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Bioethics Research Workforce

In this session, panelists discussed the challenges and opportunities associated with conducting bioethics research, including bioethics workforce training and ensuring diversity in the workforce. A U.S. national perspective was provided by Benjamin Wilfond, the director of the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital and Research Institute and a professor in and the chief of the Division of Bioethics and Palliative Care in the Department of Pediatrics at the University of Washington School of Medicine. Carla Saenz, the regional advisor on bioethics at the Pan American Health Organization (PAHO) discussed the conduct of bioethics research from an international perspective. Michael Summers, a professor of chemistry and an investigator with the Howard Hughes Medical Institute (HHMI) at the University of Maryland, Baltimore County (UMBC), described the Meyerhoff Scholars Program as an example of a successful effort to increase diversity in science, technology, engineering, and mathematics (STEM) and related fields. The session was moderated by Maria Merritt of the Johns Hopkins Berman Institute of Bioethics and the Bloomberg School of Public Health.

BIOETHICS TRAINING: A U.S. NATIONAL PERSPECTIVE

Wilfond provided a national view of bioethics training from his perspective as the past president of the Association of Bioethics Program Directors (ABPD) and the chair of the ABPD Funding and Scholarship

Task Force. He also gave his perspectives on bioethics training opportunities through the lens of his role as a co-leader on a multidisciplinary study that includes bioethics research sponsored by the National Human Genome Research Institute (NHGRI).

Current Bioethics Research Training Opportunities

In 1987, when he was a pediatric resident looking for opportunities for bioethics training, there were no formal training programs in bioethics, Wilfond said. Three decades later there are now established bioethics training opportunities for postdoctoral fellows and early- and mid-career scientists, and he shared examples for each career level.

• Postdoctoral fellows: Bioethics training available at the postdoctoral level includes individual projects funded by institutional research training grants (NIH T32) or individual postdoctoral fellowships (NIH F32) and established bioethics fellowship programs at institutions across the country (the ABPD website currently lists 17 programs).¹
• Early-career faculty: Training available to early-career research faculty includes the National Institutes of Health (NIH) Career Development Awards (K awards). The number of individuals receiving this training is unknown because bioethics is not an NIH research, condition, and disease (RCD) category, Wilfond said, and as such, one cannot search the NIH database of scientific awards for the number of bioethics K awards. He noted that other types of research, such as data science, are RCD categories, and it would be helpful if bioethics were a searchable category.
• Mid-career faculty: Opportunities for mid-career research faculty include The Greenwall Foundation Faculty Scholars Program.² A unique and valuable aspect of this program, which has trained 56 scholars since 2003, is that all current and former scholars gather twice each year for ongoing training in support of bioethics scholarship, Wilfond said.

Challenges

Wilfond listed several challenges for bioethics training. First, he said, NIH training programs tend to have a topical emphasis on genomics or

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¹ See https://www.bioethicsdirectors.net/graduate-bioethics-education-programs-results (accessed April 15, 2020).

² See https://greenwall.org (accessed April 15, 2020).

neuroethics. Foundations have focused a lot on palliative care, and this results in a lack of opportunities in other areas. Another concern is that lawyers are not eligible for most NIH K awards, with only a few institutes including them. Wilfond said that those with legal training are perhaps the best suited for bioethics scholarship, and he advocated for this to be changed. Finally, as already noted, it is difficult to identify NIH K award recipients due to the lack of a bioethics RCD category.

Demographics

In preparation for the workshop, ABPD surveyed its members to get a snapshot of the pipeline of people in training for bioethics research careers. Twenty-five of the 70 programs responded, identifying 41 trainees. The majority of the trainees were Ph.D.s (28). The rest had M.D. (7), J.D. (3), or Ph.D./J.D. (2) degrees. Trainees were focused on research ethics (18), clinical ethics (13), or a combination of both (9), Wilfond reported. Ten of the trainees were funded by NIH, but the majority were funded by institutions (25) or other sources (6). Trainees were predominantly female (29) and white (31), and Wilfond said there is a lot of opportunity for increasing the diversity of the trainees. Other trainees identified as Hispanic/Latinx (3), Asian (3), black or African American (2), American Indian or Alaska Native (1), or Native Hawaiian or other Pacific Islander (1).

