Annual Thomas P. Duffy Memorial Lecture in Medical Ethics Bioethics: A Path Forward with Vardit Ravitsky, PhD

Transcript

• 00:00Get started.
• 00:02Thank you so much, for
• 00:04being here.
• 00:06My name is Mark Mercurio.
• 00:08I'm co director of the
• 00:08program for biomedical ethics,
• 00:10here at Yale School of
• 00:12Medicine.
• 00:13And this is, as you
• 00:14just heard a few minutes
• 00:14ago, a very special night
• 00:16for us, the Thomas Duffy
• 00:17lecture.
• 00:20I wanna introduce now speak
• 00:21specifically about our speaker for
• 00:23tonight, who I'm delighted,
• 00:25to introduce to you, professor
• 00:27Vardeep
• 00:28Revitsky.
• 00:28Professor Revitsky is a full
• 00:30professor at University of Montreal
• 00:31at the School of Public
• 00:32Health,
• 00:33and she's also a senior
• 00:34lecturer at Harvard.
• 00:36She is a former president
• 00:38of the, things, the International
• 00:40Association of Bioethics. Yes.
• 00:42She's extremely well known in
• 00:44our field. She is clearly
• 00:45a leader. She is the
• 00:47president and CEO of the
• 00:48Hastings Center. Many in the
• 00:50room know, and many in
• 00:51the room would have no
• 00:51reason to know, so I'll
• 00:52tell you now. This is
• 00:53the preeminent,
• 00:54ethics think tank bioethics think
• 00:56tank in the country, and
• 00:58certainly one of the ones,
• 00:59if not the one, for
• 01:00the world. Hastings Center is
• 01:01really,
• 01:03is really our mecca, for
• 01:05in in bioethics,
• 01:07and they are now very
• 01:08ably led by professor Revisky.
• 01:10Barditz published over two hundred
• 01:12articles. She's spoken,
• 01:14all she's given hundreds of
• 01:15invited lectures all over the
• 01:16world. She has expertise in
• 01:18everything from
• 01:19reproductive ethics to AI.
• 01:22And so given the breadth
• 01:23of her knowledge as well
• 01:24as the depth of her
• 01:25knowledge, she's an ideal person
• 01:27to talk to us about
• 01:28our field overall and where
• 01:30it may be headed. So,
• 01:31Vardeep, thank you so much
• 01:32for coming. Please give a
• 01:33warm welcome to professor Vardeep
• 01:35Ryvinsky.
• 01:40Now I
• 01:42and I and I should
• 01:43have reminded you how this
• 01:44goes for those who don't
• 01:45know is that professor Rubisky
• 01:47will speak for about forty
• 01:48five minutes. If she wants
• 01:49to go less or more,
• 01:50we're gonna let her do
• 01:50it. Right? Come on. And
• 01:52then,
• 01:52after that, we're gonna have
• 01:53some time. We're gonna sit
• 01:54down. We'll have a conversation,
• 01:55and we'll have we have
• 01:56microphones on each side here.
• 01:58And now please encourage, questions
• 02:00and comments from the audience.
• 02:01But for now, the floor
• 02:02is yours, my friend. Thank
• 02:03you so much.
• 02:08Thank you. I'm truly honored.
• 02:10And, Susan, that you're in
• 02:12the room,
• 02:13I'm honored to be a
• 02:14part of this event
• 02:16and to be back in
• 02:17Yale. Last time I was
• 02:18here was twenty years ago.
• 02:20So this is really special.
• 02:23And
• 02:24I will not
• 02:25you know, the topic is
• 02:26bioethics
• 02:27a path forward.
• 02:29I'm not gonna talk about
• 02:31how bioethics is going to
• 02:32address AI
• 02:34or genomics
• 02:36or
• 02:36end of life.
• 02:38This is not a talk
• 02:39about a topic.
• 02:40This is a talk about
• 02:41our field.
• 02:43So I'm gonna start by
• 02:44doing what I do when
• 02:45I teach,
• 02:47trigger you
• 02:48to think,
• 02:49if you were giving this
• 02:50talk,
• 02:52what would you focus on?
• 02:54So I have a few
• 02:55questions for you.
• 02:58What do you think is
• 02:59the greatest achievement
• 03:00of bioethics so far?
• 03:04Our field was born in
• 03:05the fifties, sixties, seventies
• 03:08in response to certain historical
• 03:10events and developments.
• 03:12It's a field of study.
• 03:14It's a social movement.
• 03:15But if you reflect
• 03:17on the decades
• 03:18that bioethics has been
• 03:21a field,
• 03:22What do you think
• 03:23is our greatest achievement?
• 03:27And now I'm gonna ask
• 03:28you, what do you think
• 03:29is our greatest weakness?
• 03:32And, you know, when we
• 03:34think about the future,
• 03:36we wanna build on our
• 03:37strengths.
• 03:38We want to address the
• 03:40gaps.
• 03:41We want to improve.
• 03:44So the question I want
• 03:45to address tonight with you
• 03:47is how would you like
• 03:48how would we like to
• 03:50see bioethics
• 03:51positioned
• 03:52in the coming years?
• 03:54And I'm asking it, of
• 03:56course, in light of the
• 03:56challenges that are coming our
• 03:58way, and there are many
• 04:00of them.
• 04:03Before I took on the
• 04:05leadership of the Hastings Center,
• 04:07I wrote a vision piece
• 04:09that was published in the
• 04:11Hastings Center report, of course.
• 04:14And it lays out
• 04:15some of my thoughts about
• 04:17the future of bioethics, and
• 04:19the talk tonight is based
• 04:20on this paper.
• 04:22But I will also give
• 04:23some specific examples that in
• 04:24the paper I couldn't give
• 04:26because I really want to,
• 04:28stimulate,
• 04:30discussion and comments, not just
• 04:31questions.
• 04:34So why talk about repositioning
• 04:37bioethics
• 04:37now?
• 04:39Why do I believe this
• 04:40is a moment in time
• 04:42where it's particularly
• 04:44relevant to ask ourselves where
• 04:46is the field going?
• 04:49I asked you to think
• 04:50backwards for a minute,
• 04:52and I'll admit that when
• 04:53I think about the history
• 04:54of bioethics,
• 04:55I think we did tremendous
• 04:57job emphasizing
• 04:58the importance of individual autonomy.
• 05:01We moved medicine
• 05:03away from paternalism.
