Ethical Issues we have Faced over the Pandemic and Lessons Learned

May 18, 2022

Information

May 11, 2022

Mildred Z. Solomon, EdD
President, The Hastings Center
Professor of Global Health and Social Medicine, Harvard Medical School

ID7852

To CiteDCA Citation Guide

00:00OK, welcome to the evening Ethics
00:03seminar series for the program
00:05for Biomedical Ethics at Yale.
00:07My name is Mark Mercurio.
00:09I'm direct for the program and
00:10I'm delighted you're here and I'm
00:12delighted to to introduce our guest
00:14speaker in just a moment to let
00:16you know how this is going to work.
00:19As always, Doctor Solomon will speak
00:21for about 45 minutes, give or take some,
00:24and then we'll have plenty of time
00:26for question and answer, comment.
00:27And I'm going to ask you to put your
00:30questions and comments through the Q&amp;A.
00:32A function on zoom and I'll be monitoring.
00:34I'll read those to Millie and
00:36we'll have a terrific discussion.
00:37We'll have a hard stop.
00:38As always at 6:30,
00:40so please forgive me if there was
00:42something you were hoping to say and
00:44I didn't get to you or hoping to ask.
00:47Does the CME information.
00:48Karen will be putting through the
00:51chat portion of the zoom as well.
00:53So welcome and I think we'll
00:54go ahead and get started.
00:55Let me introduce please our guest tonight.
00:57I'm so pleased that that my friend
01:00Millie has been here before she is.
01:02A longstanding friend of our program and
01:05a major figure in the world of bioethics.
01:09And I'll let me tell you a little
01:11bit about our Mildred Solomon.
01:12Education Doctor is the president
01:14of the Hastings Center,
01:15the nation's founding Bioethics
01:17Research Institute, and I would say,
01:20probably the leading bioethics
01:21think tank in the country.
01:22She's also a professor of global health and
01:24social medicine at Harvard Medical School,
01:27where she directs the school's
01:29Fellowship in Bioethics.
01:30Dr Salman's research is focused on
01:32the ethics of end of life care,
01:34organ transplantations,
01:35medical professionalism,
01:36responsible conduct of research, and.
01:39Evidence based medicine.
01:40She served on numerous committees,
01:42including the National Academy of Sciences,
01:44Engineering and Medicine,
01:45the World Economic Forums,
01:47Global Futures Council on Technology,
01:49the US Secretary of Health and Human Services
01:52Advisory Committee on Oregon Transplantation,
01:55and several others.
01:56She's frequently cited in the mainstream.
01:58Media included the Wall Street Journal,
02:00NPR, and the New York Review of Books,
02:03The Daily Beast forms,
02:04Science News, the scientist,
02:06and others.
02:06She's a frequent public speaker
02:08at many places.
02:09Most notably at the Yale University School
02:12of Medicine program for Biomedical Ethics,
02:15she holds a BA from Smith College and
02:17a doctorate in educational research
02:19methods from Harvard University.
02:21We are absolutely delighted
02:22that you're with us tonight.
02:23Doctor Solomon to speak to us about
02:26some ethical issues during the
02:28pandemic and the lessons learned.
02:30I'm going to turn her over to
02:32NYU doctor Millie Salman.
02:34A warm welcome.
02:36Thank you so much Mark.
02:37It is it's really a pleasure to be here
02:39and I love all the opportunities that we
02:42take to have collaborations between the
02:44Yale program and the Hastings Center.
02:46So it's really a treat.
02:48Mark asked me to reflect on the lessons
02:50to be learned from the pandemic,
02:52and I'm going to offer some
02:53reflections and then I look forward
02:55to a robust discussion with many
02:57of you later in the session.
02:59I also want to acknowledge
03:01and thank Danny Passia,
03:03who is a program manager and a research
03:05assistant at the Hastings Center.
03:06You aren't seeing her,
03:07but she's fundamental.
03:09She's going to be advancing my
03:10slides and she and I'll probably
03:12be talking in front of everyone.
03:14So thank you, Danny for your help.
03:17I want to start first with
03:20the positive side of things.
03:22Science really came through.
03:24With safe and effective vaccines and
03:28now some promising therapeutics.
03:30This took massive investment on
03:32the part of government with strong
03:35private Public Partnerships which were
03:37essential for the vaccine development.
03:40For its part,
03:41government was willing to provide
03:43payment guarantees to industry so that
03:45if their attempts did not pan out,
03:46they would still be assured of payment.
03:49And for the most part, there was two.
03:51There was good international
03:54cooperation among scientists.
03:55We now have M RNA technologies
03:58that promise to be useful for
04:00a very wide range of viruses,
04:03and we have new antiviral treatments
04:05packs loaded in particular,
04:06and an increasing number of
04:09diagnostic tests so well done science.
04:12And yet more than two years in,
04:15we still face enormous challenges.
04:18More than 20% of Americans
04:20have not been vaccinated.
04:22Almost half of all US adults
04:24who did receive the first two
04:27vaccinations have not gotten boosters,
04:29so their facilitating viral mutation.
04:33And while so far the mutation seemed
04:35to be increasing transmissibility,
04:37but not affecting severity of illness that
04:40might simply be the luck of the draw.
04:43Viruses can just as easily mutate
04:45in ways that exacerbate their
04:48lethality as diminish it,
04:50and so long as large numbers
04:53of people remain unvaccinated,
04:54we are creating the conditions
04:56for the virus to evolve.
04:58This threatens everyone of the
05:01unvaccinated and vaccinated since
05:02many of those who are vaccinated
05:05may still become infected,
05:06and they will be especially at risk if
05:09the mutations enable vaccine escape.
05:11And of course a large number of people.
05:14Millions of people who are immune
05:17compromised or remain at risk.
05:19So vaccine refusal is a huge and
05:23lingering problem and one that I'm
05:26going to return to later in the talk.
05:29We also have not addressed the
05:33tension between national sovereignty
05:35on the one hand and international
05:38obligations on the other.
05:39While the wealthy countries have been
05:41the direct beneficiaries of science,
05:43we have done precious little to help
05:45low and middle income countries.
05:47Only 6% of people on the African
05:51continent have been vaccinated.
05:54Of course, that's a moral problem.
05:56It's also something all of us in
05:58the developed world
05:59should be concerned about,
06:00just on the basis of self interest.
06:03Viral mutation is a direct result of the size
06:06of the population able to host the virus.
06:09The more hosts, the more mutations,
06:11because each and every transmission
06:13opportunity is an opportunity
06:15for the virus to evolve.
06:17And this requires not just more
06:20generous sharing of our vaccines,
06:22which we must do,
06:25but much more fundamental action.
06:28We need to share intellectual property
06:31and help those countries build
06:34their own manufacturing capacities.
06:36Over the first part of the pandemic,
06:38North America,
06:39Europe and India successfully
06:41ramped up their manufacturing
06:43manufacturing capabilities,
06:45but we have to help.
06:47In Africa and in South and Central America,
06:50so that they too have their
06:53own capacity for manufacturing.
06:56They they also need help building
06:59basic healthcare infrastructure.
07:01And in many places where it doesn't exist,
07:03and again,
07:04that's a role that we can play that
07:06would be extremely facilitative.
07:10Of course, our unwillingness to
07:12see the plight of others is not
07:16only an unwillingness to care for
07:19the other across national borders.
07:22But it's a huge and troubling
07:24reality within our own country.
07:26The pandemic had a vastly
07:28disproportionate impact on communities
07:30of color and indigenous tribes.
07:33It laid bare, thus systemic
07:35racism and health inequities that
07:37we've known about for decades.
07:40Hopefully these realities will
07:41create an authentic call for action.
07:44How authentic. We don't know yet.
07:46Hopefully the response will be
07:48authentic and not long lasting,
07:51but that remains to be seen.
07:54For the most part,
07:55these kind of failures that
07:57I've been listing.
07:58The mainly the failure to
08:00see the suffering of others.
08:02The failure to accept vaccines and non
08:06pharmaceutical interventions like masks,
08:09our failures to act in
08:11mutually supportive ways,
08:13their failures to recognize
08:15our interdependence.
08:17And they're also failures
08:18to resist our need for.
08:20Let's call it immediate gratification.
08:24I'm going to say a little bit
08:25about what I mean by that.
08:26In a second,
08:27these problems haven't risen from
08:29lack of knowledge or imagination,
08:33nor even primarily from lack
08:35of financial resources.
08:36They're driven by distrust
08:39and self interest rather than
08:42reciprocity and mutual support.
08:44The result.
08:47Has been the erosion of social
08:49cohesion and trust in one another.
08:52In government,
08:53in science and in expertise of all kinds.
08:58So I guess to summarize that,
08:59that point is that these problems are
09:03not problems of inadequate knowledge.
09:07But of inadequate action shaped
09:11by problematic values.
09:13That's what I want to talk about.
09:15What values have we deprioritized?
09:19What values have we allowed to
09:21languish in our body politic?
09:23So let's take up a few examples.
09:25Danny that now we're going to
09:27get to the first slide.
09:29For years we have allowed our public
09:32health infrastructure to languish
09:34when COVID hit most States and
09:36counties had insufficient surveillance
09:38and contact tracing capabilities.
09:40I mean,
09:40I don't need to tell that to you.
09:42This audience is largely an audience
09:44of the of healthcare professionals
09:47who know better than anyone.
09:49We didn't have adequate equipment,
09:53not adequate support.
09:56Personal protective equipment
09:57and ventilators should have been
09:59stockpiled and even though they were,
10:00their viability wasn't checked,
10:02so all that should have happened.
10:04All those shortages.
10:05All that putting our healthcare
10:07professionals at risk was avoidable.
10:09We have known for years that
10:13pandemics were coming and really
10:15good guidance was already out there
10:18in the form of major reports by the
10:20National Academy of Medicine and
10:22key states like the New York State
10:24Task Force on Life and the law.
