Ezekiel Emanuel is the Chair of the Department of Bioethics at the Warren G. Magnuson Clinical Center at the National Institutes of Health. Dr. Emanuel is a well-known authority on the ethics of clinical research, end of life care issues, euthanasia and the ethics of managed care.
He has published in the New England Journal of Medicine, The Lancent, JAMA, and many other medical journals. His book The Ends of Human Life: Medical Ethics in a Liberal Polity received an honorable mention for the Rosenhaupt Memorial Book Award by the Woodrow Wilson Foundation. Dr. Emanuel was educated at Amherst College, Oxford University and Harvard University, from which he holds both an MD and PhD in political philosophy. He also served on the ethics section of President Clinton's Health Care Task Force, on the National Bioethics Advisory Committee, and on the bioethics panel of the Pan American Health Organization.
Question: When you read the newspaper or watch the news, what issues stand out to you?
Ezekiel Emanuel: Well first of all, I don’t look at the news. I don’t own a TV, and I haven’t had a TV for more than 30 years now. I think that’s actually one of the dreadful things science has given us is television. And I say this as where my relative makes all his money. My brother makes all his money on TV.
Look. You can’t be conscious and not worry about global warming, and about what we’re doing to our planet, and about the use of resources. You also have to be really horrified about our inability in this country to tackle that problem. There is a classic case of where we have the technology to solve the problem. We have the insight as to how to marshal that. If we let researchers go wild and support that, we would have a lot more technology. And yet we have not created the infrastructure, or the steady stream of funding, or the political will to actually do that. And that has to sour you on the notion of democracy. That fact that we can’t seem to address a very critical problem; again, the issue isn’t so much, “Is this going to pay off?” It’s going to pay off hugely. The issue isn’t, “Do we have the technology?” We already have the technology to do this.
The problem is we can’t seem to organize it. And that, for me, is a recurring theme in lots of problems. I mentioned it in relationship to the healthcare system. And I think that is something which really does bother me about the United States; that we can see the problems, we can have the ability to solve the problems; and we can’t seem to marshal the forces – social and political forces – to get it right.
Question: What is the world’s biggest challenge in the coming decade?
Ezekiel Emanuel: Energy use and global warming is one. Wars and the breakdown of political order is another. I mean when you look around this world at the number of “failed states” – Somalia, Haiti, Congo -- you really have to be scared about what that breeds.
Pakistan may turn out to be one of those states. Iraq may turn out to be one of those states. I think we all have to be very worried about that.
We have to be religious fundamentalism; there you really have, I think, something which is; worry about the culture of death. The notion that you go out and kill people and that’s a good thing. Either because you are so alienated from society and you see no future; or because the culture has created the idea that somehow killing people is a way to purity and to being saved.
We had a period; the war or religions was like that. The Catholics and the Protestants in Europe were killing each other to no end. _______ disappear.
Unfortunately, we now have that. And we’re not dealing with bows and arrows, but we’re dealing with much more sophisticated weaponry – maybe even weapons of mass destruction. That’s seemingly worrisome to me. I would not be surprised if we ended up with a nuclear explosion, and hundreds of thousands – if not millions – of people – dead. Maybe we would then step – take a step back. But I actually think that’s a real possibility.
Question: What are the challenges confronting the U.S.?
Ezekiel Emanuel: Well we’re in for a perfect storm. Medicare bankrupting the federal government because we have an increasing number of retirees. And not only an increasing number of retirees, but they’re also living longer. I think the average lifespan now, if you get to 65, is 17 and plus more years. That’s going to be a huge cost on a shrinking number of people who are going to be able to fund that; who are in the working population. So the increase of costs of Medicare, which is going to dwarf the Social Security problem. An increasing number of retirees, and tremendous problems with how to fund that.
Secondly, I worry tremendously about the primary and secondary school educational system. I don’t think we’re investing enough. And one of the reasons we’re not investing enough because so much money is going to Medicare and Medicaid that we have not been spending enough on primary and secondary education.
Educated populous is critical for economic growth. It’s also critical for a functioning democracy. And I think we need a lot more focus on education in this country. Not only primary and secondary school, but even before nursery school and probably early childhood development. That would be a major place of investment in my opinion.
Question: What should be the big issues of the 2008 US presidential election?
Ezekiel Emanuel: Look. What I think is irrelevant. They are going to be Iraq. They are going to probably be a tax situation because we’re facing a problem in 2010 – a major tax issue.
Healthcare is going to be up there, and probably global warming. Those are probably, in my view, going to be the big four issues. Whatever I have to say about it is irrelevant.
Recorded: July 5, 2007