• 05:04We gave patients and research
• 05:06participants their
• 05:07rights and their place of
• 05:09self determination.
• 05:12But
• 05:13maybe this is a controversial,
• 05:15claim. I'll make it anyways.
• 05:17I think we didn't always
• 05:18give adequate attention to issues
• 05:21related to the common good
• 05:23at the collective level.
• 05:25So this this would be
• 05:26one thing that I would
• 05:26like us to think about
• 05:28together. How do we shift
• 05:30our attention
• 05:31even more? We started, but
• 05:33even more
• 05:34towards the structural, the the
• 05:36systemic, the collective challenges that
• 05:38are coming our way.
• 05:44I want to explore with
• 05:45you tonight
• 05:46what bioethics would look like
• 05:49if it continues its evolution
• 05:52to become a field that
• 05:54embraces
• 05:55systemic collective level. Challenges
• 05:58has a global
• 05:59scale and focus,
• 06:01emphasizes
• 06:02human flourishing beyond health,
• 06:05seeks to have increased
• 06:07societal
• 06:08impact.
• 06:09I'll explore each of these,
• 06:11and I offer this vision
• 06:13not because I'm convinced that
• 06:15there's only one or that
• 06:16I'm right about every point
• 06:18I'll make tonight, but because
• 06:19I want to open a
• 06:22conversation, a wide ranging conversation
• 06:24about the future future of
• 06:26our field
• 06:27so that we make intentional,
• 06:29responsible
• 06:30choices,
• 06:32regarding
• 06:33where we invest, our intellectual
• 06:35energy, our resources,
• 06:37how we shape our future.
• 06:40When I started talking to
• 06:41people about this vision,
• 06:43and I spoke to
• 06:46dozens or hundreds of bioethicist
• 06:48about this over the past
• 06:49couple of years,
• 06:51some got all excited
• 06:52and others pushed back, and
• 06:54I call this the scope
• 06:56debate.
• 06:57Because when I say something
• 06:59like, oh, bioethics should be
• 07:00beyond health, people say,
• 07:03wait. You're going too wide.
• 07:06You're expanding
• 07:07too much.
• 07:08You are going to dilute
• 07:10our expertise
• 07:11and our effectiveness.
• 07:13We built
• 07:15a knowledge base. We built
• 07:16tools that allow us to
• 07:18address certain topics very well.
• 07:21We even were kind of
• 07:23the foundation of regulations
• 07:25and new laws
• 07:27and definitely new clinical norms.
• 07:29Let's stick to what we
• 07:30know, and let's continue to
• 07:32do well what we have
• 07:34done well, patient care, health
• 07:36care delivery, emerging biotechnologies,
• 07:39biomedical research.
• 07:41And I'm pushing against this
• 07:43because I think we must
• 07:44expand,
• 07:46to remain
• 07:48relevant,
• 07:49to have the tools to
• 07:50address the challenges of the
• 07:51future.
• 07:53I think now is the
• 07:54time to recognize that we
• 07:55have to push the envelope
• 07:56and go beyond what we've
• 07:58done,
• 07:59develop new knowledge and new
• 08:01skills.
• 08:03But I also think that
• 08:05this is not new, that
• 08:06what I'm proposing actually goes
• 08:08back to the roots of
• 08:09bioethics.
• 08:11Because when I think about
• 08:12some of our founders,
• 08:14I'm actually reinvigorating
• 08:16insights,
• 08:18that were eclipsed early in
• 08:19our history when we kinda
• 08:21took a turn towards clinical
• 08:23ethics and research ethics and
• 08:24patient centered issues.
• 08:27Dan Callahan, one of the
• 08:29two founders of the Hastings
• 08:30Center, wrote so much about
• 08:32the common good decades ago.
• 08:35Potter,
• 08:36who coined the term bioethics,
• 08:38talked about ecological and global
• 08:40bioethics.
• 08:41I don't know if students
• 08:42today read Potter,
• 08:44but the person responsible for
• 08:46the term bioethics
• 08:48talked about
• 08:49the ethics of
• 08:51our world, about natural environments,
• 08:55and definitely about the global
• 08:57level.
• 08:58And Hans Jonas talks talked
• 08:59about responsibility for the whole
• 09:01of nature and future generations,
• 09:03and these are just examples.
• 09:05So I think I'm proposing
• 09:07something
• 09:08that sounds new, but in
• 09:09a way is reinvigorating
• 09:12some of the original
• 09:14visions of our field.
• 09:17So I wanna talk about
• 09:18five points.
• 09:20I'll explain what I mean.
• 09:22I'll give some examples, and
• 09:23then let's discuss together.
• 09:28When I say from to,
• 09:30very important to highlight that
• 09:31I don't mean to abandon
• 09:34what we've done
• 09:35and what we know how
• 09:36to do well. I don't
• 09:38mean that we need to
• 09:40leave behind our work at
• 09:41the individual level at the
• 09:43bedside,
• 09:43protecting research participants,
• 09:45focusing on
• 09:47autonomy. No. Not abandon,
• 09:49but rather expand also towards
• 09:51the collective level, and that
• 09:53we have started to do.
• 09:55From local to global,
• 09:57we have a lot of
• 09:58issues locally,
• 10:00nationally,
• 10:01regionally. Of course, we have
• 10:03to continue to consider them,
• 10:05but move towards the global
• 10:07as well.
• 10:08Same for human health, same
• 10:10from scholarship to impact, and
• 10:12from a field to a
• 10:13hub. So now let me
• 10:14go a little more in-depth
• 10:15into each of these and
• 10:17what I mean.
• 10:19From individual to collective.
• 10:22We have so much going
• 10:23on in the world right
• 10:24now that we conveniently forget
• 10:27that we have barely emerged
• 10:29from one of the greatest,
• 10:33emergencies of our generation, the
• 10:34COVID nineteen pandemic.
• 10:36And I think it was
• 10:37a dramatic,
• 10:38wake up call for bioethics.
• 10:41All of a sudden, we
• 10:42needed public health ethics principles,
• 10:45not as a theoretical field
• 10:47of study
• 10:48that actually emerged in the
• 10:50history of bioethics lay later
• 10:52in the game. If you
• 10:53think about when the first
• 10:55frameworks,
• 10:57of public health ethics were
• 10:58proposed, when the journal public
• 11:00health ethics was founded, that
• 11:02was decades,
• 11:04after
• 11:05we've built our frameworks at
• 11:07the individual level.
