Israeli-Canadian bioethicist: Return to pre-COVID normal would be wasted chance

With myriad ethical issues prompted by the pandemic, Vardit Ravitsky has emerged as a prominent voice of morality and change in Canada’s public health debate

By ROBERT SARNER, The Times of Israel, July 16, 2021

TORONTO — As the world yearns for at least some semblance of a post-pandemic normalcy, Israeli-Canadian bioethicist and public health advisor Vardit Ravitsky shudders at the prospect of business as usual. She insists it will be a shame if leaders fail to act on the inequities, structural injustice and systemic discrimination laid bare by COVID-19.

“Everybody wants to get back to normal,” Ravitsky tells The Times of Israel during a recent Zoom interview from her home in Ottawa. “As we get vaccinated and gradually drop the masks, there’s a risk we return to normal and forget this ever happened. I don’t want to go back to normal because, in many ways, normal wasn’t good. I want to build something better. If we revert to normal, we’ll miss a chance to come to terms with who we really are.”

Professionally, the Jerusalem-born, Israel-raised Ravitsky wears many hats. Underpinning all her work is a deep social conscience.

As Chair of the COVID-19 Impact Committee of the Montreal-based Pierre Elliott Trudeau Foundation, Ravitsky heads a group of 12 leading Canadian scholars in various disciplines who have publicly called on decision-makers to leverage what they term “an unprecedented opportunity to reshape our social contract to ensure the protection of the most vulnerable among us.”

Ravitsky, 54, is an internationally respected authority in bioethics, a field most people would be hard-pressed to define. Increasingly prominent in recent decades, bioethics is the multi-disciplinary study of and response to moral issues of medicine and life-sciences relating to human life and health, biology and the environment.

Ravitsky’s credentials, awards, research papers and other achievements are formidable in number and stature, spanning several countries. A professor in the Bioethics Program at the University of Montreal’s School of Public Health and a senior lecturer on global health and social medicine at the Harvard Medical School, she’s also president of the International Association of Bioethics, and director of ethics and health at the Center for Research on Ethics. All that and more, in addition to her role at the Trudeau Foundation, occasional work in Israel, and being the mother of four children.

 

Throughout the pandemic, Canadian media has frequently turned to Ravitsky to comment on related ethical challenges. From questions of who should get a ventilator when there’s not enough, to whether universities should make vaccines mandatory for students, to the issuing of immunity passports, Ravitsky has addressed numerous dilemmas wrought by COVID-19 — and what she considers its silver lining.

“We need to learn from everything we’ve experienced in the pandemic so we can rebuild society on better foundations and in terms of policy,” says Ravitsky, who, together with her native Hebrew, speaks fluent English and French. “Marginalized communities, disadvantaged, vulnerable groups have suffered the most. Every aspect of the pandemic has hit these groups harder in terms of infection rates and economic and social impact.”

She’s fast to cite examples.

“We saw it in the elderly care institutions and prisons. We saw it with the people who had to lock down in smaller, confined spaces, and suffered the rise in domestic violence. We saw it in people with mental illness, and those who couldn’t access the justice system when it collapsed. We saw it in Indigenous communities which had been screaming for years about not having running water and limited health care, and then due to the pandemic, surprise, surprise, they were in an even much worse situation,” she says.

A wakeup call to action

For Ravitsky, the pandemic is a much-needed, long-overdue wake-up call.

“It was too easy to ignore these issues before COVID, especially in Canada which sees itself as a just and equitable society with respect for human rights,” says Ravitsy. “And while, relatively speaking, Canada is a great country, the pandemic shined a light on and amplified what’s not so great. We have an opportunity to rectify things, which is a political matter. Now is a chance to put pressure on decision-makers to fix gaps, to build things differently. So we’re doing what we can to inform this debate.”

To that end, Ravitsky’s committee issued a four-page manifesto in April, titled “A Commitment to Action.”

“The way forward should include more than marginal and superficial changes that rebuild on old foundations,” it declared. “We should make room for new structures, rooted in Canadian values, and based on notions of solidarity, equity, fairness, human rights, compassion, humanity, belonging and well-being.”

Earlier, committee members did an op-ed series to inform the public about their work and will soon release a podcast series as part of their “knowledge translation” about the complex issues involved. Next year, the committee will organize policy workshops involving policymakers on how to implement their ideas about justice and equity.

Ravitsky is mindful of what’s involved in effecting change in society but remains hopeful her work will help lead to results.

 

“I’m semi-optimistic because I think in some areas, we’ll see change,” says Ravitsky. “In others, you can’t tackle everything all at once. In eldercare, we’ll see change because there’s a clear recognition that things can’t continue the way they are. In Indigenous communities, we’ve been seeing change slowly happening but now finally there’s more acknowledgment that Canada is suffering from racism. In the justice system, I think there’ll be a change. In some areas, we’ll reap the benefits of what the pandemic has taught us while in others it’ll be just too difficult.”

School of life

Ravitsky has covered a lot of ground since spending two-and-a-half years in the Israel Defense Forces, rising to the rank of lieutenant. She moved to Paris to study French and French literature for a year. Hoping to become a film director, she enrolled at Tel Aviv University, studying film and philosophy for a year. She returned to Paris, graduating with a BA in philosophy from the Sorbonne while becoming interested in bioethics.

