Diana Alame. Image: John Soares
When Ebola broke out in West Africa two years ago, Diana Alame was participating in a Harvard Medical School clinical microbiology fellowship at Massachusetts General Hospital.
During the epidemic, she and her colleagues pondered, “How do we provide the best patient care? How do we take care of the people who are handling specimens from infected patients?”
Toward the end of that fellowship, when Alame was considering her next career steps, HMS announced it would begin offering a Masters in Bioethics degree (MBE).
The issues raised by the Ebola outbreak and by another of Alame’s fellowship projects—working on antimicrobial stewardship—tied in well with the new opportunity. Alame applied and was accepted.
“There’s not one human being who’s not an interested party in what’s happening in medicine and biomedical research.” —Diana Alame
Now, as an HMS master’s student, Alame wants to learn how to move beyond gut reactions when solving bioethical dilemmas. She wants to develop clear reasoning skills that will help her arrive at a moral justification for why a given issue in medicine should be handled a certain way.
Alame believes that given the natural history of infectious disease outbreaks in a globalized world and the non-judicious use of antimicrobials, “We will face more of these types of difficult situations.”
Primary driver
Alame’s experience as a physician in the U.S. Air Force whetted her interest in bioethics.
As a flight surgeon and then as commander of the Flight Medicine clinic at Grand Forks Air Force Base in North Dakota, she faced ethical questions that ran the gamut from personnel matters to operational issues.
Caring for those on special operational status required Alame to make judgments on whether they were physically able to perform aerospace activities, such as flying, parachuting, space and missile operations, and air traffic control. It was important to make the right call to ensure the safe and successful completion of military missions, she said.
She also assessed whether health issues precluded one from remaining on special operational status and for how long.
As the clinic commander, Alame worked to make sure that the facility met military codes and the same standards of care as civilian hospitals. Many of the ethical situations she faced were similar to those that civilian physicians see, she said, but some were specific to the military.
For instance, she was required to fully understand the role of the medic in humanitarian operations and the importance of adhering to the premise behind Geneva Convention protocols of treating friendly and enemy patients with equal medical care.
She also learned to navigate the medical needs of the patient versus the operational needs of the mission.
Interdisciplinary experience
Alame came to medicine from a liberal arts background. She studied psychology and music as an undergraduate. She said she believes practicing medicine is as much an art as a science because it draws on many subjects from the humanities and social sciences, such as history, philosophy, law and sociology.
By studying bioethics, she feels, she has come full circle.
“Bioethics itself is an amalgam of all these wonderful fields,” said Alame.
There are lawyers, social workers, journalists, nurses and physicians, among others, doing this work, she said: “All these people bringing their expertise to inform the medical experience and ethical debates.”
Communication is key
Alame said she is not only concerned with the ethical questions that arise in the course of clinical practice or during research, such as gene editing or artificial intelligence; she is also interested in finding ways to make sure that many different voices become engaged in a rigorous dialogue about these complex bioethical issues.
“Every single one of us has a role in it,” she said. “This is our time to ask those types of questions, learn about the topics and have a voice.”
Alame envisions a conversation with many voices seeking common, workable solutions to thorny bioethical issues.
“Bioethics has to not only be applied in a given context, but it has to be practiced,” Alame said, so that people can begin to understand how they are going to be affected on an individual level.
For her required capstone project, Alame is developing a proposal for an online journal, based at the HMS Center for Bioethics, that will capture the richness of the work being done at the School while making the bioethical issues, questions and solutions accessible to the broader public.
It takes a village
The desire to bring diverse voices into a discussion, and understanding the strength that comes from those many viewpoints, may stem from Alame’s background, she said. A first-generation American, her parents emigrated from Lebanon to the U.S.
Although her mother was not able to complete her education, partly because of the war there, Alame said, “She is the love of education embodied.”
Alame’s father, who works in finance, has been a lifelong learner. At the age of 63 he is in the second year of a doctoral program in finance.
Alame said other members of her family have stepped up to help her pursue her career in medicine. Her sister, an attorney, moved with her family to the Boston area when Alame became a resident so that she could help her sibling. Alame’s husband stayed home during her residency to take care of their young children.
Practice, practice, practice
This year, as she finishes her degree, Alame’s goal is to continue honing her skills so she can grapple with complex bioethical issues. She wants to continue to learn the language of ethics and the art of developing clear moral arguments so that she can communicate important messages, engaging as many voices as possible for the betterment of humanity.
“There’s not one human being who’s not an interested party in what’s happening in medicine and biomedical research,” Alame said.