• 11:08But all of a sudden,
• 11:09it wasn't just a theoretical
• 11:11notion.
• 11:12We needed those principles to
• 11:14cope with
• 11:15real tensions between individual freedoms
• 11:18and the common good
• 11:20to justify
• 11:21lockdowns,
• 11:22curfews, school closures, vaccine mandates.
• 11:26It was fascinating to me,
• 11:28I'm not originally from the
• 11:30US,
• 11:30and, what I care about
• 11:32the most in bioethics is
• 11:33cultural perspectives.
• 11:35It was fascinating to see
• 11:37how this this tension was
• 11:38playing out differently in different
• 11:40countries.
• 11:41There were countries in Europe
• 11:42that were nonapologetic
• 11:44about vaccine mandates
• 11:46because,
• 11:46obviously, solidarity comes before your
• 11:49right to do whatever you
• 11:50feel like. And this country
• 11:52took the term freedom
• 11:54in some really interesting directions
• 11:56during the pandemic,
• 11:58but the tension was there
• 11:59all the time. It was
• 12:00on the evening news. It
• 12:02was something that for a
• 12:03while kept us,
• 12:05at home or kept us
• 12:07very limited in our mobility,
• 12:09our ability to see our
• 12:10loved ones, our ability to
• 12:11say
• 12:13farewell to, to loved ones
• 12:15that were who were dying.
• 12:17I mean, our individual freedoms
• 12:19were seriously,
• 12:21constrained
• 12:22by,
• 12:24the common good. It played
• 12:25out differently in policies,
• 12:28but the tension was present.
• 12:31Another element of collective level
• 12:33was the theories of justice
• 12:34and resource allocation,
• 12:36all of a sudden were
• 12:37needed to feed into
• 12:39real time policies,
• 12:41triage protocols. Remember them?
• 12:44Not enough ICU beds. Who's
• 12:46gonna get the bed? These
• 12:47were real documents
• 12:49that we were afraid we
• 12:50were gonna have to implement
• 12:52so that some people who
• 12:53could benefit from treatment would
• 12:55not have access to treatment.
• 12:57Unprecedented.
• 12:58And those decisions were supposed
• 13:00to be made based on
• 13:01ethical
• 13:02clinical plus ethical criteria.
• 13:05Where where are the frameworks
• 13:07to justify that?
• 13:10Then when the vaccines were
• 13:11rolled out, we had to
• 13:12cope with national vaccination priorities.
• 13:14Do you remember the beyond
• 13:15a certain age came first,
• 13:17people with disabilities?
• 13:18There was not enough for
• 13:19everybody. We had to create
• 13:21groups
• 13:22and the criteria. Again, there
• 13:23were some clinical
• 13:25factors, but a lot of
• 13:26it was an ethical conversation.
• 13:29So,
• 13:30let alone the the debate
• 13:32between vaccine nationalism and global
• 13:34vaccine equity where some governments,
• 13:36including my own, the Canadian,
• 13:38were hoarding
• 13:39millions of doses that expired
• 13:42rather than sending them to
• 13:43countries that urgently needed them.
• 13:46So these just examples of
• 13:48some of the tensions that
• 13:49were very
• 13:51real,
• 13:52pragmatic,
• 13:53daily, discussed on the evening
• 13:55news, discussed around kitchen tables
• 13:57in every home,
• 13:59bioethics
• 14:00was there.
• 14:02And I'm asking you, do
• 14:04you think that we were
• 14:05prepared?
• 14:06Do you think that we
• 14:07had
• 14:08the conceptual frameworks,
• 14:10the theories of justice that
• 14:12are nuanced enough,
• 14:14the resource allocation principles,
• 14:17the developed,
• 14:19conceptual
• 14:20notions of how to balance
• 14:22individual freedom and common good.
• 14:24Did we come to this
• 14:25crisis prepared?
• 14:27Did we have the, you
• 14:28know, all those,
• 14:29protocols in the drawer? Just
• 14:31dust them off and hand
• 14:33them to hospitals, or did
• 14:34we development develop them in
• 14:36great panic.
• 14:38When we were invited to
• 14:40policy tables during the pandemic,
• 14:42did we speak I'm not
• 14:43saying in one voice, but
• 14:45did we rely on a
• 14:46solid robust body of knowledge
• 14:48that we spent decades developing?
• 14:51I'm saying it with a
• 14:52question mark, but I think
• 14:53from my intonation,
• 14:56you can see where I'm
• 14:57heading with this, and I'd
• 14:58love to hear what you
• 14:58think. But I am trying
• 15:00to argue that bioethics needs
• 15:02to move much more seriously
• 15:04and urgently
• 15:06into the collective level thinking.
• 15:09Not just public health ethics,
• 15:11but general principles and and
• 15:14frameworks for considering
• 15:16individuals
• 15:17within their
• 15:18communities and societies.
• 15:23So my argument is that
• 15:25our conceptual tools for addressing
• 15:26issues of justice, fairness, equity
• 15:28are underdeveloped
• 15:30and need to become more
• 15:31sophisticated.
• 15:33And we also need to
• 15:34acknowledge more seriously cultural and
• 15:36societal context because as I
• 15:38just,
• 15:39demonstrated through talking about COVID
• 15:41policies,
• 15:42these things will not play
• 15:43out the same in different
• 15:45cultures.
• 15:46And without,
• 15:47taking into account
• 15:49societal norms and cultural backgrounds,
• 15:52the tools that we develop
• 15:53will not
• 15:55be impactful in the way
• 15:56that they need to be.
• 15:59And I think this is
• 16:00all urgent because because current
• 16:01and future threats will require
• 16:03applying theories of justice and
• 16:05concepts of fairness
• 16:06at the global level and
• 16:08the intergenerational level.
• 16:10My kids sometimes
• 16:12look at me and say,
• 16:13look at the world you're
• 16:13leaving for us and for
• 16:15our children. They talk about
• 16:16climate change.
• 16:18But even when we talk
• 16:19about CRISPR and all sorts
• 16:21of biotechnologies
• 16:22that are actually changing fundamentally,
• 16:24let alone AI,
• 16:26changing what it means to
• 16:27be human,
• 16:29what world we're leaving behind,
• 16:31intergenerational
• 16:32justice
• 16:33and global justice have to
• 16:35be at the center of
• 16:37our collective level thinking.
• 16:40Moving on, from local to
• 16:42global.
• 16:44I travel a lot and
• 16:46speak in many countries.