10:25There was good guidance.
10:27Out there on how to prepare
10:29the diseases were different,
10:30but most of this advice was
10:33similar and converged on the
10:35ethical requirement to prepare.
10:38Be prepared is a moral requirement
10:42prepared by stockpiling equipment
10:45anticipating manufacturing
10:46chokeholds using tools,
10:48especially federal tools available
10:50for bringing production to scale by
10:53developing guidelines for providing
10:56care under conditions of scarcity.
10:58And building and sustaining the public
11:01health infrastructure necessary for
11:03surveillance. We knew what to do.
11:06But we didn't do it.
11:09So I'm going to talk a little bit
11:11about why I mean obviously and Danny,
11:14I need the next slide for that.
11:15Obviously there's a time scale problem.
11:19To what I mean by that is to be effective.
11:23We have to spend money now and keep
11:26spending it to sustain readiness for an
11:29uncertain benefit sometime in the future.
11:32And that's what I meant about
11:34submitting to instant gratification
11:36rather than delaying gratification,
11:38we have to spend effort now.
11:41For a future benefit.
11:44Unknown beneficiaries and uncertainty.
11:47Doing the right thing would require
11:50an old fashioned value sacrifice and
11:53it would take extraordinary political
11:55leadership with integrity to ask the
11:58current electorate to sacrifice for
12:00uncertain benefits and unknown beneficiaries.
12:02Very often when faced with
12:04time scale problems like this,
12:06we humans do what we do.
12:08We procrastinate.
12:11Another reason is that we overvalue
12:14some things and undervalue others.
12:17Our society invests vastly more in
12:20cures and rescue medicine than it
12:22does in prevention and public health.
12:27Of the $3.6 trillion
12:28spent on health annually,
12:30only three percent is directed
12:33toward public health and prevention.
12:36You know, again, there are many reasons.
12:39One is that we are culture
12:42infatuated with technology.
12:43Another reason is that there are
12:46economic drivers behind rescue but
12:49not behind public health readiness.
12:52Cures capable of rescuing us from
12:54disease usually come at least in in this
12:57society in the form of medicines and
12:59devices that are quickly commercialized.
13:01There's no similar commercial
13:04incentive for public health readiness.
13:07But despite these constraints,
13:08I think there are things we can do,
13:10and most importantly,
13:12we can consciously strive to build a
13:15more intriguing cultural narrative that
13:18values prevention as much as rescue,
13:21and that would encourage investment
13:24and public health infrastructure.
13:26I'll give you an example of
13:27a time that I did that,
13:28and maybe it's a model for something
13:30people might adapt in terms of wanting
13:32to keep the importance of prevention
13:34prominent in people's minds and investment.
13:36In the future,
13:38as a young social scientist
13:39like it was early in my career,
13:42I was living in Boston and the
13:45Boston newspapers and TV airwaves
13:47were covering the story of a toddler
13:50who very badly needed a kidney.
13:52The media story was everywhere
13:54and it seemed like the whole city
13:56was holding its breath until
13:58the kidney could be found for.
13:59Let's call her Amanda.
14:01Then suddenly a kidney was
14:04available and again,
14:05the airwaves were alive.
14:07That excitement with many commentators
14:10beaming at this happy ending.
14:12But I was wondering who was it
14:14a happy ending for?
14:16It turns out that Amanda's new kidney
14:18came from another toddler whom we
14:20shall call Elizabeth whose parents
14:22had not secured her into a car seat.
14:24This was a time before public health had
14:27mounted its successful car seat laws,
14:29and amidst the celebrations for Amanda,
14:32no one mentioned that Elizabeth's death
14:35was most likely preventable if we had
14:38had such public health legislation in place.
14:41Unfortunately,
14:42messages of prevention just
14:43don't have the same appeal.
14:45They don't engender the same compassion
14:48as narratives focused on rescue.
14:50The need to use car seats is just
14:52not as exciting or exhilarating
14:54as the truly awesome story of
14:56what biomedical technologies like
14:58organ transplantation can do.
15:01I was concerned by the 11 levels of
15:03compassion toward these two toddlers,
15:05and I wrote an OP Ed,
15:06which appeared in the Boston
15:08go in the Boston Globe.
15:10One small drop of my effort to
15:12try to focus our attention on
15:15prevention as much as rescue.
15:20A second big area that points out
15:25values that we have not prioritized.
15:27Is the. Profound disregard for
15:31health inequities that that we
15:33see in so many different ways.
15:36One of the major.
15:38Issues the pandemic has raised
15:41for us is COVID-19 terribly
15:44unequal toll on African Americans,
15:46Native Americans,
15:47and the Latin X community
15:49and indigenous people.
15:50I said that Native Americans and Latin X.
15:55People of color live dramatically shorter
15:57and harder lives in the United States.
16:01The average life expectancy
16:02for a black man is 68 years old
16:04and for a white man it is 76.
16:06For black women it is just shy
16:08of 76 years for white women, 81.
16:13We've known for decades that black
16:15Americans face the burdens of chronic
16:17illness much earlier than whites and
16:20have significantly poorer health
16:21outcomes on a number of dimensions.
16:24But throughout the 20th century,
16:26we didn't really fully understand
16:28why there were many hypothesis.
16:33As important as poverty is,
16:34it's very important,
16:36but some thought that poverty
16:38alone accounted for the differences
16:41we now know that's not true.
16:43People also hypothesize that it was
16:46because African Americans distrusted the
16:48healthcare system and came in later for
16:50care were more reluctant to have surgery.
16:53They finally got care when their
16:55disease was more advanced,
16:56or maybe because they lacked insurance
16:59or were less able to have time
17:01off or didn't have transportation.
17:04These were all guesses.
17:05You could call them hypothesis, I suppose.
17:07That were prominent in the latter
17:09half of the 20th century.
17:11It's it's very noteworthy that most
17:14of these hypothesis had to do with
17:18healthcare professionals perceptions
17:20of patients of color and their lives.
17:23But almost nothing to do with the behavior
17:26of the healthcare professionals themselves.
17:30Then came a landmark report in
17:332002 by the Institute of Medicine,
17:35now the National Academy of Medicine.
17:38And I think the next slide shows
17:40it's cover unequal treatment.
17:42A very famous report.
17:43It's synthesized a whole new
17:46generation of research.
17:47This new research showed unequivocably
17:51an important causal factor.
17:53That few people would have
17:56expected or accepted without the
17:58sophisticated studies to back it up.
18:00And what was that causal factor?
18:02It was implicit physician bias,
18:05which results in significant
18:08under referral to specialist care.
18:11Unconscious physician bias.
18:14You unequal treatment documented
18:16hundreds of studies that controlled
18:18for all those things that people
18:21were guessing about earlier.
18:23The these studies were sophisticated because
18:25they controlled for lack of insurance.
18:28They controlled for differences in
18:30patients preferences and for many
18:32other factors that were thought
18:34to cause unequal outcomes.
18:35Some of those factors did show up
18:38as significant, but when you can,
18:40they played some role,
18:42but when you controlled for them,
18:43there was no no escaping that a
18:47significant additional factor was
18:49that physicians were referring fewer.
18:51Black patients for specialist
18:53care than white patients,
18:55and therefore African Americans,
18:57had less and later utilization
18:59of specialty care.
19:03Now unequal treatment had 100 page
19:06appendix which listed hundreds of studies
19:09that were all confirming this bias.
19:12I'm going to show just one of these studies,
19:15a little going to give you a
19:16little taste for one of them,
19:16to remind to remind us all of this
19:20important report and to give you a
19:22flavor of the the nature of the studies.
19:25So yes, thanks Danny,
19:26this is a study by Kevin Schulman,
19:29John Eisenberg and their college
19:31and colleagues from several
19:32academic medical centers.
19:34And also Rand was involved with
19:35it and it was published in the
19:36New England Journal of Medicine.
19:40Epidemiological studies have reported
19:42differences in the use of cardiovascular
19:44procedures like cardiac catheterization.
19:47They were reporting differences
19:48by race and by sex.
19:50But the reasons for these
19:53differences were unclear.
19:54Solman at all hypothesized that it might
19:57have to do with physician recommendations,
20:00and specifically whether physicians
20:02referred all their patients at the
20:06same rate for cardiac catheterization.
20:08So they constructed an online survey with
20:12standardized patients played by actors who,
20:15in video segments, described their symptoms.
20:18The physicians were given consistent
20:21information about the symptoms, background,
20:23health type and severity of coma comorbidity.
20:27All patients were described as having
20:30insurance and as having a family
20:33history of myocardial infarction.
20:35They made sure to dress the white and
20:37black patients in equivalent ways.
20:38Here.
20:39For example,
20:39in the next slide is what the
20:41black patients look like,
20:43and they had younger ones
20:45described as age 55.
20:47You can see them in the top row and
20:50older ones at age 75 in the bottom row.
20:54And here I have the white
20:56patients looked in the study.
20:58I think you'll agree they did a
21:00good job of creating socioeconomic
21:02and age related equivalents.
21:06And they asked.
21:11They presented these videos at A
21:12at a meeting of internal medicine.
21:15I believe it was and asked them.
21:17Given all this equivalent information,
21:19asking them who they would recommend
21:22for cardiac catheterization.
21:23The results were really striking.
21:26Both race and sex were highly
21:28significant predictors for rates of
21:30referral for cardiac catheterization.
21:32This was after controlling for all
21:34the other potential predictors,
21:35even controlling for physicians
21:37own assessment of the risk,
21:39they thought each patient presented.
21:42They also found an important
21:44interaction between race and sex
21:46with black women being referred
21:48much less than any other group.
21:50With the sophisticated ways in which they
21:52had controlled for other predictors,
21:53it was hard to say that anything other
21:56than physicians lack of referral
21:58could account for these differences.
22:02So this introduced the whole
22:04notion of physician. Bias. Now.
