Five questions for Mary Ann Cutter

Mary Ann Cutter

In the 1970s, Mary Ann Cutter was a Georgetown University undergraduate. The pre-med student and philosophy major was introduced to the philosophy of medicine through the work and teaching of physician-philosopher H. Tristram Engelhardt Jr. and bioethicist Tom L. Beauchamp, both influential thinkers in the biomedical ethics movement in the U.S.

Later, as a graduate student in biology and then philosophy at Georgetown in the 1980s, she began work on the ways in which classifications and descriptions of diseases frame how they are treated, and how they set up ethical challenges that must be addressed.

“In the 1990s, I applied this approach in my work on AIDS, health care reform, ovarian and uterine cancers, and concepts of death,” Cutter said.

Today, Cutter is a professor in the Philosophy Department at UCCS, where she has established a lengthy, award-winning CU career that began at CU Denver in 1988. Her most recent high honor is the 2019-20 Elizabeth D. Gee Memorial Lectureship Award, presented by the CU Faculty Council Women’s Committee, in recognition of her efforts to advance women in academia, interdisciplinary scholarly contributions and distinguished teaching.

Her global work on death and dying has culminated in a popular class at UCCS as well as a major book publication in 2019. In 2012, she began work on ethical issues raised by how physicians understand and treat breast cancer, and this year is looking at how decisions are made regarding diagnosis, prognosis and treatment of COVID-19.

“In short, my interest is on how philosophical claims and assumptions frame our biomedical ethical standpoints, and guide how we think about resolving ethical dilemmas in clinical medicine,” Cutter said.

1.  Regarding your Gee Award, fellow UCCS Professor Raphael Sassower said that you have “consistently and generously supported women faculty from the ranks of full professors to lecturers.” In your experience, what are the most valuable ways women in academia can help one another?

Here are few initial thoughts:

• Know the reward system.
• Stay focused on your work and your goals. (Set aside time each day or week for your work, writing and research.)
• Balance your work and home life.
• Ask questions and inquire into possibilities because the worst someone can say is “no.”
• Be confident in who you are; you can’t be someone else.
• Avoid gossip and treat others equitably.
• Find one or two (yes, just a few) trusted mentors and ask them to be your sounding board on matters.

Personally, I find that some women faculty feel obligated to do certain tasks (in part, because they are asked to do them) and I tell them, “Don’t; just say no.” More positively, serve in ways that you can make a difference and in which you can grow and flourish.

Good service is good leadership. Knowing what and how to serve requires a stake in the activity or event. Women bring to leadership roles and their service, perspectives on life and work that come about through their unique life experiences. These perspectives are important to all of us in academia in creating a more inclusive and diverse environment.

2.  How is COVID-19 influencing your teaching and research? How have you managed remote teaching during the pandemic?

Ask teachers, and they will tell you that COVID-19 has been a challenge in many ways: (1) how to deliver educational content during a pandemic, (2) how to transition from live to remote learning, (3) how to be present to students in ways that are helpful and open to what is needed, (4) how to find assistance when questions arise, (5) how to set up the home office in ways that work, (6) how to continue the research and writing that is expected, (7) how to be the teacher, parent, grandparent, care provider, home cook, and all-around get-it-done person one is expected to be during this time, and (8) we could go on.

Personally, I transitioned well to remote learning because, years ago and as chair of my department, I saw the emergence of interest in online studies and thought I should get involved. And so, I attended online learning classes and submitted three of my courses for Quality Matters certification. I currently teach those three courses on a regular basis, both live and online, and so I was able to transition as best I could from live to remote class delivery.

I must say that I find online teaching inevitable, challenging and rewarding for those who can teach and learn this way. As an educator, I find that online teaching requires me to be organized in all that I do, succinct in my words, intentional with regard to my learning objectives, humble in my attempts to try out new things, available to learners who contact me all through the week, and open to more engaged dialogue from students who seem to be more willing to post discussion board comments than share thoughts in a live class.  

My advice to those teaching remotely follows:

• Find others who teach online in your discipline or a related discipline and seek their advice. After COVID-19 hit, I found myself along with a few others in my department becoming an informal trainer to others. We put together tip sheets and made ourselves available. The first two weeks that we moved to remote learning were pretty crazy because the call-centers that we typically use were swamped and we had to figure out for ourselves how to make something work.
• Be organized in each aspect of the course (e.g., the announcements, syllabus, modules, synchronous or asynchronous lectures, discussion boards, peer-review, assignments, surveys, etc.).
• Have a clear sense of the goals one seeks to achieve in each aspect of the course.
• Think about delivering content in a “pluralistic” way: Use text, visuals, auditory means, and multiple measures of assessment (e.g., formal and informal writing, multiple choice, discussion boards, peer-group exercises, etc.).
• Do not expect that online teaching and learning is for everyone and every discipline, because it is not.
• Have fun and try new things out and encourage feedback from students about what works and what does not work.

3.  The coronavirus pandemic has brought on some politically charged public conversation surrounding the value of life and trade-offs in terms of economic impact. What are your impressions of this discussion?