• 16:47Bioethics has a very different
• 16:49flavor
• 16:50in Europe,
• 16:52in Africa,
• 16:53in the Middle East.
• 16:55And I think we need
• 16:56to start paying more attention
• 16:58to how bioethics
• 16:59plays
• 17:00a role globally.
• 17:02I think the pandemic obviously
• 17:03gave a new meaning to
• 17:04the global village. Viruses had
• 17:06a no don't know borders.
• 17:08Nobody's safe until everybody's safe.
• 17:10All those mantras
• 17:11that we had, the way
• 17:12the WHO promoted,
• 17:14more, global equity was through
• 17:17encouraging us to recognize
• 17:19that the world is interconnected.
• 17:21But other upcoming issues give
• 17:23additional meanings to the notion
• 17:25of interconnected world.
• 17:27AI regulation is not gonna
• 17:29work nationally.
• 17:32There are current,
• 17:33biotechnologies
• 17:34that combined with medical tourism,
• 17:36as much as you try
• 17:37to control them nationally, people
• 17:39go where they can purchase
• 17:40them.
• 17:41The world is too small
• 17:42now.
• 17:44Between the the the tools
• 17:46that,
• 17:47the digital media is giving
• 17:49us
• 17:50and,
• 17:51the threats of pandemics and,
• 17:53of course, climate change,
• 17:55many challenges if we address
• 17:57them locally, we're gonna fail.
• 18:00So paying attention to the
• 18:01global level, I think, is
• 18:03one of the greatest challenges
• 18:04of bioethics in the years
• 18:05to come.
• 18:07AI is one example.
• 18:09But where I really
• 18:12feel where I'm really struggling
• 18:15is when I realized that
• 18:16thinking globally means learning to
• 18:18take diversity
• 18:20seriously.
• 18:22Now think about diversity in
• 18:23the kinda usual
• 18:25classic bioethic sense. Oh, when
• 18:27you're taking care of a
• 18:29patient, you need cultural sensitivity.
• 18:31Right? You need to understand
• 18:32where they're coming from in
• 18:33terms of their end of
• 18:34life values.
• 18:36We think that that's diversity.
• 18:37We need to diversify
• 18:39bioethics as a field, of
• 18:40course, the workforce.
• 18:42Yes. That is all very
• 18:44important,
• 18:45but it's still
• 18:47sort of local diversity.
• 18:49This is the
• 18:50need to be sensitive to
• 18:52diversity within an overall western
• 18:54context
• 18:56in which bioethics was born
• 18:58and evolved.
• 18:59And when you think about
• 19:01diversity globally,
• 19:03it is just much more
• 19:04challenging and much more complex
• 19:07because the cultures
• 19:09elsewhere
• 19:11challenge
• 19:12values that we,
• 19:14ever the we are,
• 19:17really take for granted, sometimes
• 19:19without noticing.
• 19:21And I want to give
• 19:21you the example
• 19:23of the struggle that I
• 19:24had when in twenty twenty
• 19:26one, I was the president
• 19:27of the International Association of
• 19:29Bioethics, and this is the
• 19:31actually, the only
• 19:33truly global bioethics organization in
• 19:35the world
• 19:36that for over thirty year
• 19:38organize years organizes
• 19:40every other year the World
• 19:42Congress of Bioethics,
• 19:44which is the biggest bioethics,
• 19:46meeting in the world.
• 19:48And the board,
• 19:50of the association
• 19:52has the task of choosing
• 19:53the country that will host
• 19:55the congress.
• 19:56We try to alternate,
• 19:58high income country and low
• 20:00income country. We try to
• 20:01go all over the world.
• 20:03After COVID, it was very
• 20:05difficult to find a country
• 20:06that had the resources and
• 20:08the ability to
• 20:10we wanted to go to,
• 20:12to Lebanon.
• 20:14Their economy collapsed. We wanted
• 20:16we really struggled.
• 20:17And then we had an
• 20:19offer to host
• 20:21that was really interesting.
• 20:23We considered it and decided
• 20:25to give that country the
• 20:27right to host, which is
• 20:28considered a great honor. It
• 20:30brings,
• 20:31hundreds of bioethicists to that
• 20:33location and kind of stimulates
• 20:35a lot of bioethics activity
• 20:37around the congress.
• 20:39And when we announced that
• 20:41choice,
• 20:44I
• 20:45I don't remember,
• 20:47facing that level of criticism
• 20:49other than when I spoke
• 20:50during COVID in favor of
• 20:51the vaccines on the media.
• 20:53That was also the death
• 20:54threats were not fun. But
• 20:55in the context of bioethics,
• 20:58I have never hit such
• 21:00a wave of criticism
• 21:03and resistance
• 21:04as when I announced
• 21:06that the next host of
• 21:07the congress is Qatar.
• 21:10And the criticism came from
• 21:12multiple directions.
• 21:14There were friends,
• 21:16bioethicist
• 21:17who are gay or queer,
• 21:19picked up the phone and
• 21:20said, how could
• 21:23you take the congress to
• 21:24a place where I will
• 21:25not feel safe?
• 21:27There were others who said,
• 21:29this is a country with
• 21:30a track record of violation
• 21:32of human rights,
• 21:33foreign workers who don't have
• 21:34access to health.
• 21:36What are you doing? Taking
• 21:37bioethics
• 21:38there?
• 21:40And it didn't stay at
• 21:41the level of phone calls
• 21:43and emails.
• 21:44A group of Dutch bioethicists
• 21:46wrote this piece in the
• 21:47journal
• 21:48Bioethics, which is the journal
• 21:50of the International Association of
• 21:51Bioethics,
• 21:52Bioethics, criticizing the choice the
• 21:54choice of Qatar
• 21:56in very serious terms.
• 21:58So, of course, myself and,
• 22:01the the now president, the
• 22:03new president, we wrote a
• 22:04response in bioethics, and it
• 22:06became a debate.
• 22:08It was beginning to get
• 22:10media attention in mainstream media.
• 22:12People were writing about the,
• 22:15storm within bioethics.
• 22:17They're arguing with each other
• 22:18over where to go.
• 22:20And then Udo
• 22:22Shkolnik, the
• 22:23editor of bioethics, wrote an
• 22:25editorial, a piece.
• 22:27First, he supported it, then
• 22:28he decided that it was
• 22:29a really bad idea.