22:08Unequal treatment was focused
22:10primarily on unequal access to care and
22:14therefore unequal medical treatment.
22:16It uncovered this individual
22:19level unconscious bias.
22:21But these early 21st century studies
22:23and some late 20th century studies
22:26couldn't say much of anything.
22:28About the social determinants of health.
22:31The structural injustices that
22:34disadvantaged communities of color.
22:36Thanks to social epidemiologists like Nancy
22:40Krieger and sociologist like David Williams.
22:44Also, a legal historian,
22:46Richard Rothstein and a
22:48philosopher Elizabeth Anderson.
22:50We can now trace the connection between
22:53historical and political injustices
22:55that in turn create unequal social
22:58determinants of health and how those
23:02ultimately create inequitable health
23:04outcomes for African Americans.
23:07So the early studies were at an
23:10individual level of individual bias,
23:12and the later studies connect a history
23:17of discrimination to social inequities,
23:20which in turn are the reason
23:23for the health inequities.
23:25I'm going to give you just
23:26a couple of examples.
23:27Historical research shows that
23:29most African American soldiers
23:31returning from World War Two were
23:33blocked from access to the GI Bill.
23:35And they were therefore denied the
23:38same opportunities for education that
23:40white Americans got from that bill.
23:42Think about that.
23:42Think about the role that the GI Bill
23:45might have had in your own family.
23:47I know that in my family it
23:49was absolutely critical.
23:49My dad came back from World War Two.
23:53And he went to college and later to
23:56professional school on the GI Bill.
23:57His education that education paid
24:00for by a grateful country lifted my
24:03whole family into the middle class.
24:05And is responsible for a lot of the
24:07opportunities I've had in my own life,
24:09and even in the lives of my kids.
24:13Those benefits were mostly not
24:15available to black returning
24:17soldiers and their families.
24:19Also, the practice of 20th century redlining,
24:22which we've all heard about,
24:23has also denied black
24:24Americans access to mortgages,
24:26and that too has had a tremendous
24:28ripple effect across generations.
24:30It locked African Americans into
24:33residentially segregated neighborhoods
24:34with worse schools with which then
24:37links to poorer prospects for higher
24:40education and well paying jobs.
24:42Not to mention the toll that's
24:44taken by poor housing stock,
24:46lead contamination,
24:47food deserts,
24:48and a lack of safe green recreational spaces.
24:53We also know that the daily experience
24:56of discrimination that black Americans
24:58face leads to chronic inflammation,
25:00which in turn leads to the onset
25:03of chronic illness roughly 10
25:04years ahead of white Americans.
25:07We now could see that there are multiple
25:10interlocking causal explanations,
25:12including social,
25:14economic and environmental ones.
25:17My colleague Tia Powell,
25:18who heads the bioethics center at Montefiore,
25:21shared an example with me
25:23that makes this point.
25:24Modify your as you probably know,
25:26is located in the Bronx,
25:27the poorest most disadvantaged
25:29borough in New York City a
25:32Montefiore pediatric surgeon,
25:33noticed that her practice was getting
25:36far more children with broken bones,
25:38particularly among black boys,
25:41than one should expect.
25:43It would be possible to hypothesize
25:45many reasons right,
25:46including nutrition, genetics, neglect.
25:48But it was determined eventually that the
25:52main reason was lack of parks and spaces.
25:55To play, these kids were playing
25:57on the street and running into
25:59traffic after errant falls.
26:01As the story goes,
26:02the pediatric surgeon noticed this
26:04pattern in these young boys and did
26:07something more than surgery to address it.
26:10She worked with the community to
26:12create green recreational space.
26:16There are similar efforts
26:18unfolding today in Denver,
26:19where the community is planning on
26:21planting hundreds of trees in its
26:24most disadvantaged neighborhood.
26:25They're doing this as an environmental
26:27adaptation to global warming because it's
26:30been recognized that these segregated
26:31areas where historically there's been
26:33little to no public investment in trees
26:35or parks are experiencing harmful
26:38health effects as temperatures rise.
26:41So the question I'd like to pose to you,
26:43in which I hope we can discuss at the end,
26:46is how far do health care providers
26:49responsibilities actually go?
26:51I'll share my answer.
26:53It's that, at a minimum,
26:55health care providers should be
26:57studying disparities in their
26:59own patient populations and then
27:01designing interventions specifically
27:03targeted to redressing the observed
27:05problems in under referrals, care,
27:08delivery and follow-up services.
27:10But one can also go beyond care,
27:13delivery into community interventions.
27:15For you know.
27:18I've given you a couple examples.
27:19Another example would be that some
27:21health systems are working with lawyers
27:23and tenants rights organizations to
27:24make sure that landlords respond
27:26to environmental threats,
27:28undermining Children's Health.
27:29And some institutions have become so
27:32frustrated by repeat bouts of life
27:34threatening asthma that they are
27:36directly providing air conditioners
27:38themselves for the homes of their
27:41pediatric patients with asthma.
27:44So how far do you think healthcare
27:47professional responsibilities should go?
27:48What is reasonable to expect
27:51of healthcare organizations?
27:53What should become a core responsibility?
27:55Maybe even a professional obligation
27:58and what should be supererogatory
28:01but praiseworthy?
28:02So let's come back to that in
28:05the conversation.
28:05And now I want to enter kind
28:07of the third part of my talk.
28:09I've already talked about.
28:10You know our emphasis on rescue
28:12rather on cure rather than rescue.
28:15I've talked about a kind of
28:18blindness to inequity,
28:19and now the third thing I want to talk about.
28:23Is shown in this slide the way in
28:27which vaccine refusal shines a light.
28:30On what I want to call
28:32unfettered individualism.
28:38One of the fault lines exacerbating distrust
28:41and making it very hard to figure out how
28:43to live together has been the challenge
28:45of navigating an age old ethical tension,
28:48which is always seen in pandemics
28:50and is very common in public health.
28:53The tension between individual liberty
28:56on the one hand and the common good.
28:59There's a long tradition of laws,
29:01policies, and norms that have recognized
29:04that during times of existential threat.
29:07Like pandemics, the state needs and
29:10must have the authority to restrict some
29:13liberties demanding quarantine or isolation,
29:16or cordoning off a region
29:19by restricting travel.
29:20This goes back a really long way.
29:22I want to share a nice experience I had.
29:24I was in Dubrovnik,
29:26Croatia several summers ago and my host
29:29pointed with great pride to this building.
29:33The building with the red roof.
29:36He told me this was the first
29:39facility in Europe to quarantine
29:42international travelers to Dubrovnik,
29:44Dubrovnik.
29:44At that time was the New York City or
29:48the Hong Kong of its time a major hub
29:51of international trade and travel.
29:54This building was built for quarantine.
29:58In 1377,
30:00more than 600 years ago.
30:03He was proud of this because it
30:06demonstrated his nation's very early,
30:08though admittedly rudimentary
30:09understanding of science and of
30:12infectious disease transmission,
30:13and because it showed a state governing
30:15well by acting to protect its population.
30:20Today, there's a dangerous
30:22misunderstanding of liberty.
30:24People are waving.
30:25Don't tread on me flags both
30:27literally and figuratively,
30:29asserting that state requirements to
30:30wear a mask or to get vaccinated are
30:33serious restrictions on their liberty.
30:38Despite all these this pushback,
30:42it looked as though.
30:44Employer mandates might turn the
30:46tide and get us to a point where
30:50we had maximum vaccination rates.
30:52The Biden administration implemented an
30:55OSHA rule that all employers with 100
30:58employees or more must require either
31:01vaccination or that employees be tested
31:03frequently and have negative tests.
31:06Of course, some people complained,
31:08but in the end rather than lose their
31:11jobs or test so frequently that many
31:13people were beginning to get vaccinated,
31:15the the mandate worked and I became
31:18hopeful that the United States would reach
31:21a more appropriate level of vaccination.
31:24But now, just as it was showing promise,
31:27states began passing legislation and
31:30their governors drew up executive
31:32orders to make it illegal for school
31:34districts or county governments to
31:36require basic protections like masks.
31:38And some states attempted to stop
31:42employers from requiring vaccinations
31:44as a condition of work.
31:46Eventually, in January 2022,
31:47just a few months ago,
31:49the issue came before the US Supreme Court.
31:52Which allowed a state prohibition against
31:56the OSHA employer mandate to stay in place.
31:59That SCOTUS decision was the end of,
32:02in my view,
32:02of any chance to get very widespread
32:05levels of vaccination.
32:06The employer mandates were working.
32:09The states tried to limit them
32:10and the US Supreme Court allowed
32:12the prohibition to stand.
32:16Similarly, a US District Court in
32:17Florida has overturned a federal
32:19mass mandate on public transportation
32:21that's still being played out.
32:22I want to also mention because this is
32:25an audience of healthcare workers that
32:27healthcare worker mandates have stayed in
32:29place and have been reaffirmed repeatedly.
32:33I'm talking about general
32:36employment mandates,
32:37employer mandates in general.
32:41This recent Supreme Court decision on the
32:43federal mandate for employer requirements
32:46threatens the federal government's
32:48ability to protect the population,
32:49not just during this pandemic.
32:52But it could vastly limit the
32:54federal ability to manage all manner
32:56of future public health crises.
32:58Our society is failing to recognize that
33:00many of the biggest challenges we face,
33:03cross state lines and our
33:06federal emergencies that require
33:08coordinated federal assistance.
33:10And rules for the common good.
33:16These actions taken against vaccination
33:18and mask mandates are being justified
33:21on the basis of liberty claims.
33:23And in my view these are false claims.
33:25The ones that are based on a very
33:28thin understanding of liberty.
33:30For hundreds of years,
33:31political philosophies of all types
33:33have recognized that one's rights
33:36end where one's actions harm others.
33:38John Locke, who 17th century
33:40writings on liberty,
33:41were greatly influential on our
33:43nation's founders and are on
33:45our own Constitution emphasized
33:47that liberty is not synonymous
33:50with the license to harm others.
