Jacob Appel
Bioethicist and Writer

Keeping Politics out of the Hospital

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How bioethicists can steer clear of political tensions on the job, and why past friction between bioethicists and doctors is quickly disappearing.

Jacob Appel

Jacob M. Appel is a bioethicist and fiction writer. He holds a B.A. and an M.A. from Brown University, an M.A. and an M.Phil. from Columbia University, an M.D. from Columbia University's College of Physicians and Surgeons, an M.F.A. in creative writing from New York University, and a J.D. from Harvard Law School. He has most recently taught at Brown University in Providence, Rhode Island, and at the Gotham Writers Workshop in New York City. He publishes in the field of bioethics and contributes to such publications as the Journal of Clinical Ethics, the Journal of Law, Medicine & Ethics, and the Bulletin of the History of Medicine. His essays have appeared in The New York Times, The New York Daily News, The Chicago Tribune, and other publications.

Appel has also published short fiction in more than one hundred literary journals. His short story, Shell Game With Organs, won the Boston Review Short Fiction Contest in 1998. His story about two census takers, "Counting," was shortlisted for the O. Henry Award in 2001. Other stories received "special mention" for the Pushcart Prize in 2006 and 2007.

He is admitted to the practice of law in New York State and Rhode Island, and is a licensed New York City sightseeing guide.

Appel contributed a Dangerous Idea to Big Think's "Month of Thinking Dangerously," advocating that we add trace amounts of lithium to our drinking water to help reduce the suicide rate.

Appel is a Big Think Delphi Fellow.


Question: Should bioethicists take stances on issues of politics and social justice?

Jacob Appel: I do think they should, and I do.  But I think that it is important to distinguish the different hats that a bioethicist wears.  When I'm in a classroom at Brown or NYU or Columbia, I make a point of not telling the students how I feel about topical, or hot-button issues.  They can certainly go online or find a journal with my viewpoints, but few of them do and you really want to be an arbiter.  You want to be an impartial judge letting them come to their own conclusions. 

In the same way, in the hospital.  You want to let families reach their own conclusions and you want to show them viewpoints you don't agree with as well as the ones you do.  In contrast, as a public intellectual, or a public figure engaged in the discourse, you should be advocating for a particular position.  What I like to tell the students at Brown, and this derives, it's not my idea, it's something Vartan Gregorian, the former President of Brown said in a, I believe, the commencement address about 10 years ago.  He said, the problem with modern universities, paraphrasing, "On the problem with modern universities is that they breakdown all of the student's preconceived notions, but don't give them any new ideas, and they leave the university believing that all ideas have equal value and hence, in some sense, believing in nothing.”  I think it is important to have all **** ideas broken down, to be able to see that people who disagree with you aren't idiots, they simply start with different premises and have different value sets and come to logical conclusions based on them.  But once you do that it's also important to operate in the world with a deeply held set of beliefs that you can fight for and that you are not mutually exclusive.

Question: Is there ongoing friction between bioethicists and doctors who see them as meddlesome?

Jacob Appel: I think historically, there was much more friction then there is today.  Historically, physicians lived in a fairly **** of the world and the bioethicists were often clergymen, or philosophers who came in with moral judgments that were often detached from the field of medicine.  As the brilliant ethics thinker and clinician, Ken Frager at Columbia University says, "All good ethical decisions should stem from the facts of the case.” As we have more physicians who become bioethicists and as the bioethics field now increasingly is a field populated by physician/clinicians who happen to practice ethics, that conflict is largely evaporating.  We're all on the same page, I think.

Recorded on March 1, 2010
Interviewed by Austin Allen