• 22:31And a part of his
• 22:32change of heart was that
• 22:34the topic
• 22:35the Qataris chose
• 22:36with the board of the
• 22:38association
• 22:39for the congress was
• 22:41religion, culture,
• 22:42and global bioethics.
• 22:45For the first time ever,
• 22:46we were going to the
• 22:47Middle East. For the first
• 22:48time ever, we were going
• 22:50to an Arab country. They
• 22:51wanted to talk about religion
• 22:53as a part of bioethics
• 22:55and culture
• 22:57as a part of the
• 22:58global conversation,
• 23:00but some bioethicist in the
• 23:01US said,
• 23:03no, we don't do religion.
• 23:04We're bioethics.
• 23:06We're a fundamentally
• 23:08secular field.
• 23:09You cannot put the world
• 23:11religion in the title of
• 23:12the World Congress of Bioethics.
• 23:14So that was
• 23:16a piece by the editor
• 23:17of the journal.
• 23:18Then David Magnus, the editor
• 23:20of A Job, wrote a
• 23:22very critical piece,
• 23:24and a group of us
• 23:25wrote a response to Magnus.
• 23:26And you can identify some
• 23:28names here, Julian Savalesco, Art
• 23:30Caplan,
• 23:31Alex Capron, who was the
• 23:32president of IBM.
• 23:33So this was becoming a
• 23:35real, also academic debate.
• 23:38But beyond the criticism of
• 23:40specifically Qatar, it became a
• 23:41conversation about what it means
• 23:44to respect diversity
• 23:47at the global level.
• 23:49What does it mean to
• 23:50say we don't go
• 23:52where
• 23:54people don't share
• 23:55our values?
• 23:57And I was saying to
• 23:58people, do you wanna just
• 23:59stay in Switzerland forever?
• 24:00Because that was the the
• 24:02the pro the congress prior
• 24:03to that was in Basel.
• 24:06First of all, show me
• 24:07a country that has a
• 24:08clean track record.
• 24:10When we hosted it in
• 24:11the US under the Trump
• 24:12administration,
• 24:14people called to boycott the
• 24:15congress because people from Muslim
• 24:17countries couldn't come into the
• 24:18US. So show me a
• 24:19country that has a a
• 24:21clean track record, but also
• 24:23what does it mean to
• 24:24say I don't engage
• 24:25unless you share
• 24:28some values with me?
• 24:29Or at least
• 24:31what does it mean to
• 24:32say we will not go
• 24:33where we can actually now
• 24:35I'm making my our arguments.
• 24:36We're not gonna go where
• 24:37we can help
• 24:39on the ground
• 24:40those who work to promote
• 24:41human rights because we don't
• 24:43want to be associated
• 24:46with certain
• 24:47sets of of values.
• 24:50So then we decided to
• 24:51write a target article
• 24:54about proposing
• 24:55a theoretical
• 24:56framework for
• 24:58bioethics
• 24:59conferencing.
• 25:00So I think this I
• 25:01I think it's a new
• 25:02term.
• 25:03Where what what are the
• 25:05ethics of bioethics conferencing?
• 25:08But, again, this was just
• 25:09a way of talking about
• 25:10global bioethics and what it
• 25:12requires.
• 25:13What does it mean to
• 25:14go to be open minded
• 25:16when you truly disagree?
• 25:17What does it mean to
• 25:18have a conversation when you're
• 25:20exceptionally
• 25:20uncomfortable?
• 25:22What does it mean
• 25:23going to a place where
• 25:24you wanna help the feminists
• 25:26and the human right activists
• 25:28and those who do work
• 25:29on
• 25:30getting, migrant workers health rights,
• 25:32but it means that you
• 25:33have to go someplace where
• 25:34some people would not feel
• 25:36safe.
• 25:37What does it mean to
• 25:38truly,
• 25:40do the work of diversity
• 25:41globally?
• 25:42And that's what the piece
• 25:43is actually about.
• 25:45Because that was a target
• 25:46article, you know the format,
• 25:47age of invites commentaries
• 25:49from the field of bioethics.
• 25:53Many people wrote. They had
• 25:55to select, but
• 25:56this is a huge amount
• 25:57of commentaries.
• 25:59And people went at this
• 26:00from all directions,
• 26:01agreeing, disagreeing.
• 26:03But, again, that stimulated a
• 26:05conversation about something that I
• 26:07think we have to address
• 26:09as a field.
• 26:10We cannot stay in our
• 26:12boxes and in our comfort
• 26:13zones and talk to each
• 26:15other on the basis of
• 26:16some
• 26:17basic agreement where we marginally
• 26:19maybe,
• 26:20have some that some some
• 26:22differences.
• 26:23We need to learn to
• 26:24talk
• 26:25where we're really feeling threatened,
• 26:28uncomfortable,
• 26:29and out of our depth.
• 26:30And that's where the interesting
• 26:31work is going to happen
• 26:33in the future.
• 26:34In my opinion,
• 26:35let's discuss.
• 26:38I'd also wanted to show
• 26:39you that in the media,
• 26:41locally,
• 26:42there was a lot of
• 26:42attention.
• 26:43For example,
• 26:45to the notion that a
• 26:46World Congress of Bioethics didn't
• 26:48ignore religion.
• 26:50For the for the region,
• 26:52for the Middle East, that
• 26:53was huge that people could
• 26:54talk about what actually mattered
• 26:56to them
• 26:57in the way that they
• 26:58deliver care, in the way
• 26:59that they talk to their
• 27:00patients.
• 27:02And, again, you know, the
• 27:03the
• 27:04the scandal around academics
• 27:06not agreeing with each other.
• 27:09So what does that mean
• 27:10to do globally,
• 27:13to do bioethics globally in
• 27:15a diverse world
• 27:16that is increasingly
• 27:18polarized?
• 27:19I don't have the answers,
• 27:21but I think our field
• 27:23has to,
• 27:24pay a lot of attention
• 27:26to that question.
• 27:27From human health to human
• 27:29flourishing,
• 27:30what do I mean?
• 27:32Think for a second if
• 27:34somebody asked you I don't
• 27:35know. Sometimes when I go
• 27:36into, into a country and
• 27:37they ask me what do
• 27:38you do, if I dare
• 27:39to say I'm a bioethicist,
• 27:41I'll get stuck at the
• 27:42border for twenty minutes explaining
• 27:44what it is.
• 27:45If I say medical ethics,
• 27:47I always get my mom's
• 27:49doctor was not ethical.
• 27:51Let me tell you what
• 27:52he did.