33:53This quote is a wonderful quote
33:56from his writings in 1690.
33:58Reason teaches all mankind,
34:00who will but consult it.
34:02That being all equal and independent,
34:05no one ought to harm another in his life,
34:07health, liberty or possessions.
34:11The lives of the immunocompromised,
34:13for whom the vaccines may be less protective,
34:15as well as the health of many people
34:18contracting long COVID are at stake.
34:20In fact,
34:20all of our health is at stake
34:22because so long as there are
34:24large populations on vaccinated,
34:26we may see more and more mutations,
34:28and some of them may prove
34:30more and more lethal.
34:32But the arguments about liberty are,
34:35I think,
34:36to wrongheaded because it's not only
34:38that our actions are harming others,
34:41and so you can't Trump.
34:42You can't use liberty as your
34:44excuse if you're harming others,
34:45but also it's important to
34:48ask what is liberty for?
34:51What does liberty for if it's not?
34:54To create the conditions in
34:56which people can flourish.
34:58And as new variants emerge like the
35:00next generation of Omicron's Omicron sub
35:02variants that we're seeing right now,
35:04there is growing likelihood of a return
35:07to restrictions on social interaction,
35:09travel, recreational activities,
35:10and in person education far
35:13from supporting liberty.
35:15Vaccine refusal is undermining everyone's
35:17ability to pursue their life goals,
35:20which of course is the reason we care so
35:22deeply about liberty in the first place.
35:25Now I don't mean to imply that
35:28public policy here is cut and dry.
35:31You know black or white.
35:32It's actually very nuanced.
35:34Not all public health measures are
35:36reasonable nor self evidently,
35:38right.
35:40For us to support limitations on free
35:43movement and constraints on liberty,
35:45the limitations and the constraints should
35:48be reasonable and proportionate and
35:50not unduly restrict individual rights.
35:53The keywords here are the qualifiers
35:57unduly reasonable, proportionate,
35:59like many criteria in ethics.
36:02They require careful consideration,
36:03and they're not self evident.
36:06People can legitimately disagree
36:07when a law or policy goes over the
36:11line to become unduly restrictive
36:13or unreasonable or disproportionate.
36:16But in order to be able to draw those
36:19lines to make any well considered judgments,
36:22we need to have enough trust in one
36:24another to have a meaningful conversation.
36:27In the end,
36:28government policies may not be
36:30acceptable to everyone.
36:31They rarely are universally accepted,
36:34but they should at least be informed
36:37by science.
36:37Discussed and trustworthy venues and
36:40include explanations and justifications
36:42that are transparent and well explained.
36:46And of course we shouldn't just
36:48do everything scientists tell
36:50us. Ultimately, questions like to
36:52lock down or not, or to mandate
36:55vaccines are political questions.
36:56They should be informed by science, but.
36:59They shouldn't be decided by scientists.
37:02They should be decided through civic
37:05participation and good governance.
37:07And unfortunately its civic participation
37:11that is now threatened by the
37:13forces that have undermined trust,
37:15made all of us vulnerable to
37:19conspiracy theories and demagoguery.
37:21And greatly impeded our ability
37:24to manage this pandemic.
37:26Earlier this year,
37:27the Hastings Center examined the
37:29erosion of democracy in the United
37:31States and offered recommendations
37:33for building more robust,
37:35respectful and inclusive
37:37citizen participation.
37:39The next slide shows the cover of our
37:41report and I hope you can see the subtitle.
37:44Let me read it for you.
37:45It's called democracy in crisis.
37:48Civic learning and the reconstruction
37:51of common purpose by civic learning.
37:55We meant all the activities
37:57by which citizens learn about,
37:59talk about,
38:00debate and make collective decisions
38:03about civic issues.
38:05This happens at many many levels and
38:07takes many forms from classroom debates
38:10to community town halls to formal,
38:13structured deliberations.
38:14When civic learning is encouraged
38:16and practiced,
38:17people develop habits of the heart.
38:19In the mind that build trust
38:21and a sense of common purpose.
38:23By doing this thinking together,
38:25we build trust.
38:27But citizen participation has
38:29been in decline for decades.
38:32So our report.
38:33Describes a path forward for
38:36strengthening it.
38:38First and foremost,
38:39we take justice to be a basis for
38:42civic participation and that means
38:44redressing systemic racism as well
38:47as the vast material inequality.
38:50The wealth gap in American Society,
38:53which has left large numbers of
38:55people both black and white living in
38:58both rural and urban areas in great
39:01financial precarity and that vulnerability.
39:05Predisposes people to
39:07resentment against elites.
39:09And makes them susceptible.
39:11Makes all of us who feel that
39:15susceptible to conspiracy theories.
39:18Civic learning requires a
39:19sense of common purpose,
39:21but citizens will not have a sense of
39:23common purpose when they recognize
39:25that their interests are ignored
39:27and they and the communities they
39:29live in are struggling to survive.
39:32So the provision of basic public
39:34goods like healthcare,
39:35a quality education,
39:37food,
39:37security and housing are essential
39:39to building the conditions for
39:42civic participation in a democracy.
39:44Our report also acknowledges that the
39:46business models of broadcast media,
39:48the Internet and social media,
39:50monetize public attention and
39:52therefore create strong incentives
39:55to share outrageous,
39:56bizarre and conflict provoking information.
40:00This has to be fixed through regulation
40:03or perhaps replaced with business
40:05models that create incentives to surface,
40:07you know more trustworthy information,
40:09but it is a huge problem.
40:11There are many other recommendations
40:13in the report.
40:14Including reforms to science education.
40:17Beautiful essay on that and the
40:19restoration of civics in school curriculum.
40:23I'm not going to try to attempt
40:25to summarize all of the essays
40:27in this essay set,
40:28but the Hastings Center will
40:30provide a summary of the findings
40:32and the link to the report itself.
40:34If you contact Schiefer busy,
40:37you can see her email VIZIS.
40:41At thehastingscenter.org,
40:44I also think it's retrievable on my
40:47Twitter account and I'll check on that
40:50after this talk at Mildred's Salon.
40:55So let me let me wrap this up with a summary.
41:00I've talked about trust.
41:02If we can regain trust in
41:05each other in our government.
41:09And in science, then I hope.
41:11We will have a strong enough foundation
41:15to commit to some core values essential
41:18to working together to address
41:20collective problems like pandemics.
41:22So first I see trust as the
41:26primary enabling condition. And.
41:29If we regain it and build trust. Umm?
41:37I hope we will be able to rebuild
41:40public health infrastructure.
41:44I've talked about our failure to
41:46build it because we have undervalued
41:49prevention and overvalued cures.
41:51I've also talked about equity
41:54both within our nation.
41:57Think that there's another
41:59point on the next slide.
42:00Yes, we could advance the slide.
42:02I've talked about equity in three ways,
42:04equity within our nation.
42:05I've just talked a lot about the
42:08wealth gap and about systemic racism.
42:12So that we need to address financial
42:15precarity and discrimination that
42:17breeds distrust and cynicism.
42:20I've talked about equity across generations,
42:22so that we care about things that might have
42:26future benefit for future beneficiaries,
42:29not just ourselves.
42:29This is critical not just for building
42:32public health infrastructure for pandemics,
42:34but it's obvious that that is one
42:36of the stumbling blocks for our
42:38ability to address climate change.
42:40And I've talked about equity between
42:44nations so that we can provide assists to
42:47low and middle income countries so they
42:50will have a chance to protect themselves.
42:52And then I've also talked about rebalancing,
42:55liberty and personal sacrifice so that
42:57we are willing to accept some modest
43:00infringements on our liberty in order
43:03to act on behalf of the common good.
43:07With these values in mind.
43:10That's sort of a summary of other
43:12things I was trying to the point I was
43:14trying to make throughout this talk.
43:16And and I know that some of it is.
43:21I don't know, you know,
43:22you don't necessarily end up
43:24in a happy place. When we,
43:25when we describe these problems.
43:26So I do want to end with
43:29a more optimistic message.
43:31I've named these threats,
43:33but there are also important cultural
43:35shifts toward a more compassionate,
43:37inclusive future.
43:40And let me name just a few things
43:41that do give me a lot of hope
43:43despite the alarming growth
43:45in white supremacist groups.
43:46Recent polls show that a much
43:48larger percentage of us than
43:50ever before in American history
43:52believe that racism is a problem.
43:54There's also growing recognition
43:56that hourly wages have to rise
43:58and even support in some quarters
44:00across the political spectrum,
44:01really across it.
44:03For a universal basic income,
44:05because people are recognizing that
44:08artificial intelligence and robotics
44:10is likely to displace millions of workers.
44:13Scientists,
44:13as I mentioned before,
44:15have shared their findings with
44:17unmatched speed and collaboration
44:18and healthcare professionals have
44:20demonstrated enormous fortitude far
44:22beyond what should be expected of you.
44:25Demonstrating that there is ample goodness,
44:27compassion,
44:28and courage among Americans.
44:30So I see these as hopeful signs if
44:34we can grasp these glimmers of hope
44:37and amplify the core values that I've
44:39been talking about in this talk,
44:41I think we can choose.
44:42A wiser path and we can build a stronger,
44:45more sustainable and more trustworthy
44:49society. That's it, thank you.
44:53That was marvelous really. It really was.
44:55It was a I mean quite a quite a tour.
45:01And I appreciate the last bit
45:02of optimism because I was I was
45:04toward the end kind of looking for
45:06something sharp to cut myself with.
45:07I mean by the end of this,
45:09but but you know, we can run away
45:12from it or we can face it right?
45:13That's our, that's our option.
45:16The idea of sacrificing for the
45:19future is such an important one,
45:22that that investing in things I mean
45:24getting to your initial issue and to
45:26the and to the talk about the pandemic
45:29is is preparing for the next pandemic.
