the War on Terror, includes an archive of 60,000 pages of government documents describing the medical system in military prisons. These efforts were driven by Dr. Miles' special interests in holding physicians accountable for their involvement in torture-related activities. Dr. Miles also has extensive international experience including global work with refugees and is on the advisory council of World Without Genocide. He was the medical program director of the American Refugee Committee from 1981 to 1982 during which time he was the chief medical officer for 45,000 refugees along the Thai-Cambodian border. Dr. Miles has served as the president of the American Society of Bioethics and Humanities and in 2017 he received the Lifetime Achievement Award from that organization which is its highest honor. He has also won the American Bar Association Human Rights Award and the Sullivan-Ballu Award for Human Rights. In recognition of his great contributions to clinical care and to the field of clinical medical ethics, his important work in helping to build the McLean Centre and his great research and writing aimed at reducing torture related to medicine. It is an honor to present the 2019 McLean Prize to Steven Miles. Dr. Miles will now deliver his keynote lecture entitled Medical Ethics of Solidarity. Please join me in congratulating Dr. Steven Miles and in welcoming him back to the University of Chicago. Well, this is a pretty awesome audience to try to speak to but I'll do my best. I'm very honored to receive the McLean Award and time is far too short to thank everybody who has taught me including those who are trying to heal communities that are a great deal of pain, including patients, my students and colleagues as well as Mark Siegler and Father John Parris who are teachers of mine who happen to be in the room. I'd also like to thank Barry McLean and the McLean family for your support in this award and for the Centre. Teachers are stewards of an enormous public trust. That privilege of stewardship is its own reward. However, in an age of anti-science and false history, this award affirms the enormous worth of authentic teaching. The last year has been, I think, one of the most impressive years for medical ethics of my lifetime. Issues of bound, Medicare for all or incremental insurance reform. Laws that allow a pharmacist of one faith to ambush customers with different values. Covert data harvesting on social media for health profiteering and so on. There are countless stories and I want to lift up two of them in detention centers across the United States. Physicians are administering psychoactive drugs, restraining and oversee withholding vaccinations to immigrant children held in these crowded detention centers with outbreaks of vaccine-preventable diseases. Children who are protected or separated from their relatives and denied legal representation of guardians. Although some medical associations and ethicists protest such practices, discussions of possible labor actions through pressure for conventional medical care or to hold the physicians and nurses responsible for this care professionally accountable for irregular practices simply have not appeared yet on the radar screen of American medicine. A second issue, health plans, hospitals. Clinicians across the United States have been using Optum's cardiac app to assess patients for cardiac treatments. This app triaged African American patients away from cardiac treatment as it recommended much more aggressive care to many more and less sick white patients. The right to fair healthcare for every African American who has been evaluated by the Optum app has been disadvantaged by this app. This is an ethics problem, a clinical ethics problem of the first rank. Surely any hospital that found a white supremacist cardiologist would revoke his or her privileges and immediately begin a look-back of affected patients, their treatments, their outcomes, and their current needs. We've done look-backs many times before, for example, with implanted defibrillators, but so far I have not heard an ethics call to identify this is a problem for look-back, clinical remediation, and compensatory justice. Now medical ethicists can be credited for suggesting that such issues are amenable to a value-centered analysis and a media chorus invites medical ethics to speak to such public health catastrophes. A chorus suggesting that protagonists reconsider their personal causes is the essence of classic Greek tragedy, and later on I'm going to discuss the implications of such themes in classic Greek drama for us. But first, philosophy 101. Every right implies a correlative duty. A patient's right to give informed consent before being treated implies a correlative duty to inform and secure consent before treatment. Similarly, in public health, vulnerable persons' rights under the principle of justice to equal opportunities for health oblige a correlative duty to remedy structures of neglect, stigmatization, or exploitation that make vulnerability injurious to health. Now autonomy-focused principalism, our dominant model, tends to be aloof from the social realities of health affecting vulnerability. A principled relationship, after all, presumes the status of being respected as a person rather than being stigmatized by class, of being in the global north rather than the global south, of being a citizen rather than being stateless, and so on. And so I'm going to talk today about how clinical ethics might reform itself by adding a clinical ethics of solidarity. A clinical ethics of solidarity rests on an authentic social empathy. It lifts up justice as essential to equitably improving healthcare for all. It would balance rather than supplant an unbalanced priority on respect for personal autonomy, which inevitably will turn