There are so many trade-offs or risk assessments that we have confronted during this pandemic, including the value of life vs. economic impact, individual vs. societal rights, individual vs. societal obligations, and those raised by just allocation of resources. We have encountered such trade-offs in our work life (e.g., live vs. remote classes), our personal and family lives (e.g., physical visits with family vs. Zoom visits), and our social networks (e.g., opened vs. closed businesses).

Regarding the value of life vs. economic impact, we have all been asked in some way to restrict life choices in order to save lives (e.g., by following state and local laws regarding social distancing, wearing masks, and running our businesses, etc.). This has resulted in economic impact to varying degrees. Alternatively, some have been able to redesign their economic lives in order to minimize negative impact on others (e.g., by delivering work products remotely), and some have been able to maintain their incomes. 

Such scenarios – involving how we work, shop for essentials, visit with each other, and take care of ourselves – highlight the trade-offs we all have in our day-to-day lives, but, during this pandemic, they have been focal points because of the emergence of a novel and evolving viral infection that leads to sudden death among certain segments of the population (e.g., the elderly, the minority, and those in work environments in which there is close human contact). And we have confronted the limits of medical resources and worried about things like dying alone and not being able to mourn our loved one’s passing in our expected ways. Some of these trade-offs (e.g., restricting my choices when I venture out into public) are unavoidable and some (e.g., allowing patients to die alone in hospitals) need to be addressed more critically.

In addition to thinking about how we as humans deal with trade-offs, the epidemic has been an opportunity to thing about how we manage uncertainty in decision-making. The pandemic has confronted us with the challenge of making decisions quickly and in a fluid way about something that we do not fully understand in order to prevent against otherwise preventable deaths. How we manage uncertainty in clinical decision-making as patients and health care providers is the focus of my upcoming book.

4. What can you tell us about that and other book projects you have in the works? What inspires you to take on a topic in book form?

My current projects include two sole-authored books, Managing Uncertainty in Clinical Decision-Making: The Case of COVID-19 and Practical Ethics: Readings and Reflections.

I work on book-length projects because I am interested in providing a perspective on a subject matter that provides its background, its current terrain, and suggestions about how to think about it. This work requires more pages than what an article typically allows.

I’ll share a bit about the first book because it relates to COVID-19. Managing Uncertainty in Clinical Decision-Making: The Case of COVID-19 focuses on how we manage uncertainty in the diagnosis, prognosis and treatment of COVID-19, and addresses the ethical duty we have to recognize such uncertainty.

Uncertainty pervades clinical decision-making in a number of ways. It affects how we understand and treat clinical problems such as COVID-19. Clinical problems, such as COVID-19, are uncertain because knowledge and treatment of them are always limited. They are limited by their nature as changing and evolving natural phenomena and the empirical methods that are used to know them. Clinical problems are uncertain because they are expressed differently in patients and therefore respond differently to treatment.

As a consequence, it is important for clinicians and patients to recognize clinical uncertainty, think through how to manage it, and acknowledge the ethical implications of addressing uncertainty in clinical decision-making in order to respect those in the health care setting, maximize patent welfare, and allocate health care resources equitably. 

More specifically, and when possible:

• Reduce the timeline when making decisions (in part because evidence is more relevant in the short run);
• Take one risk or a set of risks at a time and avoid unnecessary or irrelevant risks;
• Think through how to manage clinical uncertainty through “multiple means” of evidence and “multiple ways” of framing it;
• Invest in keeping options open and be flexible or fluid in decision-making (in light of the evolving nature of clinical evidence and how we come to know);
• Keep one’s personal and collective goals and values at the forefront and tend to them (and do not compromise central moral principles);
• Do the best one can, accept the decisions one has made, and minimize speculative guessing about decisions made in the past (thereby, engaging in compassion for the self and others); and
• Practice making decisions under uncertainty (through, for instance, finding a mentor to run through options, paying attention to how one cognitively and emotionally processes it). 

5.  Among your many awards is the title of President’s Teaching Scholar, a systemwide designation you received in 2018. What has it meant to have that title?

The short response to this question is that being recognized as a President’s Teaching Scholar in the University of Colorado system has been the honor of my career. 

The President’s Teaching Scholar Program (PTSP) recognizes faculty “who exemplify a zeal for teaching and learning, a passion for their discipline, high regard for their students, an altruistic attitude toward students and colleagues, full respect for diversity in teaching styles and learning communities, an interest in assessing the effects of classroom teaching, and a desire to promote civil discourse both inside and outside the classroom.”

Teaching has been the central focus of my life as a philosopher-ethicist. In every aspect of my courses in biomedical ethics, death and dying, and practical ethics, I take my role as moderator of discussion and mediator of dispute seriously and sensitively as students navigate controversial — and sometimes quite personal — topics in ethics in the context of health care, science, law, public policy, and the workplace.

My overriding responsibility to my students is to create an environment that students deem educational, engaging, practical, inclusive, fair, respectful, and open to revision. I take the opportunity to work with others in an educational role in the areas of biomedical ethics, and death and dying, seriously, enthusiastically, and with great care.