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What do you do?
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: Beyond a simple title, how would you describe what you do for a living?
Ezekiel Emanuel: I spend a lot of time thinking, a lot of time writing, and a lot of time talking about important problems in biomedicine.
Early in my career, I spent a lot of time worrying about how to improve end-of-life care in this country.
I’ve spent the last 10 years trying to think about how to do research studies and experiments better with people, more ethically, more fairly.
And in the last probably five to seven years, I’ve spent a lot more attention on healthcare reform and trying to figure out how to reform healthcare systems, and how to improve it because I think it’s in a terrible state.
But mostly what I do is any problem related to medicine, or biomedicine, or science that has an ethical component, I get a chance to think about it.
And if something crosses my desk that’s interesting; one of the things that crossed my desk probably around 18 months ago was how we’re preparing for pandemic flu. And I thought that many of the rationales for the preparation were not very good. And so I decided well, let’s write a paper and think about it and see if we can propose something better. So that created a whole other project. But it was serendipity. It came out of the blue; but I thought it was a serious public problem but not being well-handled in terms of ethics.
Question: What is the study of bioethics?
Ezekiel Emanuel: Well it’s really looking at ethical issues; anything 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 is the joy in what you do?
Ezekiel Emanuel: The best thing that I do actually is train the next generation. We have about six new fellows a year. Some of them come right out of college. Some of them already have PhDs, or law degrees or medical degrees. And working with them – because they’re incredibly smart – is one of the great things that I do. That’s one of the pleasures.
Another pleasure is trying to influence public policy, and to sort of try to make a difference in how things are done in the world.
A third thing is, one of the great things about working for the National Institutes of Health is that we have interest and research all over the world; and we’ve been able to go and work in almost all continents – especially in Africa and Latin America and Asia – meeting new people, seeing how their healthcare systems work, seeing their challenges. Having them open up their houses, their hospitals, their clinics to us is a tremendous, tremendous privilege. And it really allows you to understand what’s common among people; and what’s also very culturally different; and I think also where certain practices that we still have might have come from hundreds – if not thousands – of years ago.
Question: What is the struggle in what you do?
Ezekiel Emanuel: The struggle? I think one of the big struggles is trying to get complicated both 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.
We’ve got a paper we’ve been working on for about six or eight months, trying to really work this out. And I can see that we’ll work it out tentatively, but it’s probably going to be several years of really working on this one problem to really get it. And even then I’m not 100% sure if we’ll get it as clear.
Similarly, I’ve been working for a number of years now on a better plan for universal healthcare reform in the United States. And again, trying to figure out all the parts and how to communicate it to people clearly, and how to address a number of the sort of not very fine details, but other details that really might bore people, but are going to make a huge difference to the success or failure of reform.
And then again to communicate that to people who might not be experts is another big challenge, which I love. I like to talk. I like to lecture. I like to try to make complicated things clear to people.
Question: How does the media affect bioethics?
Ezekiel Emanuel: Oh just hugely! I mean what is a problem? How they address problems; how they can sometimes do tremendous job educating people about the complexities of the problem; how sometimes they can do a terrible job because of the shortness; that they don’t allow the complexities and the subtleties to get through. In general actually, I think reporters have really been very interested in trying to understand the details.
I would say that the second problem with the media is the attention span problem. That’s a general problem in our culture. You got to say it in 250 words or less; but also once you’ve said it--How much coverage do we now have today in July 2007 on pandemic flu? The threat hasn’t gone away. If anything, the threat has gotten worse. And yet, you talk to a reporter, “Well we did that last year.” And that, I think, is a terrible problem. Because some of these problems require a long-term focus on an issue.
Healthcare reform is another really big issue, which you’re not going to solve it in a year. You’re not going to solve it in the next five years. It’s going to take a long time to focus on the problem; and yet the media doesn’t have that attention span.
Recorded: July 5, 2007
Emanuel weighs competing values.
- Modern antibiotics can effectively treat bubonic plague, which spreads mainly by fleas.
Bacteria under microscope
needpix.com<p>Today, bubonic plague can be treated effectively with antibiotics.</p><p style="margin-left: 20px;">"Unlike in the 14th century, we now have an understanding of how this disease is transmitted," Dr. Shanthi Kappagoda, an infectious disease physician at Stanford Health Care, told <a href="https://www.healthline.com/health-news/seriously-dont-worry-about-the-plague#Heres-how-the-plague-spreads" target="_blank">Healthline</a>. "We know how to prevent it — avoid handling sick or dead animals in areas where there is transmission. We are also able to treat patients who are infected with effective antibiotics, and can give antibiotics to people who may have been exposed to the bacteria [and] prevent them [from] getting sick."</p>
This plague patient is displaying a swollen, ruptured inguinal lymph node, or buboe.
Centers for Disease Control and Prevention<p>Still, hundreds of people develop bubonic plague every year. In the U.S., a handful of cases occur annually, particularly in New Mexico, Arizona and Colorado, <a href="https://www.cdc.gov/plague/faq/index.html" target="_blank">where habitats allow the bacteria to spread more easily among wild rodent populations</a>. But these cases are very rare, mainly because you need to be in close contact with rodents in order to get infected. And though plague can spread from human to human, this <a href="https://www.healthline.com/health-news/seriously-dont-worry-about-the-plague#Heres-how-the-plague-spreads" target="_blank">only occurs with pneumonic plague</a>, and transmission is also rare.</p>
A new swine flu in China<p>Last week, researchers in China also reported another public health concern: a new virus that has "all the essential hallmarks" of a pandemic virus.<br></p><p>In a paper published in the <a href="https://www.pnas.org/content/early/2020/06/23/1921186117" target="_blank">Proceedings of the National Academy of Sciences</a>, researchers say the virus was discovered in pigs in China, and it descended from the H1N1 virus, commonly called "swine flu." That virus was able to transmit from human to human, and it killed an estimated 151,700 to 575,400 people worldwide from 2009 to 2010, according to the Centers for Disease Control and Prevention.</p>There's no evidence showing that the new virus can spread from person to person. But the researchers did find that 10 percent of swine workers had been infected by the virus, called G4 reassortant EA H1N1. This level of infectivity raises concerns, because it "greatly enhances the opportunity for virus adaptation in humans and raises concerns for the possible generation of pandemic viruses," the researchers wrote.
The word "learning" opens up space for more people, places, and ideas.
The coronavirus pandemic has brought out the perception of selfishness among many.
- Selfish behavior has been analyzed by philosophers and psychologists for centuries.
- New research shows people may be wired for altruistic behavior and get more benefits from it.
- Times of crisis tend to increase self-centered acts.