• 27:53So I'm try I'm find
• 27:54I'm trying to find something
• 27:56to say that would get
• 27:56get me through the line
• 27:57quickly.
• 27:58But if you ever tried
• 28:00to explain bioethics to someone
• 28:01who really doesn't
• 28:03know, you would give examples
• 28:05such as,
• 28:07decisions at the end of
• 28:09life,
• 28:11reproductive
• 28:15ethics.
• 28:16You you would give sort
• 28:17of mainstream
• 28:18bioethical,
• 28:19topical
• 28:20issues
• 28:20to explain what the field
• 28:22does. Genetics.
• 28:24What does it mean to
• 28:25talk about human flourishing and
• 28:27not just human health? So
• 28:28let me ask you this.
• 28:31Oh, first, I'll say what
• 28:32what I what I want
• 28:33it to mean. I want
• 28:34us to move beyond the
• 28:35focus on health and set
• 28:37the more ambitious goal of
• 28:38exploring the conditions
• 28:40for human flourishing.
• 28:42So if I asked you,
• 28:43is poverty
• 28:45bioethics?
• 28:47Does bioethics work on poverty,
• 28:49on issues that emerge?
• 28:52Now we know that the
• 28:54number one predictor
• 28:56of life expectancy in the
• 28:57United States is
• 29:01your postal code.
• 29:04So if socioeconomic status
• 29:08and,
• 29:09and poverty
• 29:10are not if we don't
• 29:11recognize that they're tied to
• 29:12health,
• 29:13we're just not doing our
• 29:15job. We're not doing a
• 29:16comprehensive job. Social social determinants
• 29:19of health,
• 29:20you know, it bioethics doesn't
• 29:21start when you walk into
• 29:22the hospital. You have to
• 29:24ask what got you there
• 29:25with a certain condition at
• 29:27a certain age.
• 29:29Is racism
• 29:30the work of bioethics?
• 29:32The Hastings Center just published
• 29:34a special recently published a
• 29:36special issue, special report
• 29:38on how racism plays out,
• 29:41historically in medicine.
• 29:43Huge impact. Is war a
• 29:46bioethical issue?
• 29:49Since the beginning of I'm
• 29:51Israeli. It's been a really
• 29:52tough year since the beginning
• 29:53of the war in the
• 29:54Middle East.
• 29:55Bioethicists
• 29:56have been criticized over and
• 29:57over again for not speaking
• 29:59up
• 30:00about war.
• 30:02So we just published another
• 30:03target article in Ajob,
• 30:06talking about,
• 30:08war as
• 30:09a bioethical
• 30:11challenge
• 30:11and the need of bioethics
• 30:13to speak about what war
• 30:14does
• 30:16to
• 30:16public health and to health
• 30:18infrastructure.
• 30:19Not in a political way,
• 30:21through the lens of the
• 30:23impact on the systemic
• 30:25impact on health and human
• 30:27flourishing.
• 30:28So, you know, you could
• 30:29look at that article and
• 30:31say, well, that's not bioethics.
• 30:33We we argue that it
• 30:35is.
• 30:36Climate change. Is climate change
• 30:37bioethics?
• 30:39We see the impact already.
• 30:41We know that marginalized communities
• 30:43will be impacted more.
• 30:45We know that this will
• 30:46impact migration patterns, and this
• 30:48will change the way we
• 30:49deliver care in some countries.
• 30:51How can we ignore climate
• 30:52change as a field?
• 30:54Misinformation,
• 30:56of course. During COVID, we
• 30:57saw misinformation
• 30:58kill
• 30:59people.
• 31:00We know that
• 31:02factually,
• 31:03misinformation caused people to not
• 31:05get vaccinated, and there were
• 31:06preventable deaths
• 31:08based on the mistrust
• 31:10in health and science.
• 31:12Threats to democracy,
• 31:14are those a bioethical issue?
• 31:16You know, I'm I'm stretching
• 31:17it,
• 31:18and people look at this
• 31:20list and say,
• 31:21well, then everything's bioethics.
• 31:24And I push back and
• 31:25say, no. Not everything is
• 31:27bioethics, but bioethics has to
• 31:29be able to accommodate
• 31:31challenges
• 31:33to health and human flourishing
• 31:36no matter where they come
• 31:37from.
• 31:38They don't have to be
• 31:39at the bedside.
• 31:43So what I'm advocating for
• 31:45is the more ambitious bioethics
• 31:47that would focus on removing
• 31:49barriers to flourishing
• 31:51and building,
• 31:52societies that promote it.
• 31:55Almost,
• 31:56the last point is from
• 31:58scholarship to impact.
• 32:01I think when we look
• 32:02at the past, bioethics
• 32:04produced a superb,
• 32:05literary canon. We built a
• 32:07rich and nuanced knowledge base,
• 32:09both conceptual and empirical.
• 32:11We used our expertise to
• 32:12contribute to decision making,
• 32:15and we do engage regularly
• 32:17with the media, and we
• 32:18make genuine efforts to be
• 32:19more accessible to the general
• 32:21public. We do all that.
• 32:22But at the end of
• 32:23the day, we're still
• 32:25an academic field.
• 32:27And those of you who
• 32:28have students,
• 32:30if your student asks you,
• 32:32what should I prioritize?
• 32:33An op ed in the
• 32:34New York Times
• 32:35or a peer reviewed article
• 32:37in
• 32:38I won't say in the
• 32:39New England. I'll say in
• 32:40a in a journal that
• 32:41is good, but read by
• 32:43a very limited number of
• 32:44people. What would you say
• 32:46to your student?
• 32:50You would probably
• 32:51encourage them to do what's
• 32:52right for their career
• 32:55until they get to the
• 32:56point that they can afford
• 32:58to do social impact
• 33:00because they're secure
• 33:02in their professional path.
• 33:05So I'm calling on us
• 33:06to acknowledge impact
• 33:08as a
• 33:10core mission
• 33:12of equal value to scholarship.
• 33:14Now when I talk about
• 33:15impact, it has to be
• 33:16based on expertise. I don't
• 33:17want, you know,
• 33:19master students talking to the
• 33:21media about their opinions,
• 33:24based on expertise, based on
• 33:26research.
• 33:27But I would love to
• 33:28see bioethics paying as much
• 33:30attention
• 33:31to social impact
• 33:33as it does to scholarship.