A Model for Developing Bioethics Research Objectives

The approaches to bioethics research are diverse, Wilfond said, and he briefly described a model for developing bioethics research objectives that was developed by ABPD (Mathews et al., 2016). Together, the type of question (descriptive or prescriptive) and the stage of the question (hypothesis generating or hypothesis testing) drive the selection of the appropriate methodology or approach (see Figure 5-1). Methods can be conceptual or empirical (qualitative or quantitative) or involve consensus/engagement. Wilfond noted that the stages and methods are iterative and that there can be more than one method for a particular type and stage of question.

Incorporating Bioethics Training into Multidisciplinary Studies

In closing, Wilfond said that one opportunity for improving training in bioethics is to take advantage of existing studies. He mentioned one ongoing multidisciplinary study as an example and said that five individuals were able to fund bioethics training through individual awards and supplements (two NIH K Awards that built off the main study, a sexual minority supplement, a diversity supplement, and an administrative supplement).

Multidisciplinary studies that include bioethics as well as other disciplines represent an opportunity to improve training in bioethics, he said.

BIOETHICS TRAINING IN LATIN AMERICA AND THE CARIBBEAN

An international perspective was provided by Saenz, who focused her remarks on achievements and challenges in bioethics training in Latin America and the Caribbean. In 2014 Saenz and colleagues published an assessment of four bioethics training programs in Latin America and the Caribbean that had been funded by NIH’s Fogarty International Center over a 12-year period (Saenz et al., 2014). Conducting this type of study was difficult, Saenz said, because some of the information needed to be obtained directly from the people who were leading the training programs. Program leaders are eager to highlight the accomplishments of their program, and it can be difficult to discuss where the programs are not succeeding, she said.

The conclusion of the assessment, she said, was that the field of research ethics and bioethics training had advanced significantly in the region since 2000, but that some challenges remained. The main challenge identified in all of the training programs in the region, she said, was the need for trainees to develop the analytic skills required to produce conceptual work. The assessment found that the majority of the bioethics research conducted by those who had been trained was descriptive. In preparing for this workshop, Saenz said, she looked back to see how the field had changed in the 6 years since that assessment. She came to the same general conclusion that progress has been made, but some of the same challenges persist.

A subsequent, comprehensive assessment was done of the Fogarty-funded programs across low- and middle-income countries (LMICs) to identify lessons learned and training needs. The main finding, Saenz said, was that individuals require in-depth training to be able to produce knowledge on bioethics. She said this conclusion is particularly relevant to Latin America and the Caribbean. To illustrate, she said if one were to look at articles published in the last 5 or 10 issues of the journal Developing World Bioethics, one would find that far fewer articles come from Latin America and the Caribbean than from Africa or Asia, for example.

Advancing Bioethics Training to the Next Level

Bioethics training can be divided into three levels, Saenz said. Level one is very basic training, she said, such as the type of training needed by someone participating on an institutional review board. Level two would be training that might lead to a master’s degree in bioethics, for example,

and level three would be training researchers to be experts in bioethics. Training programs in Latin America and the Caribbean need to take that last step and develop a cadre of experts for the region, she said. It is not uncommon in Latin America and the Caribbean that those who have taken courses on bioethics at a master’s level are expected to teach bioethics. She observed that this does not happen in other disciplines. For example, it is not expected that someone who took a statistics course as part of his or her graduate education would be able to start a biostatistics training program or lead biostatistics research. Bioethics needs to be considered on par with other academic disciplines, Saenz said.

There are three main barriers preventing Latin America and the Caribbean from taking that last step toward increasing regional bioethics expertise, Saenz said. First, she said, it is difficult to train people to develop the practical skills needed for bioethics expertise. It is easier to pass on knowledge than practical skills. There are only a handful of experts in Latin America and the Caribbean, and they are already busy with numerous global projects, she said, and training people is time consuming.

The second barrier, she said, is that “it is very hard to teach new tricks to old dogs.” A priority in establishing the bioethics training enterprise was to institutionalize bioethics, Saenz said, but targeting training efforts to mid-career researchers has not led to institutional change. For example, she said, an anesthesiologist who attends a weekly bioethics class will continue being an anesthesiologist and is unlikely to embark on the project of producing knowledge on bioethics. She emphasized the need to start training in bioethics research much earlier in people’s careers.

Finally, Saenz said, bioethicists in Latin America and the Caribbean speak a different bioethics “language.” For example, she said, cardiologists in Latin America and the Caribbean consume international cardiology literature, engage in a global dialogue, and produce global cardiology knowledge. In contrast, she said, there is limited consumption of international bioethics literature by the bioethicists in the region and also limited production of bioethics literature that meets international standards. Bioethicists need to break out of this cycle and engage in global dialogue on issues that affect the region, she said.

