Ezekiel Emanuel on Bioethics
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: What is the study of bioethics?
Ezekiel Emanuel: Well it’s really looking at ethical issues related to biomedicine. So as I’ve said, issues like: how do you manage with scarce medical resources in the case of pandemic flu?
But it also applies to organs for transplant. What are the principles we use to allocate those scarce items? How do we think about prioritizing?
So it’s really thinking about the values that underlie decisions; how you weigh competing values. How do you justify them? That is, how do you give people reasons so that they ought to agree?
So one of the things which I like about it is it tends to be somewhat theoretical. You deal with abstract values, but it’s also practical. You have to know what’s going on in the world. You have to know what the real-life problems are. You have to know what are the practical solutions that you can actually implement.
Question: What are the important issues in bioethics today?
Ezekiel Emanuel: Bioethics, I would say, there are problems which need to be addressed, but I also think there’s a sort of manpower problem. We do not have a very good training program in this country [USA] for bioethics. We don’t support it actually, despite the fact that it occupies a lot of media attention. Despite the fact that everyone says how important it is. You always hear this phrase: “Our technology is outrunning our values and our bioethical understanding.” And yet we have a very poor way of actually supporting it over the long run so people can take time and address big problems, and think for a while on some of these problems.
As I mentioned, some of the issues that we address, we can be sure that it’s going to take us two years to think through some of this stuff. And we don’t have a mechanism to really support that.
And one of the consequences of that is we have not been good at training young people to come through, and to attract some of the smartest young people into the field. And I think that’s a huge issue. Obviously there are lots of particular issues that we need to address better. But I think if we had a lot more smart people in the field with a lot more sustained support, those issues could be well addressed.
Topic: A tough call.
Ezekiel Emanuel: I think one of the big struggles is trying to get complicated issues clear in my mind and then clearly expressed and communicated to other people. So let’s take this issue of how to allocate scarce resources like organs, or if we had a pandemic flu vaccine. What are the values at stake? Well one of the things I can tell you, a pretty definitive conclusion, is there’s not a single value that is going to determine how you allocate those things. Well one of the challenges is how do you then balance multiple values? And how do you articulate how you’re balancing them and why other people should see it the same way? That is a very challenging thing.
Recorded on: July 5, 2007.
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