• 33:35And impact can mean many
• 33:37things, policy development,
• 33:38implementing recommendations,
• 33:40public engagement in education,
• 33:42mainstream, and social media. Many
• 33:45younger,
• 33:46early career researchers
• 33:48come and ask me how
• 33:49to engage,
• 33:51how to,
• 33:52inform the public.
• 33:54And there are very specific
• 33:55ways to do it responsibly.
• 33:57Choose a niche,
• 33:59something that you really know,
• 34:01and
• 34:02create a following on social
• 34:04media who's interested in that
• 34:07very specific expertise that you
• 34:09can offer.
• 34:10Develop a voice.
• 34:11Create a presence.
• 34:13Find your find your tools.
• 34:15There are so many ways
• 34:16to have impact these days.
• 34:18The world is hungry for
• 34:20information.
• 34:21We're fighting misinformation.
• 34:23We have to do everything
• 34:24we can to build trust
• 34:26and to be trustworthy.
• 34:28And so I'm just inviting
• 34:29everybody to join in,
• 34:32the the the attempt, the
• 34:34effort, the investment to have
• 34:35impact throughout your career,
• 34:38not when you're kinda, you
• 34:39know, sitting on your,
• 34:41academic,
• 34:42laurels and you can afford
• 34:45to to give attention to
• 34:46it. Do it right from
• 34:47the beginning as soon as
• 34:48you develop your expertise.
• 34:52So my point is that
• 34:53these contributions
• 34:55should not be seen as
• 34:56peripheral to our mission.
• 34:57They should be key considerations
• 34:59in how we train,
• 35:01how we formulate our research
• 35:02questions,
• 35:04how we write our grant
• 35:05proposals, and how we evaluate
• 35:07our achievements.
• 35:08So this is a road
• 35:09map for
• 35:10a real transformation of careers
• 35:12in bioethics.
• 35:14Many have tried before.
• 35:17Academia
• 35:17is not easy to change,
• 35:19but bioethics has done historically
• 35:22many things that other fields
• 35:24have struggled with. We are
• 35:25truly interdisciplinary.
• 35:27Our, margins are truly kind
• 35:29of fuzzy. We invite people
• 35:31in. We expand all the
• 35:33time. Maybe we can be,
• 35:35maybe we can bring this
• 35:37change into academia.
• 35:38So going forward, I inviting
• 35:41us to design our field
• 35:42to meet the challenges of
• 35:43impact. And lastly,
• 35:45from a field to a
• 35:46hub.
• 35:48I'm using the metaphor of
• 35:49bioethics as a hub.
• 35:51Think, for example,
• 35:53of a field
• 35:55spending decades
• 35:57mapping an island.
• 35:59We mapped our areas of
• 36:00expertise,
• 36:01our methodologies.
• 36:02We incorporated more and more
• 36:04empirical methods.
• 36:06We've evolved.
• 36:07But in a way, we're
• 36:09still in our territory, and
• 36:10I'm inviting us to build
• 36:11the bridges,
• 36:13to the outside world. And
• 36:15I'd love to see bioethics
• 36:16use its convening power and
• 36:18its,
• 36:20maturity,
• 36:21to become to operate as
• 36:23a hub to expand our
• 36:24mission. We mean we need
• 36:26more players,
• 36:27but it doesn't mean that
• 36:28all these players should be
• 36:29seen as or define themselves
• 36:31as bioethicists.
• 36:33They can be other things
• 36:34and they can come play
• 36:35with us.
• 36:36I think we're recognized enough
• 36:38to use our convening power
• 36:39and become a hub for
• 36:40thinking and activity.
• 36:42There's a lot of writing
• 36:43that tries to figure out
• 36:44where we are in our
• 36:45development. Are we in adolescence?
• 36:49A paper was published a
• 36:50couple weeks ago in bioethics,
• 36:52saying that we're adult we're
• 36:56teenagers,
• 36:56according to our, you know,
• 36:58stage of development.
• 36:59I think we're at least
• 37:00young adults.
• 37:01I'll give us that. I
• 37:03have teenagers teenagers at home.
• 37:05We're not teenagers,
• 37:08but we're still a young
• 37:10field. And I think we're
• 37:12now recognized
• 37:13enough,
• 37:15to to have real,
• 37:19standing
• 37:20and reputation
• 37:22and to be a convening
• 37:23power to do even more
• 37:25interdisciplinary
• 37:26work that has, again,
• 37:28expansive,
• 37:29broader reach.
• 37:31So these are my points.
• 37:34Maybe you agree with one
• 37:35or two and reject the
• 37:36others. Maybe for each one
• 37:38of them, you only buy
• 37:39a part of the story
• 37:40I'm telling, but you think
• 37:41I'm exaggerating.
• 37:43I know I'm pushing,
• 37:44pretty far in terms of
• 37:46where where I'd like us
• 37:47to go,
• 37:49But I'm really seeing this
• 37:50point in time in the
• 37:52history of bioethics
• 37:53as a point of openness,
• 37:55of where we need to
• 37:56sort of embrace,
• 37:59bigger challenges,
• 38:01broader understanding of the human
• 38:03condition,
• 38:05go globally,
• 38:06go systemically,
• 38:08and, be courageous.
• 38:10Be courageous to face the
• 38:11challenges of diversity, the challenges
• 38:13of an interconnected world,
• 38:15the challenges that the future
• 38:17is bringing,
• 38:18such as AI and climate
• 38:19change.
• 38:20I think that if we,
• 38:21follow this vision, we will
• 38:23be better equipped
• 38:25to really make a difference
• 38:26in the lives of individuals,
• 38:28communities, and societies.
• 38:29Thank you for
• 38:35inviting
• 38:41me.
• 38:44It's closest to us here.
• 38:47Well, that was outstanding.
• 38:50What I'm gonna, ask we
• 38:51do now is for the
• 38:52next little bit, we've got
• 38:53the hall till seven o'clock.
• 38:55We'll see how we do.
• 38:57I invite your questions.
• 38:59What will be maybe.
• 39:06So I invite certain questions.
• 39:07We've got microphones on, on
• 39:09each side. Oh, look at
• 39:10this. I've got one here
• 39:11too.
• 39:13Microphones all over me. Alright.
• 39:15You said that.
• 39:18That was,
• 39:20absolutely amazing,
• 39:23and very ambitious.
• 39:24I appreciate I'm looking at
• 39:25my boss, Jessica. I'm pleased
• 39:27to I'm hoping you got
• 39:28the message across to Jessica
• 39:29just how important bioethics is.