In conclusion, Saenz said that progress is being made through conducting honest, critical assessments of bioethics training programs and collaborating to move programs from level two to level three and increase the bioethics expertise in the countries of the region.

LEARNING FROM WORKFORCE DEVELOPMENT IN SCIENCE, TECHNOLOGY, ENGINEERING, AND MATHEMATICS

Summers described the Meyerhoff Scholars Program at UMBC as a model for creating institutional culture change.³ The Meyerhoff Scholars Program was started by UMBC president Freeman Hrabowski. As background, Summers said that Hrabowski, who is African American, first came to UMBC in 1987 at a time when black students were protesting because they perceived the campus as racist. Today UMBC leads the country in graduating black M.D.–Ph.D.s, is second in the country in graduating black Ph.D.s (behind Howard University), and is considered a national model for inclusive excellence in STEM, Summers said.

The program was launched in 1989 with 19 male African American students. The program was opened to female African American students in 1990, and in 1996 the program opened to students of all backgrounds who have an interest in the advancement of minorities in STEM fields. Historically, Summers said, about 71 percent of the scholars are underrepresented minorities, about 15 percent are white, and about 14 percent are Asian. Critical support for the program comes from NIH, HHMI, and private donors.

The student-centered program involves cohort learning and immersion in research and attracts high achievers, Summers said. He described the program as “intrusive,” with high exposure of the students to research in the learning environment and high expectations for performance. To date there have been approximately 1,500 Meyerhoff participants. Of the more than 1,100 graduates thus far, 91 percent obtained a degree in a STEM field, and 930 graduates have pursued graduate or professional degrees (312 Ph.D.s awarded, 82 percent to minorities; 59 M.D.–Ph.D.s awarded, 90 percent to minorities; 265 STEM master’s degrees awarded, 86 percent to minorities; with 258 students currently enrolled in graduate schools, 81 percent of which are minorities).

Program Assessment and Replication

Assessment is critical to be able to quantitatively demonstrate the impact of the program to financial supporters, Summers said. He shared the results of two studies comparing outcomes for Meyerhoff scholars with those of students who declined an offer of admission from the program. Students who enrolled elsewhere graduated with similar grade point averages (GPAs), he said, but were half as likely to graduate with a degree in a STEM field and seven times less likely to obtain a graduate degree in a STEM field (Maton et al., 2009, 2012).

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³ For more information, see https://meyerhoff.umbc.edu (accessed April 15, 2020).

The program has also had a broad impact across UMBC. By 2005 there was a 400 percent increase in non-Meyerhoff African American STEM degrees awarded, Summers said. On average, the GPAs of African American students at graduation equaled that of white students, and Meyerhoff program components had been implemented in the broader curriculum, he added. In 2018 the graduation rates for African American students were equal to or exceeded those for white students across all majors.

Beyond UMBC, Summers pointed out that the U.S. Surgeon General Jerome Adams and the principal deputy assistant secretary for health Sylvia Trent-Adams are Meyerhoff Scholars Program alumni. In addition, 40 Meyerhoff alumni hold tenured or tenure-track faculty positions, including positions at Duke University, Stanford University, Johns Hopkins University, and other research universities. Other alumni have chosen to teach at smaller colleges to give back to their communities, he said.

The Meyerhoff Scholars Program, with support from HHMI, partnered with the University of North Carolina at Chapel Hill and The Pennsylvania State University to replicate the program on their campuses. Summers noted that these schools have very different environments and minority compositions, and yet, he said, after 1 year their programs were outperforming the Meyerhoff program, and after 2 years each had raised substantial funding for their endowments (Sto Domingo et al., 2019). This shows that Meyerhoff-like outcomes can rapidly be achieved at large, predominantly majority research universities, Summers said, and he attributed the success to support from like-minded administrative and faculty leadership and inter-institutional partnerships. The Chan Zuckerberg Initiative is currently partnering with UMBC to replicate the Meyerhoff program at the University of California, Berkeley, and the University of California, San Diego.

