Public Spectacles and Private Lives

Thoughts on “The Case” in Public Bioethics

This year I’ve been contemplating the ethics of highly publicized bioethics “cases.” Here I am thinking about medical (or medical-related) individual patient situations that enter mainstream awareness through news media, and then are debated in the public sphere, as well as among academic bioethicists.

I am writing from the United States, where there is a history of these public cases shaping bioethics as a field. We can name patients that are part of milestone evolutions in bioethics: Baby K, Karen Ann Quinlan, Terry Shiavo, Dax Cowart. Jahi McMath is a more recent case that put in the public spotlight the concept of brain death among other themes. The names of patients who were on the forefront of biomedical technologies also enter our field’s collective memory, such as the first people to receive transplanted organs or be born via invitro fertilization.

The methodology of “the case” is also common to how bioethicists theorize. Journals dedicate special sections to academic perspectives on a case, and scholarly articles sometimes turn on or weave in case examples to illustrate or motivate a point or analysis. To be clear, I do all of this myself, having written case studies in journals and worked composite cases into my scholarship. At the same time, especially as a feminist bioethics scholar, I am sensitive to both the benefits of “the case” methodology to investigate particular situations and through narrative practices, and the many risks involved in telling and representing stories that involve others.

There have been two public cases in the United States that have sat especially uneasy with me, both due to my understanding of their facts, but also due to what they showed about how a public – including a public of bioethics scholars – talks about a case in which they do not and cannot know all the facts.

One is the case of Adriana Smith, a woman in Georgia who, at nine-weeks pregnant, was declared brain dead in February 2025 and was maintained on life support until the fetus could be delivered. In a post-Dobbs context in which reproductive rights are curtailed in many states, Ms. Smith’s case received significant attention for how starkly it appears to show the extent of reproductive injustice pregnant people are now facing in the United States.

As a bioethicist involved in clinical ethics consultation and with scholarly interests in reproductive justice, I found the case both appalling and intriguing. There are so many things wrong with what seems to have happened. It also invites so much curiosity as to how it could have happened. We’ll never know from the perspective of Ms. Smith, certainly, nor likely her medical team, what it really was that people knew, said, did, didn’t do, weighed, valued, feared, or prioritized to create the outcomes publicly shared. And as much as my training and background invite curious questions as to how this all could have happened and why, I also recognize that this case is not mine to know. It is typically precisely because we are not directly involved in cases like this that we can engage in public speculation and analysis. Were we involved directly, patient rights to privacy would keep us from sharing information or explain reasoning. Instead, we are left, often, with only part of a story. And these are the stories of specific individuals. It is Ms. Smith’s tragedy, and her family’s. For the rest of us, it becomes an “interesting case.”

The other case deeply on my mind and in my inbox via bioethics listservs this year was that of Byron Black, a man on Tennessee’s death row who challenged his execution on August 5^th due to how his pacemaker might interact with the lethal injection protocol used in Tennessee executions. There is growing attention to incarceration itself as a bioethical problem. And there is longstanding bioethical controversy regarding execution in the United States, especially given the adoption of lethal injection as the primary means of execution. Lethal injection, intended to be a more “humane” form of execution, requires administration of pharmaceutical products that some manufacturers are unwilling to supply, and most medical professionals unwilling to administer, given medical ethical commitments.

Mr. Black’s case, in which he and his lawyers raised concerns that his pacemaker might cause him to experience cruel and unusual suffering during his execution, introduced novel questions regarding the state’s obligations to prevent such suffering. Did his pacemaker need to be deactivated prior to his execution for it to not be cruel and unusual? If so, who would do this? Would it require a medical professional be willing to deactivate it? Would one doing so be upholding an obligation to minimize harm? Or would it be complicity in state execution? What if Mr. Black did not consent to de-activating his pacemaker? There were numerous questions about medical ethics related to professional obligations, conscientious objection, and medical autonomy even when other aspects of one’s autonomy is constrained by terms of their punishment.

Again, along with my fellow bioethicists I am interested in these questions. This is in part because I have bioethical interests in incarceration. In a forthcoming book chapter, Takunda Matose and I argue that bioethics needs to pay attention to incarceration in the US in new and different ways than it has before. But my interest in incarceration as a bioethical topic, and in Mr. Black’s case specifically, also emerges from knowing some of the men incarcerated on Tennessee’s death row alongside him.

For five years I was part of reciprocal education group that met weekly in Unit 2 (death row) of Riverbend Maximum Security Prison. Mr. Black was not part of the group, but he was a neighbor and friend of many of the men who were. Again, I am reminded that Mr. Black’s “case,” while interesting bioethically, is also one we can only know partially. And it is a very personal tragedy to him and those involved in his life.

I’m writing this today as a form of distraction from the fact that another Unit 2 insider I did know, Harold Wayne Nichols, is scheduled to be executed tomorrow. This comes over five years after his original execution date in August 2020 was put on hold during the Covid-19 pandemic. At the time, I wrote about various of the bioethical issues intersecting with his scheduled, and subsequently stayed, execution. This included the irony of a single man’s death being stopped by the mass death of others during a global pandemic, and of a state imposing restrictions on reproductive freedom in the name of being “pro-life” nonetheless executing a man that is the paragon of prison rehabilitation. ( Rehabilitative programming on a death row prison unit is its own logical puzzle if the state never intends to permit clemency for one successfully rehabilitating).

Today, I recognize that there is so much I could say as a bioethicist or a feminist philosopher about the imposition of the death penalty, complexities of punishment and its theories, or different conceptualizations of justice operative across criminal-legal systems and bioethics. But I am also deeply aware that for every public spectacle of an interesting “case” there are private lives and stories, often tragic, each from their own unique perspective. Tomorrow, Red’s death (the name by which I know him) is going to be a personal tragedy for him, for those of us that know him, and for so many touched by this situation for which his execution will not be justice, and not just another compelling case.

Elizabeth Lanphier, PhD, MS, HEC-C is a philosopher and clinical ethicist, and co-editor of the IJFAB Blog. These thoughts are hers alone and do not represent those of any institution or organization with which she may be affiliated.