45:31Well, we're not even through with getting
45:34people to invest money that we never pay out.
45:36You know this this the image
45:37of we we've all heard it.
45:39Read and listen.
45:40Of the old man planting a tree under
45:43whose shade he'll never sit to do
45:46some things for future generations.
45:49This was really so nicely done.
45:50I invite folks to to put your comments
45:53or questions into the Q&amp;A portion.
45:55I see there's already several,
45:57so I'm going to get to it here in my friend.
46:01And see what we have.
46:04Let's begin preparations have
46:06become very politicized.
46:08What are your suggestions for mobilizing
46:11desire and overcoming these major
46:13barriers of our current info demic.
46:17Well. I I can make two comments.
46:21I mean it's very troubling and
46:22it's going to be very hard,
46:24but one of the things we've
46:25talked a lot about in our report,
46:27this democracy of crisis in crisis
46:30report is that there's a lot of
46:33opportunity at the local level.
46:35You know, take climate change.
46:36For example.
46:36There's a lot of efforts to do climate
46:39adaptation where you don't have to
46:40fight with each other about the cause.
46:42You don't have to fight over
46:45whether it's man-made or not.
46:46To to make your local community
46:49hardier against water rising and
46:52and heat and things like that.
46:54So there are some promising
46:56examples of where.
46:57If we just stick to working
46:58together to fix a local problem
47:00that everybody can kind of see,
47:01because there is more heat,
47:04there is more water rise we need to
47:06fix some things and not fight about our
47:08differences around what is causing it.
47:10That is one example.
47:14Also. One of the essays.
47:17Actually,
47:18I wrote this with a a very interesting
47:20professor at the Ed school at Harvard.
47:23We talk about how notions of
47:26civic participation have really
47:28eroded in the last 30 years.
47:31It used to be that there were at
47:32least three courses on civics in
47:34every high school experience for
47:36a kid to graduate high school.
47:38They had three and one of them
47:39was problems of democracy.
47:41Where you where nobody was afraid to
47:43bring up real controversial issues
47:45and discuss them in the classroom.
47:47It was the material for for the teaching.
47:50It was it they were real civics examples.
47:53And then this generation doesn't
47:55have that experience.
47:56The whole model of education
47:58has shifted from having a civic
48:01orientation to being financial,
48:03preparing kids for for earning a living.
48:06And the there's.
48:07There's no teaching of that type now.
48:10And of course,
48:11now it's gotten even worse in the last month.
48:12Few months as school and school
48:14boards are becoming a place where
48:16a lot of these polls,
48:18the polarization is getting acted out.
48:20Nevertheless, there there are good examples.
48:23Of reorienting how we?
48:28How we teach kids and prepare
48:30kids for for citizenship,
48:32but the United States was the first
48:34country to have public education
48:36to mandate public education.
48:38Thomas Jefferson said that it was essential
48:41for a democracy to have mandatory
48:43public education to teach people how
48:46to participate in in the in democracy.
48:51And we've just we just
48:52have to get back to that.
48:53We have to keep focusing on that.
48:56The other thing is the Internet,
48:57the party the question had to do with the
49:00Internet and and and Miss disinformation.
49:02The Knight Foundation has just invested.
49:06Scores of millions of dollars to.
49:09Basically,
49:09I don't know if they would use this term,
49:11but I think it's fair.
49:12Basically,
49:13they're trying to create a new field,
49:15a new interdisciplinary field
49:17of inquiry to help us understand
49:20how disinformation gets into our
49:22computers and travels at and
49:24what are the factors that make
49:26disinformation that facilitate the
49:29rapid dissemination of disinformation.
49:32And they're,
49:33they're seeding interdisciplinary research.
49:36About 10 universities to try to really
49:39take a careful look at how is this
49:41happening and how can it be interrupted.
49:47Thank you next question.
49:48How do you reconcile narratives of
49:50preparedness versus rescue when the
49:53tangible experience of most Americans of
49:55color is we demand equitable healthcare?
49:58Which is the right of all people
50:00of color versus institutional and
50:01interpersonal racist and Q, Anon,
50:04and all sectors of American Society?
50:09Additionally, would you speak on
50:11accountability measures for racist
50:13healthcare practices and policies?
50:16I think I could take the second question.
50:17I think I understand the
50:19second question a bit better.
50:22I think that healthcare systems
50:24should be collecting data by
50:27race and looking to see if.
50:30There are differential referrals to
50:32specialist care like we saw in the studies
50:36that the IOM put out in the early 2000s.
50:39I think there's an obligation to be
50:42collecting data about one's own practices
50:45and looking for differences that are
50:47shouldn't be there differences by group.
50:50So I think there's a responsibility
50:52of health systems to collect
50:53that kind of data and learn,
50:55learn from their own patterns and let
50:58their patterns speak to them when, where?
51:00There may be trends that you're
51:01not you that you don't like.
51:03I think that's one really
51:05big area of accountability.
51:07The Hastings Center just sponsored.
51:11A HealthEquity summit. We Co.
51:15Sponsored it with the.
51:17Association of American Medical Colleges.
51:19The double AMC.
51:20The American Medical Association and
51:22the American Board of Internal Medicine.
51:25And we also reached out to nurses.
51:27The American Nurses Association
51:28and all of us work together,
51:30and we developed a two day summit on the.
51:34The first day was on the history of.
51:37It's what I mentioned in my talk.
51:38The first day was on the kind of the history.
51:41What happened in our laws and
51:44policies that ended up with
51:46such residential segregation.
51:48Why do we have all this
51:50residential segregation?
51:50It turns out it's not because people
51:52like to live near each other it it was
51:55actually a consequence of a federal policy.
51:57And we laid that all out in day
52:00one and David Williams showed the
52:02relationship between all that and why
52:05that ends up with health inequities.
52:07Day two we had panels on what
52:11can be done in research.
52:13What can be done in clinical care?
52:14What can be done in clinical education
52:16both for medical and nursing education?
52:18So these are recorded.
52:20We have them all available and I think
52:22the best answer I have for this question
52:25is I gave you Schaefer's email address.
52:29Email her and ask her to
52:30send you all these materials.
52:32It's 8 hours of programming
52:34at least over 2 days.
52:37Thank you so much and someone
52:39actually comments here.
52:40I'm Carol Montgomery Taylor
52:42bioethicist from Omaha, NE.
52:43No question, just appreciation and
52:46also comments that democracy and
52:48crisis is available on Amazon.
52:52There you go. Wow.
52:54It's also about time. She says that
52:57someone addressed the loss of civic
52:59mindedness rampant in our time.
53:00Thank you for that comment, Carol.
53:03A question please,
53:04a significant amount of
53:05vaccine refusal has occurred
53:06within minority communities,
53:08likely because of lack of trust.
53:09As you point out,
53:10how would you balance the need
53:12to build trust with vaccine mandates,
53:15particularly if such mandates
53:16were to undermine trust
53:19so number one? At first there was a
53:21lot of discussion at the beginning of
53:24the pandemic that there were worries
53:27that black Americans would not be and
53:30Native Americans would not be open to.
53:33Vaccine at the same rates as
53:34whites because of lack of trust,
53:36and that's been pretty much disproved.
53:40Black leaders read Tucson, for example.
53:45A number of people put together a social
53:50marketing campaign of black leaders.
53:53Encouraging vaccination in the black
53:55community and also neighborhood
53:57by neighborhood.
53:58Examples of activities like using
54:01hairdressers and stuff and and they
54:03found they were able to increase
54:06black vaccination rates tremendously.
54:08It was a very successful campaign.
54:10And so, and they don't.
54:12They've asked that we stop assuming
54:15that it's lack of trust.
54:17That is the reason there may
54:20be lack of access.
54:21And that when the message
54:23comes from people who.
54:25You look you know who who you identify with.
54:28You're more likely to to respond,
54:31so I think there's been a.
54:33In fact. We've also seen that.
54:34Hope that principle of the
54:36message coming from somebody
54:38you identify with and you trust,
54:40is also true in the evangelical community.
54:42Now we know that evangelicals have
54:44been very resistant to vaccine,
54:46but when you start to look closer,
54:48you can see that there's actually a
54:50fissure in in the evangelical community,
54:52and some were very pro vaccine,
54:54and some were not.
54:56And so again,
54:57a leader from inside that community
54:59itself took it upon himself.
55:01I'm just blocking out his name to develop
55:03a program that answers evangelicals,
55:06questions,
55:06questions that are cynical about
55:08vaccination or cynical about pharmaceutical
55:10companies and answers them from within
55:13the framework of their own thinking.
55:15And he too has been able to have,
55:17you know,
55:18be quite persuasive.
55:20I don't think vaccine mandates
55:21have to just one last point.
55:23I don't think vaccine mandates have to.
55:25That's a good question.
55:27Like if you mandate something,
55:29might you get a?
55:31Might you enhance the?
55:33The whiplash might there be a whiplash
55:35and you might actually undermine trust.
55:38I think that's worth thinking
55:40about and worrying about.
55:42But my reply would be.
55:46If we invested more in Health Communications,
55:50we should be researching.
55:52I just gave you 2 examples
55:54of communication style.
55:55You know the importance of the messenger in
55:57both the black community and the evangelical.
56:00I think we should be studying and investing
56:02in studying Health Communications and
56:05doing Health Communications research.
56:07I believe there is probably a
56:10message about mandates that
56:12people who might otherwise have.
56:15Had a reaction against might begin.
56:18There might be ways to frame
56:21the mandate issue that different
56:24groups could identify with better,
56:27you know if we thought about
56:30like you're helping children,
56:31you're helping your relative who's
56:33immune compromised there have to
56:35be a way to design messages that
56:37helps people get the hot get away
56:40from this cardboard reaction.
56:44There are also I mean.
56:46I think one of the fundamental
56:47questions in terms of lessons
56:48learned a lesson not yet learned.