DISCUSSION

Fostering an Early Interest in Bioethics

There is a need to attract a more diverse group of people to the field of bioethics at an earlier age, Wilfond said. He suggested that there could be an opportunity to draw students to bioethics through the Meyerhoff Scholars Program. The majority of the Meyerhoff scholars care about social justice and societal issues, Summers said, and they have a strong desire to make an impact in their communities. Many of the Meyerhoff students who have gone on to earn their Ph.D. have then done postdoctoral work in policy, he said, because they see this as a pathway to a position where they can have a greater impact on issues they care about. The Meyerhoff approach to increasing interest and involvement in research fields, Summers said, is to expose students to the opportunities open to them in these fields,

not only as bench scientists but as leaders. The program prepares them to confidently pursue those positions, he said, and “to not be sidelined by imposter syndrome.” The goal, Summers said, is for these students to assume leadership roles in government and academia so that they are in positions to share their experiences on expert panels and be included in discussions of NIH funding priorities, for example.

When considering early engagement initiatives, Saenz said, an important difference to keep in mind is that everyone is exposed to STEM fields early in life, with formal education beginning in elementary school, while exposure to ethics analysis is limited. Thus, the field of bioethics is starting from a disadvantaged position when seeking to attract students. Wilfond observed that young people who are interested in the sciences are also interested in the ethical implications of science and think of ethics as an aspect of the science. It does not occur to them that bioethics is itself a career pathway. What is needed, as discussed by Summers, is exposure to careers in bioethics. Wilfond said he gives a presentation on bioethics careers to a program for underrepresented minorities in the sciences at his institution each year in the hope that someone will become interested. Kahn also agreed that bioethics training is reaching people too late in their careers. Most of the funding is offered at the postgraduate level, and ideally training should be happening at the undergraduate level, Kahn said.

Leading a bioethics research program does not necessarily mean that one is in a “leadership position,” Merritt said, noting that many prominent bioethics researchers would not describe themselves as being in a leadership position. She suggested that, for bioethicists, the pathway to leadership is a somewhat different career path than the research path.

Merritt asked about metrics used by the Meyerhoff Scholars Program and about the tracking of students who obtain leadership positions. Summers said that the program is competitive and specifically selects students based on their stated interest in research and demonstrated leadership potential. One of the metrics is how many enter graduate programs after leaving UMBC.

Mentoring in Bioethics

Wilfond suggested that part of what is needed to move bioethics expertise in Latin America and the Caribbean from level two to level three is mentorship. Many of the Fogarty programs include mentorship and collaboration, he said. He asked Saenz what would help the region to create opportunities for bioethicists to advance to that third level of expertise. There is no equivalent of the U.S. style of mentorship in the Latin American and the Caribbean educational systems, Saenz said, noting that professors are paid per hour of instruction. There is no protected

time to prepare for and conduct mentoring meetings with students. She added that the majority of research training programs funded by Fogarty in Latin America and the Caribbean involve researchers traveling to a site for a couple of weeks or months and then returning to their regular full-time jobs. In practice, she said, there is little time for continuous mentorship. Because it is unlikely that the system will be redesigned, Saenz suggested that more visiting fellowships could help to fill the mentorship gap for bioethics researchers in Latin America and the Caribbean. In addition, existing fellowships should host more researchers who are at the stage of their careers where they need mentorship to move from level two to level three. In response to a question from Summers, Saenz said that a key advantage of researchers coming together at the international research ethics training programs is immersion. Everyone attending is working in the same area, and part of the learning process is becoming aware of what others are doing as well as getting a “reality check” on what you know and do not know.

Ensuring Diversity Among the Decision Makers

There is a need for greater diversity among those who make the decisions about awarding funding, Merritt said, including the leaders of funding organizations and other sponsors of bioethics research as well institutional boards and university leadership. Summers agreed and said that many programs that began with a focus on increasing the representation of minorities have expanded to include those with socioeconomic differences (e.g., the National Institute of General Medical Sciences Maximizing Access to Research Careers Awards and the Initiative for Maximizing Student Development Program). There are more poor white children in the United States than poor black children, and specific attention is still needed on the issues faced by minority students, Summers said. In the United States, women and minority students are still disadvantaged relative to their white male or Asian male counterparts. Summers reiterated that minority students also suffer from imposter syndrome to a great degree. In addition to calling for more diversity in the leadership of schools and funders, Summers also called for greater racial diversity among NIH research faculty.

Advancing Bioethics Research

Merritt prompted panelists and participants to reflect on what research or actions might be needed to develop greater diversity at every career stage in bioethics. Their suggestions included the following.