to focus on the concerns of the respected and privileged. Social empathy is not learned in books. It is learned by sustained, real, engaged relationships. And ethics of solidarity's depth of field sees social determinants of health. It sees persons in the context of prisons and homes for the aged and toxic slums and fear. Where health is compromised by casts of race, gender, sexuality, and privilege. As an example, as my introducer referred to, academic health centers proudly address Parkinson's disease. They have specialty clinics and they do research programs. And yet in the United States there are as many survivors of torture as persons with Parkinson's disease. There are torture survivors among our patients and our colleagues and the families of people that we all know. And in fact I know of at least one torture survivor in this room. Many of these people are disabled by depression, wounds, and chronic pain. They need rehabilitation to reach their potential as students, workers, parents, spouses, and citizens. We teach students how to recognize Parkinson's disease, who teaches our health community how to screen for survivors of torture. Where are the clinics and researchers for these people? Which ethics committees address how academic health center structures make such suffering and vulnerable persons invisible? And ethics of solidarity would address what Alexander Capron called bioethics 1090 problem. In which 90% of bioethics scholarship focuses on matters that are germane to 10% of the population. And ethics of solidarity is not a call to politicize bioethics. It simply acknowledges the fact that sociopolitical culture manufactures health-harming vulnerability. In how it structures laws, opportunities, entitlements, and social conventions, and even cardiac apps. Now the Greek plays of 2600 years ago have a fascinating double helix structure. Well no double helix. I don't think they did. Escalus' majestic orastia, for example, had a protagonist plot where two young adults, brother and sister, successfully conspired to murder their mother who, with her lover, had killed their cruel father. Now the other strand of the helix in that play is the chorus commentary. At the beginning, the chorus worries that the rest is an electra. Entirely understandable personal obsession for vengeance does not simply avenge. It compounds murder with matricide. Now choruses in Greek drama rarely offered the antithesis to the protagonist's positions. Rather, choruses challenged the protagonist's pride in their self-sufficiency in defining the foreground ethics problems, its solution, and its downstream consequences. Choruses suggest how a broader perspective on civic virtues and civil society might amend the protagonist's formulation of the primary moral problem and its solution. As in other Greek tragedies such as Oedipus, the resties and electra are exiled. Exiled is a social reorganization that is usually self-imposed or ordered by a ruler. It's not imprisonment. It's not a death sentence. It essentially removes a protagonist, their voice from discourse on the public square, because his or her claim of moral authority was found wanting compared to the choruses' broader understanding of natural justice, civic virtues, or what the Greeks called decay. Now, to Professor Socrates, exile from the discourse on the public square was worse than death, so he chose to split the difference, rank hemlock, while he was giving his last lecture. The Orastiah tragedy, like the Oedipus tragedy, ends when the gods in chorus concur that the protagonist's parochial priorities were wanting and that a natural, compassionate social justice is required for civil society to flourish. Our ethics journals are filled with our causes. There are hundreds of articles about the probably fake CRISPR babies from China. The nuances of minimally conscious states and rare quaternary care treatments that are irrelevant to the hundreds of thousands of people who can't afford insulin. The media chorus, speaking in lamentations on the front page of our newspapers, in editorials and in letters, invites the protagonist of medical ethics to turn their attention to the problems of public health and social justice as they are lived and experienced by society at large. Those are the kinds of issues I spoke of at the beginning of this talk. Now, Escalus and Sophocles said that the protagonist who do not heed the wisdom of the chorus risked exile or, in our time, scholastic marginalization. That risk is real. Human rights and humanity, bioethics and the humanities are yoked synonyms. A balancing of autonomy-centered principalism with a clinical ethics of solidarity asks us to develop an authentic social empathy and heed the cautions of the chorus in order to improve public health and seriously reduce health disparities by elevating respect for justice. Thank you. Steven, stay. Steven. Steven. That's totally fine. So congratulations. It's really a fantastic lecture and obviously a fantastic career and enormous contribution. So we have a couple of tangibles that we'd like to give you. So the first is the award, which says the University of Chicago McLean Center for Clinical Medical Ethics awards Steven H. Miles, the McLean Center Prize in Clinical Medical Ethics for Contributions in Internal Medicine, Geriatrics, Human Rights and Global Health. So congratulations. Thank you so much. Thank you very, very much. I have to tell you that, like, Mark is legendary for being cheap on honorariums. So he called and he said, will you come down and give a talk at the McLean Conference? I said, are you going to pay my plane fare? He said, I'll pay. Is this the usual $150 honorarium? He said, I think I can do better than that. And I honestly did not know until yesterday what the award was. And I am blown away. Thank you.