56:50One of the fundamental questions
56:52that so many physicians have asked
56:54is how is it that I've cared for
56:57this person for the last 30 years?
56:59Last 20 years, the last 10 years.
57:02And I tell this person,
57:03you really for your own
57:04health should get a vaccine,
57:06and then they see something on on
57:08Facebook or they see someone on TV,
57:10tell them otherwise,
57:11and that that's enough to plant
57:13the doubt that they don't get it.
57:14How is it that one?
57:16Trust the stranger that one
57:17never even meets physically
57:19meets over one's own physician.
57:20I think that's a question that
57:23physicians should be doing everything
57:25possible to get the answer to.
57:27How did we lose?
57:28How did we, as a profession,
57:30absolutely lose that?
57:31I mean, I, I mean,
57:32I see it in my own extended
57:34family of people who say, well,
57:35my my pediatrician says going to do this.
57:37But then again,
57:38there's some people who say to that.
57:39Well,
57:39we're the same people that you're
57:41believing over your own pediatrician.
57:42There's
57:43something very damaging
57:44going on, and we're losing.
57:47Trust and expertise of all kinds.
57:49We are, but I have a specific question.
57:51You mentioned the evangelicals,
57:52so can you explain to me why in
57:56particular you talked about vaccine
57:58resistance among evangelicals?
57:59Is there a a theory or is there an
58:02explanation for why this particular
58:04group of individuals would be resistant
58:06to vaccines compared to others?
58:09Perhaps because there was a disproportionate
58:11support for Trump among evangelicals,
58:13so they were following his lead and he was
58:16providing all kinds of disinformation.
58:18Although he wasn't against vaccines,
58:19he should get. I mean,
58:21this was part of the credit for this.
58:22Yeah, he was booed actually when
58:24he finally said no, I'm vaccinated.
58:25You should get vaccinated too at a rally
58:28a few months back and he got booed.
58:30So yeah, I. There's a kind of
58:34mass hysteria going on here.
58:35I I don't know. I can't answer that.
58:38I just I just don't know.
58:39But you're right,
58:40that is what we have to be looking at.
58:42Fair enough,
58:42I want to find the evangelical
58:44program that this Minister did
58:46because he took very seriously
58:48some questions that were coming
58:50from their faith tradition and he
58:52answered them in their own terms.
58:55So I will try to.
58:56I will try to locate
58:57that and send it to you.
58:58Mark
58:59that sounds good. Thank you so much.
59:01Next question please from the
59:03perspective of a practicing
59:04clinician and as a researcher.
59:06Some of this lack of trust and lack of
59:08sacrificing for the common good seems
59:10like it might contribute to the greater.
59:12The satisfaction observed
59:14in healthcare workers.
59:16Do you have any thoughts on how to
59:18publicize this risk to clinician
59:20well-being and the workforce?
59:25Well, should we publicize this to
59:27the clinician to clinicians and the
59:29healthcare workforce? Or should we?
59:33Not publicizing it to the clinicians
59:35rather ohh size it more let people
59:39know that this that this climate is
59:41actually burning out the clinicians.
59:44I think we should be advertising that I
59:46think that's a really good idea, Deborah.
59:50Nurses. Are the most trusted
59:53healthcare professionals of all.
59:56And are also being burned out
59:58and feeling betrayed at real.
59:59And you know resilience.
01:00:02I mean and and physicians are being.
01:00:06You know the pressures are just unbelievable,
01:00:09so I do think people should know that.
01:00:11Absolutely,
01:00:11I think that's a really good idea.
01:00:14I don't know how to do that,
01:00:15but I think it's a good idea to do.
01:00:18You know you would see on the news so
01:00:20often that the worst months of the pandemic
01:00:22so often you would see on the news,
01:00:24they show an emergency room.
01:00:26They show just the mayhem and they show
01:00:27some nurse walking home at the end of
01:00:29her shift and they interviewed some
01:00:30physician who was exhausted and they
01:00:32would talk about how you know this is
01:00:34really terrible and this, you know. And.
01:00:36And once the vaccines came out, of course,
01:00:39then it became to the minds of many,
01:00:41myself included,
01:00:42twice as terrible because so much of this,
01:00:44most of that suffering was actually
01:00:46preventable. Not all of it,
01:00:47but most of it was actually preventable.
01:00:49And to see that going on in the
01:00:51hospitals was just an amazing thing.
01:00:53And I was surprised and discouraged that
01:00:55more people weren't weren't moved by that.
01:00:57But somehow I think they that so many
01:01:00folks just flat don't believe it.
01:01:02They say, well, that's all true,
01:01:03but I've also heard.
01:01:04I mean, we see we saw some of this in some.
01:01:07And and so many things in in the in,
01:01:10it may still exist,
01:01:11but certainly in the earlier years of the
01:01:13climate change debate there were really,
01:01:15you know,
01:01:15there were two sides of the argument.
01:01:17Well,
01:01:17some scientists say that climate change is
01:01:19occurring and some scientists say it isn't.
01:01:21Well,
01:01:21that was the simplistic view.
01:01:22But then you realize, OK?
01:01:23Well, 99 scientists say it is,
01:01:26and there's this one that says,
01:01:27well, maybe it's not,
01:01:28you know,
01:01:29and that person's paid for
01:01:30it by the oil company. So
01:01:31you got. But then put simply,
01:01:33well, there's two points of view.
01:01:35Well, that's too simple.
01:01:35A way to look at it, I recognize.
01:01:37But but the the fact that that in
01:01:40this particular problem the fact
01:01:43that folks because I I don't,
01:01:45it's a, it's a pretty rare physician
01:01:47who was telling people this
01:01:48isn't an issue where don't get,
01:01:50don't get vaccinated that.
01:01:54That that fascinates me and worries me,
01:01:55and that's a question that of course,
01:01:57if we get the answer to,
01:01:58we could fix if we could regain
01:02:00that trust somehow, all right enough
01:02:02to complaining about the trust.
01:02:03Let's hear the next question,
01:02:04one of the lingering legacies of the
01:02:06pandemic is resource scarcity such as
01:02:08recurring shortage of blood products.
01:02:10And now I donated contrast.
01:02:14What lessons have we learned about
01:02:16applying resource allocation frameworks
01:02:18to these shortages in ways that are
01:02:20universal and predictable but also
01:02:22take into account the unique factors?
01:02:24Of each shortage,
01:02:25what are we doing about resource shortage?
01:02:27What do we learn?
01:02:29So I think that.
01:02:32There were efforts all around the
01:02:35country to quickly create guidance.
01:02:38For the concern that we were going
01:02:41to be scarce on ventilators and.
01:02:43A lot of those issues are very relevant
01:02:46to any other kind of commodity scarcity.
01:02:49They happen to be worried about
01:02:51ventilators in the first strokes of this,
01:02:53but the reasoning that was published
01:02:55there were important pieces in all
01:02:58the major medical journals, I think,
01:03:00showed an awful lot of good work.
01:03:02They also evolved over time,
01:03:04especially in two ways.
01:03:07One was that people with disabilities
01:03:10became concerned about the first
01:03:13generation of the guidance.
01:03:15And I.
01:03:17Was because the Hastings Centers
01:03:21for years had.
01:03:24Then looked at a lot of ethical
01:03:26issues at the intersection of
01:03:27bioethics and disability justice.
01:03:29I was particularly following the
01:03:31concerns that people in the disability
01:03:33rights community were raising
01:03:35about these allocation schemes,
01:03:37and so I worked with Matt
01:03:40Winia and Larry Gostin,
01:03:41and we produced a prospective in
01:03:43New England Journal of Medicine.
01:03:45So we were adding our two cents.
01:03:47There was an important two cents.
01:03:49I think it was.
01:03:50We were suggesting modifications
01:03:52to the allocation.
01:03:54Themes that were then dominant
01:03:56by paying attention to their
01:03:58impact on people with disability,
01:04:00and we were integrating the
01:04:03disability rights people's concerns
01:04:05into a guidance on on triage.
01:04:10Basically, and then a second thing,
01:04:13I think we learned in the second
01:04:15or third generation of these
01:04:17guidances was that they also could.
01:04:24Discriminate against.
01:04:27Poor people or people of color
01:04:29because they were based on the
01:04:31likelihood of survivability and if
01:04:34poor people or people of color,
01:04:36have chronic illnesses sooner
01:04:38and are sicker than when they're
01:04:41scored for survivability.
01:04:43They they are dinged in
01:04:45the in the scheme and so.
01:04:50People added a way to account for
01:04:53that that had to do with looking at
01:04:57what neighborhoods people lived in and
01:04:59taking into account that they might,
01:05:01that they try to counterbalance the impact.
01:05:05Also, instead of a raw
01:05:08survivability assessment,
01:05:09they made it narrower so that it
01:05:12you were likely if you were likely
01:05:14to survive to discharge rather than
01:05:17trying to prognosticate about your longevity.
01:05:20Since blacks live less long than white,
01:05:23so we made these kind of tweaks
01:05:25and important.
01:05:26I don't mean to under, you know,
01:05:29undermine their significance with that word.
01:05:30We tweaked the the people,
01:05:33quickly,
01:05:33put together guidances,
01:05:34and then they revised them as
01:05:37they got criticized by disability
01:05:39rights and by communities of color,
01:05:41and came out with another generation
01:05:43of guidance.
01:05:44So I don't think that the the
01:05:46guidance is that different.
01:05:47Depending on what the shortages are,
01:05:49the only other thing I'd like to say.
01:05:51Is that even though I've written
01:05:53on this myself,
01:05:54I'm really kind of tired that bioethics
01:05:58is focusing on rationing schemes rather
01:06:01than fighting for more of what is needed.
01:06:05It's hard, it's hard to.
01:06:08We don't like to be advocates,
01:06:10right?
01:06:10We think of ourselves as scholars
01:06:13and analysts and not advocates.
01:06:15And where is the line between
01:06:18ethical analysis and advocacy?