Identifying Successful Models of Integrating Bioethics Research into Multidisciplinary Studies

Wilfond briefly described the Cancer Health Assessments Reaching Many (CHARM) study, which is intended to identify interventions that could improve access to genetic testing for diverse populations. The CHARM study involves 10 institutions and 70 people from a wide range of disciplines, including bioethics. One approach to improving bioethics research is to integrate it with other types of research, rather than considering bioethical issues separately, Wilfond said. As such, one area for investigation is identifying and describing successful models of the integration of bioethics research with other disciplines within a project (such as was done for CHARM).

Including the Low- and Middle-Income Country Perspective When Developing Solutions

Saenz reminded participants that LMICs lag behind the United States in institutionalizing basic privacy and research ethics practices. She encouraged participants to include the perspective from LMICs in discussions. Research should not be focused on developing first-world solutions with the expectation that LMICs can just catch up, she said.

Establishing Bioethics Research as a Viable Career Option

Students are savvy when considering career options, Summers said. Areas that are underfunded and do not pay well are not going to draw graduates to postdoctoral fellowship programs. He suggested that to enhance interest among junior researchers, NIH and the National Science Foundation should provide leadership and resources that demonstrate that bioethics is going to be a major area of focus over the next two decades and that funding will be available to early-career investigators.

Filling the Pipeline

Piecing together funding for bioethics training is a concern, Kahn said, but a greater concern is having a pipeline of incoming students to fund. He went on to suggest to Summers that they should discuss how Johns Hopkins University might recruit graduate students from the Meyerhoff Scholars Program.

The pipeline of potential students is increasing as new programs launch, Summers said. There were initially concerns that a Meyerhoff-like program could not succeed at Penn State. Only about 5 percent of students at Penn

State are African American, and it was speculated that the parents of high-achieving black students would be skeptical of the program. Seventy families were invited to the first selection weekend, and 68 families attended. Normally the Meyerhoff Scholars Program at UMBC makes 25 offers of admission because there is funding for 18 students. The program at Penn State made 25 offers and had 23 students accepted, he said, and this trend continues. The key to success is support from upper administration in making these programs a priority, Summers said.

There are a variety of programs helping to fill the pipeline, Summers said. For example, the mayor of Baltimore funds the Baltimore YouthWorks program, which allow Summers to bring about 12 inner-city high school students to work in the laboratories at Johns Hopkins University each summer. The East Baltimore campus of Johns Hopkins University is adjacent to Paul Laurence Dunbar High School, Kahn said, and nearly all of the students there are African American. Faculty from Johns Hopkins are now teaching some of the science curriculum at the high school, and Kahn agreed that the students do not realize that they could someday be doing the same type of work as the researchers who are teaching them. He highlighted the need for approaches to support students entering undergraduate study areas that will prepare them for graduate education and bioethics careers.

Recognizing the Importance of Local Context in Training

It is important to take the local context into account when training the next generation of bioethics researchers, one workshop participant said. Researchers come to the United States for training or to attend training that is provided locally in other parts of the world, but they conduct their research in the context of their own country. Local context shapes the way people operate, how they think about questions, and how they relate those questions to the work they are doing, the participant said, and local context is just as important as training for how they will develop as scholars. It is difficult to “be immersive the other way around” to bring a researcher’s context into their training. There is a need to be introspective in considering implicit biases and assumptions about bioethics and to consider how one’s views apply in other parts of the world, the participant said. The participant had personally experienced both the benefits of mentorship and training and the challenges of being different, coming into the bioethics research workforce from another discipline and coming to the United States from another country as a person of color.

Commenting on context, Wilfond said that he describes bioethics to nonscientists using three animals of the Pacific Northwest. The salmon swims upstream, and bioethics is similar in many ways, challenging conventional assumptions and asking questions. The penguin is not from

the Pacific Northwest, but penguins thrive through collaboration, and collaboration is a critical part of bioethics. The last animal is a 50-foot tall rubber duck in the Tacoma harbor. This rubber duck was originally in Toronto, where it was not simply a rubber duck, but a symbol of U.S. dominance, cultural insensitivity, government excess, and environmental disregard. It is all a matter of perspective, he said, and a fundamental part of bioethics training is to look at things from other perspectives. Collaboration, challenging assumptions, and acknowledging different perspectives are fundamental to bioethics, Wilfond said, regardless of where it is practiced. Several Meyerhoff scholars are from Africa and the Caribbean and they help to bring perspective to discussions of issues such as health care, Summers said.

