What is your counsel?
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: Collectively, what should we be doing?
Ezekiel Emanuel: Domestically we have to address four problems, and we have to address them relatively soon.
We have to address the global warming/energy problem. As I said, I do think we have the technologies. I do think we need to put in the infrastructure incentives just to let our best inventors and our manufacturing go wild.
Second, we need to reform the tax system to make it more fair, and to bring down income inequality. And I do think that’s going to be very important for funding initiative.
Third, we need to change our healthcare system to get a sustainable healthcare system that does guarantee everyone high quality care, and keeps the cost constrained.
And the last is we need to invest in education. I think those are our four big domestic issues. And I think they’re all within our grasp, and I think we need to do it for posterity.
Question: What should we be doing globally?
Ezekiel Emanuel: As far as the world goes, I think the global warming environment/energy complex of problems needs to be addressed, and I think we can address it. I think we do need to figure out how to bring development to other parts of the world. It’s clear that China and India are developing. They are addressing their poverty problem. They still have many poor people, but they have engines of development and engines of innovation that are going to solve their problems.
When I traveled to Africa and to parts of Latin America, that is simply not on the mark. They have political, and domestic, and cultural problems which they themselves need to address; but they also need help in addressing long term, sustainable development issues.
We’ve been very bad about that. All the investments at the World Bank have been not great. All of American foreign aid tends to be more for our farmers than for them. We need to integrate them into the world economy. And I think we need to pick out some countries and sort of really show them that it can work, and work hand-in-hand with them about political reform and corruption reform.
Clearly, Africa has huge problems. I actually – having traveled there many, many times – think that colonialism clearly has a part. But the fact is the “Big Man Syndrome” isn’t a result of colonialism, the corruption, the suppression of women is not; those are not problems of colonialism. Those are endemic, cultural problems of people, and they need to begin to overcome that.
And there are some places which are very helpful. Mali, which is an incredibly poor country – its average per capita income there is under $200 a year – has had a stable transfer of power and government. And you know, that’s a very hopeful sign. Now we have to give them a stable economy and figure out how they can actually develop, and work with them on that. And I think there are other places which can be big successes, but it’s going to take patience; it’s going to take investment. It takes a long term strategy. That’s not something the United States is very good at. I mean the long term, we are awful at the long-term.
Question: What should we be doing as individuals?
Ezekiel Emanuel: I do not proscribe to everyone. I can easily tell you what I think.
But I do think we all need to be very conscious about our energy consumption. Our family has gone carbon-neutral. It’s _______ very easy to go on the web and become carbon-neutral.
We bought a Prius. We’re going to buy our second Prius as cars.
So I think people – especially the upper middle class who can afford it – needs to be much more conscious of its energy consumption.
I do think that collectively, we need to figure out what our contribution is to people. I mean this issue of taking without giving is something that I find very, very bothersome. I mean we live an incredibly good, charmed life. We need to stop being so self-indulgent about it.
I would say five years ago, I was doing some work in Uganda, and I took my kids to Uganda. The family went to Uganda for three weeks. Nothing cures your kids like consumption. And the conspicuous consumption of having the latest “this,” the latest fashion of “that” is going to Africa to see how other people live. And then being a shopper at second-hand clothing stores is grilled into you. Wanting to do good for people around the world is something that is very, very powerfully motivating to youth.
I certainly think that something that I see a lot of kids in this generation of college students being very interested globally and wanting to get involved that way. I think it’s going to be much, much more positively influenced, and much more widely available to kids.
Recorded: July 5, 2007
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