01:06:19But this question makes me want to say,
01:06:23OK, we've done a lot around
01:06:25rationing in an ethical way.
01:06:26Now,
01:06:27could we also do a little bit of
01:06:29advocacy to bring attention to these
01:06:30shortages and make sure they get fixed?
01:06:33OK, let's get to the next
01:06:36question to that point.
01:06:38Doctor Duffy cuts to the chase almost
01:06:40all of what has been identified as
01:06:42necessary to address the current
01:06:44quagmire in America is denied by a
01:06:46political party of former president
01:06:48and possibly the next president.
01:06:49Does the Hastings Center have an
01:06:51obligation to address this threat
01:06:53and its current practice of sowing,
01:06:55distrust and racism in America?
01:06:59We all have a responsibility
01:07:01and we all need to vote the
01:07:03right and we all need to vote.
01:07:06We need to really be present
01:07:08and not look the other way.
01:07:13That's my answer. We also.
01:07:17Are trying to do that by focusing
01:07:19on civic participation and the
01:07:21conditions that give right.
01:07:22You know that encourage
01:07:23people to participate.
01:07:24Vote and other kinds of forms of
01:07:26civic participation and by bringing
01:07:28attention to what's at stake through,
01:07:30for example, our HealthEquity summit.
01:07:33Thank you. As a physician involved
01:07:36in public health education,
01:07:38I was struck that there were times
01:07:40when public health institutions
01:07:41gave inaccurate recommendations and
01:07:43attempts to guide public behavior,
01:07:45EG initially saying masking was unnecessary,
01:07:48advising the public to take
01:07:50whatever vaccine was available.
01:07:51When M RNA vaccines were clearly
01:07:54superior to conventional vaccines,
01:07:55what are your thoughts on what,
01:07:57if anything, public health
01:07:59institutions and experts can do to
01:08:01avoid contributing to mistrust?
01:08:05Respect the audience I mean.
01:08:09For goodness sakes, that was ridiculous.
01:08:11It was showed such distrust of Americans.
01:08:16And do the homework to figure out if you're
01:08:19I understand they were real worries.
01:08:22People had about messages
01:08:25being too complicated.
01:08:27But do the homework to figure
01:08:28out how you can message it.
01:08:30That's why I was saying I would love I.
01:08:32I do believe that CDC has just formed.
01:08:36And resourced center with MCDC that is going
01:08:38to do more Health Communications research.
01:08:41I sure hope so because they need.
01:08:44They need to treat this like it's a field
01:08:47and study it and put resources into it.
01:08:50If they were worried that a more complicated
01:08:53message was going to undermine people,
01:08:55they should have researched it.
01:08:56Focus grouped it,
01:08:57field tested it and treated it
01:08:59like the important thing it was
01:09:01to come up with something that
01:09:02would help people understand it.
01:09:04But instead they just kind of thought.
01:09:06Americans were too stupid to get
01:09:07it and didn't do their own homework
01:09:09to shape it into a helpful message.
01:09:12Well, was it stupid with the with
01:09:14the mask issues was that they were
01:09:15concerned the public was too stupid
01:09:17or was that they just wanted to make
01:09:19sure the public didn't take things for
01:09:20themselves that were needed elsewhere.
01:09:26Here's another question please,
01:09:27that's a good point.
01:09:28Yeah, that's a good point.
01:09:31Another question, please,
01:09:32do you think the effects of the
01:09:35COVID-19 pandemic and particularly
01:09:37choices made by national leaders
01:09:40in earlier stages will effectively
01:09:42translate to lasting policy changes
01:09:45to prepare for future pandemics?
01:09:49I feel like that's what I was trying
01:09:50to say in my talk. You know that.
01:09:53That's our obligation that that's
01:09:55our obligation, and I hope that
01:09:58we're organizing ourselves now.
01:10:00But I don't know that we are so the
01:10:03White House just came out in January.
01:10:06I think it was with a comprehensive plan
01:10:09for for managing the next pandemic.
01:10:11And and they identified all the
01:10:13things that need to be done.
01:10:15And Elie Adachi ADASHI and Glenn
01:10:20Cohen wrote a piece maybe in JAMA
01:10:24saying great about this report.
01:10:25It's wonderful.
01:10:26It says everything we need to do.
01:10:28And has Congress appropriated
01:10:30the money for it now?
01:10:32And have we geared up?
01:10:34It's going to require enormous coordination
01:10:37across different government agencies.
01:10:38Have we figured out how to do that?
01:10:40No, not yet.
01:10:42Yeah, I don't know,
01:10:44so this I'm not trying to get us depressed.
01:10:46Mark.
01:10:48Well here's another question.
01:10:49Basically along the same lines,
01:10:50the same point as someone points
01:10:52out other than other than the COVID
01:10:54pandemic during the last decade,
01:10:55there were five major influenza pandemics,
01:10:58and each time we face the same
01:11:00problem and deciding who lives
01:11:02despite all preparedness plans.
01:11:04So what are your recommendations?
01:11:05In order not to repeat the same mistake
01:11:08over and over and ensure social justice?
01:11:11So we're the same?
01:11:12Mistake being essentially being unprepared.
01:11:16And this is what we've been
01:11:17talking about all along.
01:11:20Perhaps we need a leader or a small
01:11:23a small set of leaders that have the
01:11:25trust of the vast majority of people
01:11:27and a willingness to a willingness
01:11:29as you put to sacrifice the pressure
01:11:31for the sake of the future to
01:11:33sacrifice not to plant those trees.
01:11:37Comment as an immunocompromised patient,
01:11:39I wear a mask at all times
01:11:41outside of my apartment.
01:11:42Even in the building where I live.
01:11:44I literally bought a mask
01:11:45that says it's just a mask.
01:11:47There seems to be a big problem
01:11:49in certain socioeconomic
01:11:50groups about wearing masks.
01:11:52I can see it between types of mega stores.
01:11:57Gently related to social class. Yeah. Umm?
01:12:08There we go.
01:12:10I don't know someone comments
01:12:12and outstanding conference.
01:12:13They're working on bioethics
01:12:16and medical setting.
01:12:17The Pueblos of New Mexico and Navajo
01:12:20Nation have done an excellent job
01:12:22of getting people vaccinated.
01:12:23It's pointed out.
01:12:26I am an evangelical and and
01:12:28twice boosted and have gotten.
01:12:31Have you shown have you shield?
01:12:32Because I am immunocompromised so
01:12:35there's one individual who tells us that.
01:12:38And maybe if you want.
01:12:40If you're interested,
01:12:41Elizabeth sent us a notice to
01:12:43why you think that within the
01:12:45evangelical community there's a
01:12:47significant resistance to to vaccine.
01:12:49Or if you think that's even true,
01:12:51I guess that that's was your observation.
01:12:54But I think there's diversity there. Yeah,
01:12:57OK, thank you very much for
01:12:59such a compelling talk.
01:13:01Trust is a main criteria for
01:13:03developing the common good for all.
01:13:04How do we come up with a common good
01:13:07paradigm with all our diversities and
01:13:09all the inequities in our society?
01:13:11And we must learn to share rather than
01:13:14sacrifice for individual liberty.
01:13:17How do we do that?
01:13:17You got that figured out really?
01:13:19Yeah, come back next year
01:13:20and tell you OK, yeah.
01:13:25That's a cop says one thing
01:13:26we can all do is vote.
01:13:27I think that's what you said as well.
01:13:29Yes, we have to vote.
01:13:30Not a question but a comment.
01:13:32The resource you asked about
01:13:35evangelicals of fears and concerns
01:13:37can be found in an excellent
01:13:40statement from the Christian
01:13:42medical and Dental Association.
01:13:44Cmda.org explains why
01:13:46vaccinations are important,
01:13:47safe and and involves one's responsibility
01:13:50for the common good of society.
01:13:53This is from John Plank Hill.
01:13:54And so there is this statement from
01:13:57the question medical and Dental
01:14:00Association CMA about the vaccines as
01:14:03an informational point for all of us.
01:14:07What recommendation would you have
01:14:09for changing medical education
01:14:10given these issues with effective
01:14:12public Health Communication as a
01:14:15medical education or I have heard
01:14:17frustration from trainees within this
01:14:19issue and that's a great question.
01:14:21Teach medical students.
01:14:22What do we do differently?
01:14:24What do we do better
01:14:25I I love this question. I mean,
01:14:28I know that medical and nursing
01:14:30education is jam packed and nobody
01:14:32wants to add anything to the curriculum.
01:14:35Isn't that the truth?
01:14:37But why not? I mean, this should become
01:14:40a criterion in in the same way that
01:14:43you have to show that you know how to.
01:14:45Do you know a certain kind of diagnosis.
01:14:47You should be able to show that you sit down.
01:14:50You don't stand up,
01:14:51you look the person in the eye.
01:14:52And you make a statement
01:14:54that open is an opener.
01:14:56I mean there there's ways
01:14:58to learn communications and.
01:15:01I I think we have to do this,
01:15:02especially around vaccine refusal
01:15:04and and, you know, in fairness to the
01:15:06people who lead our educational efforts,
01:15:08there is a great deal of effort that
01:15:10is put into teaching our medical
01:15:12students here at Yale, and I'm sure
01:15:14elsewhere about the communication,
01:15:16the communication we learn about.
01:15:19We teach about both for the medical students
01:15:22and for the residents and Fellows is the
01:15:25one to one communication with a patient.
01:15:27There's the other aspect of it which
01:15:29is a communication on a much broader.
01:15:31Kyle, that's a good point,
01:15:32and every physician doesn't necessarily
01:15:34have to be expert at that home.
01:15:36Would wish that there were more of
01:15:38us who were really good at it who
01:15:40could write in the newspaper or go on
01:15:44television and really gain the trust.
01:15:46And it's frustrating when one sees certain
01:15:49physicians on television who do seem
01:15:51to gain trust and who we look at say?