Funding Doctoral Students’ Research in Bioethics

Panelists were asked to comment on whether there should be more support from NIH⁴ or other funders for graduate students who want to conduct their doctoral research on bioethics. Saenz fully supported funding more doctoral research and said it would be the easiest way to move from level two of bioethics expertise to level three. Each NIH institute has different mechanisms for supporting people, Wilfond said, and it was discussed among the panel that the NIH F31 award is for predoctoral students. The National Institute of General Medical Sciences has several programs at the undergraduate and graduate levels geared toward increasing diversity, Summers noted. Funding opportunities are very effective in engaging researchers, Wilfond said, noting that the more funding opportunities there are, the more they will be used, making those opportunities important.

Training Research Ethicists for Transdisciplinary Research

A workshop participant observed that embedding ethicists in research projects is an approach that has been taken successfully in the fields of synthetic biology and neuroscience. This requires skills in collaboration and transdisciplinary research in addition to skills in ethics and bioethics, the participant said, going on to ask the panelists how researchers might be trained to fill these types of roles. There is a distinction between an integrated model and an embedded model, Wilfond said. In an integrated model, such as the CHARM study, bioethics is integrated throughout the

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⁴ The Fogarty International Center and NHGRI are part of a bioethics funding opportunity aimed at graduate students, International Bioethics Research Training Program (D43 Clinical Trial Optional). More information on this funding opportunity is available at https://grants.nih.gov/grants/guide/pa-files/PAR-19-243.html (accessed April 29, 2020).

design and conduct of the project. In contrast, an embedded ethicist is readily available to consult as needed.

Saenz said that much of the work she performs at PAHO is the integration of ethics in all of the organization’s programs.⁵ Ethics is part of the package that PAHO delivers to the member countries it works with, she said. Embedding ethics into these programs requires a high level of expertise in biomedical ethics as well as public health ethics. She pointed out that public health ethics had not been addressed by the workshop, and said that in-depth expertise on ethics should include public health ethics.

The population of older adults is expected to increase significantly in the next 10–15 years, according to a workshop participant. Eighty percent of that population will be living in an LMIC, and one in five will have a mental health condition, the participant continued. Funders such as Fogarty create programs that embed teaching about bioethics into the management of current real-life health issues. For example, digital health will be a critical solution for older adults struggling with mental illness, and perhaps bioethics training could be embedded into the support of these programs, the participant suggested. This is happening to some extent in certain regions, Saenz said, noting that an advantage of this approach is that it gets straight to the discussion and analysis of the issues. A problem with bioethics training in Latin America, Saenz said, is that it is very focused on memorizing, and there is limited attention to deeper ethical analysis. While embedding ethics training into real-life situations provides opportunities for ethics analysis, it does not solve the problem of taking that final step to develop higher-level bioethics expertise.

Clarifying That Normative Research Is Fundable by the National Institutes of Health

A workshop participant recalled the discussion by Saenz that many bioethicists focus on descriptive work and not normative theoretical work,⁶ noting that this has also been a critique of NIH-funded ethical, legal, and social implications (ELSI) research. There is a perception among those who receive funding for ELSI research that NIH is less likely to fund normative research and that it favors empirical projects, the participant said. One potential solution would be for NIH requests for applications to state explicitly that normative research is fundable. This finding of the

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⁵ For an overview of the bioethics-related work being conducted by PAHO, see https://www.paho.org/hq/dmdocuments/2013/CSP28-14-e.pdf (accessed April 28, 2020) and https://iris.paho.org/bitstream/handle/10665.2/49706/CD56-INF-21-e.pdf?sequence=1&isAllowed=y (accessed April 28, 2020).

⁶ Normative theoretical ethical studies primarily focus on the criteria of what is morally right or wrong, and examine the process by which moral standards are developed.

Fogarty study was somewhat unexpected, Saenz said. The bioethics training program directors are generally more interested in—and are experts on—normative components, but nearly all the trainees produced empirical descriptive bioethics research. This could be because the empirical approach is closer to their background in scientific research, Saenz said.

Normative research is fundable, Wilfond said, who was also aware of the general perception that it is not. He said he often uses a strategy of proposing complementary projects that have both an empirical aim and a normative aim because review groups often have a more difficult time reviewing proposals for conceptual work. ABPD has been involved in communicating to bioethicists that NIH wants to support them and has facilitated NIH giving presentations at bioethics meetings to promote the image of the agency as approachable, Wilfond said.