Back in Israel, she began a master’s degree in philosophy at Hebrew University. A year later, she moved to the United States for family reasons and completed her MA in bioethics at the University of New Mexico. After three years, Israel beckoned, as Bar Ilan University offered her a scholarship to do her PhD while she also taught bioethics there.

 

In 2003, Ravitsky left Israel to do a postdoc at the National Institutes of Health in Washington, DC, one of the world’s leading medical research centers. She then was named to her first academic position, in one of the best bioethics programs in the US, at the University of Pennsylvania. While there, she also began working as a senior policy advisor on ethics for Canada’s federal agency for health research, eventually moving to Ottawa.

For all her peripatetic ways, Ravitsky remains strongly connected to Israel, where her parents and two eldest children live in Jerusalem. Her brother resides nearby in the settlement of Efrat.

“He and I love each other to death, but we’re not politically aligned,” says Ravitsky, who describes herself as always having been “extreme left” in her views.

Several times a year, she visits Israel, where her work has included helping the country’s Health Ministry draft legislation on end-of-life care for dying patients.

Her husband, who’s from Ireland, consults for Canadian cannabis companies on product development and regulatory affairs. He previously worked in science policy with the Canadian government.

In touch with her roots

Despite growing up in a Modern Orthodox family, Ravitsky has since adopted a largely secular lifestyle while retaining certain Jewish traditions at home.

In her professional life, she’s keenly aware of her Israeli upbringing.

“I feel the influence every day, especially the Israeli way of thinking, the let’s-get-it-done approach,” says Ravitsky. “Sometimes it means thinking outside the box, being solution-oriented rather than getting stuck on theoretical assumptions. Sometimes it’s about shortcuts. Academically, you’re supposed to be rigorous and methodologically aligned. Yes, but sometimes there’s a lot of adaptability and nimbleness and the Israeli way of dealing with things adds to the way I manage these situations.”

Earlier in her life, another important influence was her uncle, Aviezer Ravitzky, an Israel Prize laureate and one of the country’s most respected philosophers and thinkers.

Being from Israel also creates challenges for her.

“Some of my students and colleagues are Muslim and from Arab countries, including some who are on social media openly criticizing Israel,” says Ravitsky. “Especially when tensions rise between Israel and the Palestinians, such as the recent war with Hamas, it can be very difficult. Personally, I manage the situation well by maintaining positive, affectionate relationships with people at work but I never hide my Israeli identity.

“I’m a passionate Zionist, I love my country, it’s home and yet, like many Israelis, I’m extremely critical, on ethical grounds, of many aspects of Israeli politics and government decisions.”

Still, for all of Ravitsky’s criticism of Israel, seeing it vilified through distorted media coverage and in the court of public opinion is difficult for her.

“It’s heart-wrenching because being from Israel, you know nuances that not only aren’t communicated, but maybe cannot be communicated,” she says. “When things are taken out of context, when something is true, but it’s half the truth, without the context, it’s completely twisted. This inability to communicate to the world the complexity of the reality on the ground, which works against Israel, is disturbing.”

Born to lead

While many people now see Ravitsky as a public health ethicist, her greatest expertise is in the field of reproduction and genetics. Ironically, despite specializing in that area for 30 years, she’s gained far more prominence over the past 15 months through her high-profile involvement in public health issues linked to COVID-19.

In her extensive research, Ravitsky has explored subjects such as in-vitro fertilization, pre-implantation genetic testing, germline gene editing, the status of frozen embryos, posthumous reproduction, and public health approaches to infertility.

Over the past decade, one main area of study has been the socio-ethical aspects of non-invasive pre-natal testing (NIPT). She’s probed the views of pregnant Canadian women and their partners regarding pressure to test and terminate a pregnancy, the societal impact if NIPT were to become routine and the need to address disability rights when introducing new prenatal testing technology.

NIPT is highly relevant to Israel which, according to Ravitsky, is the number one per capita user in the world of prenatal genetic tests, contributing to the termination of many pregnancies. She attributes that to Israeli society being so invested in encouraging healthy babies.

 

“Israeli medical professionals are very directive and heavy-handed when it comes to managing pregnancies to ensure the outcome of a healthy baby in a way that’s insensitive to the whole area we call disability rights,” says Ravitsky.

“If, as a society, we target certain conditions [such as Down syndrome] during pregnancy, and we encourage women to terminate these pregnancies, we send a message to those living among us with these conditions that they shouldn’t even be here,” she says. “We’re sending a message to these families that their children were accidents, that they should’ve been caught and terminated before birth. There’s little sensitivity in Israel to this disability rights discourse that’s happening in other countries.”

Ravitsky views the attitude of Israeli doctors toward pregnant women as often being paternalistic.

“When it comes to the decision to continue or terminate a pregnancy, it should be each woman, each family deciding what’s right for them,” says Ravitsky. “I’m not anti-abortion and I’m not pro — but I’m pro-autonomy, respecting everybody in their individual decisions, which shouldn’t be based on the attitude of the healthcare system.”

Ravitsky seems to thrive on being heavily engaged in her work and caring about the issues she tackles. One look at her resume and it’s hard not to be impressed and wonder how she manages so much on her plate.

“I’m lucky to have been born with lots of energy,” says Ravitsky. “I need little sleep. I’m very hyper, to the point that some people have told me that when they worked with me, they got dizzy. I know I’m an intense person with crazy amounts of energy who needs a lot of stimulation to be happy.”