01:15:53Well, that's one of that's somebody
01:15:55who I really respect. You know?
01:15:57And then you see, you say,
01:15:58how come people aren't listening to him?
01:16:00My goodness.
01:16:01And and then you see someone says
01:16:03something bad about that person.
01:16:05Where did that come from?
01:16:06That it's important to to demonize this
01:16:08person because they're promoting vaccines.
01:16:11For example, very,
01:16:12very frustrating, to say the least.
01:16:15But now I'm getting this depressed.
01:16:16Alright. Hang on here. Umm?
01:16:20Uh, so we have more questions.
01:16:24There is diversity in my church. This was.
01:16:26This was the question about evangelicals,
01:16:27again response from Elizabeth.
01:16:29Thank you, Elizabeth, for this.
01:16:31There is diversity in my church.
01:16:32Only one person of 100 has chosen not to
01:16:35get vaccinated and refused to wear a mask.
01:16:38Also we we are having hybrid services and
01:16:41went completely virtual for some time
01:16:43during the early stages of the pandemic.
01:16:45I think there's a difference between small
01:16:47churches and mega church pastors who
01:16:49have sway over larger groups of people,
01:16:52including their television audience
01:16:53who may have aligned themselves.
01:16:55With POTUS 45.
01:16:59Thank you, that's very helpful to know
01:17:01that is helpful to know. Now I
01:17:03invite more questions in the Q&amp;A.
01:17:10One person comments.
01:17:11Carol comments that she's Native
01:17:13American and was raised in the city,
01:17:16but she knows many who live on the
01:17:19reservation that were literally
01:17:21dying for access to vaccinations.
01:17:23I mean, that's particularly frustrating
01:17:25to think in the US that there's
01:17:27people who can't get the vaccine.
01:17:29Who want it?
01:17:30It's such a, it seems to those
01:17:33who are ill informed like myself.
01:17:35I mean, I realize their storage
01:17:37and transport issues and such,
01:17:38but this isn't this isn't heart surgery.
01:17:40This isn't even a vaccine.
01:17:42I mean, we should try to advertise that.
01:17:44Could she say some more about that?
01:17:46I mean, why isn't there plenty
01:17:49of vaccine on those reservations?
01:17:51I don't understand.
01:17:52We we have. No shortage here.
01:17:55So, and we have refrigerated trucks.
01:17:58I just don't get it.
01:18:02Well, OK, for that I mean the
01:18:05Indian Health service should
01:18:06be held accountable for that.
01:18:10You mentioned at the very
01:18:12beginning of your talk.
01:18:13Now Jonathan, because I I I like that
01:18:15maybe you could talk for a minute more
01:18:17on this because our time is nearly up,
01:18:19but I'm interested in your thoughts
01:18:23on the ethical requirement to prepare.
01:18:27To me there seems an analogy.
01:18:28Once again with with the
01:18:31environmental issues that it it
01:18:34speaks to our obligation to the
01:18:37future in terms of what we do now.
01:18:41And I wonder if you wanted to say
01:18:43anything else about that ethical
01:18:44requirement to prepare kind of
01:18:46flesh that out a little bit more.
01:18:51I, I think that it it it
01:18:54engages preparation engages
01:18:56with so many moral commitments.
01:19:00When you prepare, you demonstrate that
01:19:02you feel you have some accountability.
01:19:05For impacts on future.
01:19:08Events on future people.
01:19:11Future, it's it's.
01:19:13It's a statement almost
01:19:15of your accountability.
01:19:17And it's also a recognition that
01:19:20your actions are interventions
01:19:23that are determinative.
01:19:25It's a it's a form of agency.
01:19:33So it's also preparation I
01:19:35think is going to become more
01:19:37and more important because.
01:19:39People often ask me what do I where
01:19:41do I think bioethics is going?
01:19:43And I think bioethics is.
01:19:45I think the ethical challenges that
01:19:48we're facing now in the 21st century are.
01:19:50Different than the ones we were
01:19:52facing in the 20th century,
01:19:53when bioethics was created.
01:19:57Maybe not different additional,
01:19:59so when bioethics was first created.
01:20:01I mean, I think it's fair to
01:20:03say that we were dealing mostly
01:20:06with individual level concerns.
01:20:08Like the right to die sort of concerns
01:20:12or allocation concerns for rationing,
01:20:15or, you know, that's.
01:20:17They were things that would affect
01:20:19the decisions that were made would
01:20:22affect an individual very seriously,
01:20:24but they didn't really necessarily affect
01:20:27a population like end of life care or
01:20:29fairness in in organ transplantation
01:20:31that would affect an individual
01:20:32if we didn't have a fair system,
01:20:34it would affect an individual,
01:20:36but the kind we still face those kind
01:20:38of problems and value ethics still
01:20:40needs to be thinking about those
01:20:42kind of problems in the 21st century.
01:20:43But now we are facing.
01:20:46Collective decision problems about.
01:20:51How we manage our shared environment? So.
01:20:58Global warming is the perfect example, right?
01:21:02Umm?
01:21:05Pandemics, shared environment.
01:21:06How are we going to manage
01:21:08the shared environment?
01:21:09Because our policies and our what we do,
01:21:12how we prepare is going to affect all of us.
01:21:16It's going to affect a population level,
01:21:19not just the individuals whose lives
01:21:21will be saved by getting an organ
01:21:24that was distributed fairly. So.
01:21:27I mean another example is geoengineering.
01:21:30You know they're now proposals to block
01:21:33sunlight in order to manage global warming.
01:21:36So, like planetary interventions
01:21:38that we think it's important to have
01:21:41IRB's for research studies to oversee
01:21:44oversee research with individuals,
01:21:46now we're going to do these actions that
01:21:48are planetary and there isn't anybody
01:21:50that's responsible for oversight of it.
01:21:52So we're facing what I'm calling
01:21:55collective decisions. Really big.
01:21:58Collective decisions that affect
01:22:00our shared environment.
01:22:02And.
01:22:04They require coordination and preparation.
01:22:08And.
01:22:09I just hope we all realized that
01:22:10we just have to work together and
01:22:12that's why these values that I was
01:22:14mentioning I think come into play
01:22:16and are so important that we have.
01:22:19If we're going to do that,
01:22:19we have to think about equity.
01:22:21Obviously, if it's a shared environment,
01:22:22how does what?
01:22:23What are the distributional
01:22:25effects on different groups?
01:22:27And we have to think about the common good,
01:22:28not just the liberty side.
01:22:31That's my answer,
01:22:33thank you. We have time
01:22:34for one more question.
01:22:38There are many health care
01:22:39facilities that do not mandate
01:22:41the vaccine to their staff,
01:22:42including clinical practitioners.
01:22:43Can you speak about how we,
01:22:46as healthcare practitioners
01:22:47can allow this to be?
01:22:50I just think that's a mistake and I
01:22:52think it's a failure of leadership.
01:22:54I do understand it in small rural
01:22:56hospitals where they're the leadership
01:22:58is just terrified that they're
01:23:00going to have to close, because if
01:23:02they insist upon a vaccine mandate,
01:23:05their employees are going to leave.
01:23:07And I think we've even had instances
01:23:09of that in rural upstate New York,
01:23:11so I understand the pressure on these.
01:23:13I. I'm really do. I don't want to.
01:23:16I don't want to end by,
01:23:17you know, just disrespecting.
01:23:18How hard it is to be the leader of a
01:23:21healthcare organization where there's
01:23:23that kind of resistance and where there's
01:23:26a shortage of healthcare professionals.
01:23:28So if somebody actually leaves
01:23:29because of the mandate,
01:23:31you may have to close your doors.
01:23:34But you know, it's just wrong,
01:23:37and fortunately,
01:23:37even though I was saying that I was
01:23:40sorry to see that the Supreme Court.
01:23:42Vitiated the employer mandate in every case,
01:23:47health care mandates have been upheld.
01:23:50It has to come before the Supreme Court,
01:23:52but in all the other courts lower
01:23:53courts it this has been upheld.
01:23:55Everybody recognizes that there is
01:23:57a responsibility that comes with
01:23:59being a healthcare professional.
01:24:00It's part of your job.
01:24:02To
01:24:03have a responsibility to comment being
01:24:07a citizen in terms of the public,
01:24:09could we haven't come that
01:24:10end because that's really
01:24:11what it comes down to.
01:24:12That question about.
01:24:13What should the Hastings Center do?
01:24:15We all have to be citizens
01:24:17and we all have to vote.
01:24:20Here's one quick quick
01:24:21comment and then I'm going to
01:24:22ask you just one last thing.
01:24:24So this was just thank you, Barbara for this.
01:24:27Richard Russo wrote an excellent article
01:24:28in the Atlantic about the tendency to pay
01:24:31attention to the uninformed Grapevine.
01:24:33Instead of expertise, he called it
01:24:35the I know a guy syndrome mentality,
01:24:38so that's something worth taking a look at.
01:24:40Yeah, we should look at that. That's great.
01:24:41And with that, our time
01:24:43is nearly million wanted.
01:24:44There's a final thought
01:24:45you'd like to leave us with
01:24:47before we close the night.
01:24:48Let's keep our hopes up even as
01:24:51we see the dark. Let's keep.
01:24:53Let's keep our hopes up and
01:24:54keep on working together.
01:24:56That sounds good. I thank you so much.
01:24:58I thank you all for joining us and we'll
01:25:00be back again soon with the next one.
01:25:02You can see our schedule and
01:25:04biomedical ethics at yale.edu.
01:25:06If you Google us and we are sometimes
01:25:10blessed, often blessed with wonderful
01:25:12speakers and so that was certainly one
01:25:14of those nights Doctor Millie Solomon.
01:25:16Thank you so much for this evening.
01:25:18We appreciate it and we say
01:25:19goodnight to you and thanks.
01:25:21Thank you.
01:25:23Thanks everybody, thanks
01:25:24for this opportunity, Mark. See Emily.