• 39:31I was a little discouraged.
• 39:32There wasn't more conversation about
• 39:34the financing of bioethics, but
• 39:37maybe next year, you'll come
• 39:38back and try and talk
• 39:39to us more about that.
• 39:39I'm not a miracle worker.
• 39:41I'm just so vicious. Oh,
• 39:43I think you're you're you're
• 39:44doing an awful lot. I
• 39:45wanna ask you something very
• 39:46I mean, there's so much
• 39:47of this that that,
• 39:49that really,
• 39:51rang true and others and
• 39:53you anticipated one of my
• 39:54criticisms about if you know,
• 39:56I was worried if we're
• 39:57about everything, then we're about
• 39:58nothing, and I worry about
• 39:59that. I mean, if we
• 40:00talk about how we
• 40:02collect our,
• 40:04how we collect fossil fuels
• 40:05from the ground, then that
• 40:07ultimately is bioethics. And so,
• 40:08you know, geology is bioethics.
• 40:10And no. I I I
• 40:11got your point. Now and
• 40:12I'll and I'll I want
• 40:13you to respond to that
• 40:14before I ask my real
• 40:15question. But but go ahead.
• 40:16Because you did mention briefly
• 40:18why that's you did respond
• 40:20to that anticipate in response
• 40:21to that criticism of if
• 40:22we're really about everything,
• 40:24then we're about nothing. So
• 40:26I I wanna give you
• 40:27a chance to talk more
• 40:28about that. Thank you for
• 40:29that. It's it's an opportunity
• 40:30to nuance.
• 40:31We're not about everything. We're
• 40:33about how everything touches human
• 40:35health.
• 40:37We can't think I I
• 40:39believe we cannot think about
• 40:40human health as starting when
• 40:42we have a health crisis.
• 40:44We wanna think about health
• 40:45in terms
• 40:46of maintaining our health,
• 40:49the factors that support our
• 40:50health,
• 40:51public health,
• 40:54all the the conditions
• 40:56that allow us to thrive
• 40:58within societies.
• 40:59So it's still about health,
• 41:01only a very broad view
• 41:03of health, which is actually
• 41:04when you go back to
• 41:05the definition of the WHO,
• 41:07this ambitious definition that, do
• 41:09you remember what it is?
• 41:11Complete state of physical and
• 41:13mental and social well-being.
• 41:16We've had this definition for
• 41:17a long time.
• 41:19I think it's dangerous to
• 41:20think of health as relevant
• 41:22when it fails.
• 41:24I appreciate that. Now
• 41:26let me let me get
• 41:27to one more question, and
• 41:29then, Mark, I know I
• 41:29know the others who have
• 41:30questions as well. One of
• 41:32the things that occurred to
• 41:33me is what I think
• 41:35bioethics is about also something
• 41:36that medicine is very much
• 41:38about my career in, in
• 41:39neonatology and critical care, which
• 41:41is it needs to be
• 41:42about anticipation.
• 41:44And, of course, the answer
• 41:45to your question of were
• 41:46we prepared for the COVID
• 41:47pandemic, the answer to that
• 41:48was painfully obvious,
• 41:49to all of us, prepared
• 41:51as bioethicist even for the
• 41:53COVID pandemic.
• 41:54And and, you know, and
• 41:55I've long maintained that that
• 41:56will be our last pandemic
• 41:59until the next one.
• 42:00And and we need,
• 42:02we need to be prepared.
• 42:03One of I had kind
• 42:04of an interesting perspective on
• 42:06this as I was still
• 42:07a chief of neonatology,
• 42:09though, thankfully, I had an
• 42:10interim chief at the time,
• 42:11because I was also working
• 42:12with people like Ben Tolchin
• 42:13and Mark Siegel and others
• 42:15as we were trying to
• 42:16come up with our triage
• 42:17protocols.
• 42:18But one of the things
• 42:18that fascinated me from that
• 42:20perspective was when it came
• 42:21to how we were gonna
• 42:22respond to the the the
• 42:23virus to the pandemic in
• 42:25the hospital,
• 42:26about every fifteen seconds, the
• 42:28CDC would come through with
• 42:29another,
• 42:30requirement or recommendation,
• 42:32and it was kinda making
• 42:33the clinical leadership
• 42:34really crazy. Everybody was trying
• 42:36their hardest to do what's
• 42:37best, recognizing that, you know,
• 42:39we were this was we
• 42:40were a work in progress.
• 42:41Everybody was just learning about
• 42:42this virus. And so there's
• 42:44lots of recommendations,
• 42:45but that was in tremendous
• 42:47contrast to bioethics.
• 42:49And on a national level,
• 42:51from a governmental level, there
• 42:52was
• 42:53dead silence.
• 42:55There was no guidance, and
• 42:56it struck me as interesting.
• 42:57When you asked the question,
• 42:59did we respond in one
• 43:00voice?
• 43:01I wondered, we don't really
• 43:03have one voice. We have
• 43:04no
• 43:05focus. Now some would say,
• 43:06well, that's the Hastings Center.
• 43:07Hey. I won't argue with
• 43:08that. Maybe it's a little
• 43:09bit the Hastings Center, but
• 43:11we don't have one voice.
• 43:12And I had said it's
• 43:13too bad because we had
• 43:14a president's commissioning bioethics, as
• 43:16you know, for many, many
• 43:17years, and that administration had
• 43:18actually eliminated it. And so
• 43:20we had no one voice.
• 43:22And when I protested that
• 43:24and actually with in subsequent
• 43:26administration,
• 43:27I actually questioned, can we
• 43:28please get a commission back?
• 43:30Can we get a national
• 43:31voice? Can we try and
• 43:32build national consensus in bioethics?
• 43:34But someone said to me,
• 43:35well, be careful what you
• 43:36wish for because maybe what
• 43:37that group is gonna end
• 43:38up recommending depending on who's
• 43:40in office, etcetera, might not
• 43:41be something you want. So
• 43:42my question to you is
• 43:44with that, when you ask,
• 43:45do we respond to one
• 43:46voice, could we have more
• 43:48of a formal arrangement
• 43:50so that we can speak
• 43:51in one voice?
• 43:53I mean, you look
• 43:55again,
• 43:56I really grow up here,
• 43:57but
• 43:58coming to this country at
• 44:00this point in time,
• 44:01it seems everything seems so
• 44:03polarized
• 44:04that I think the answer
• 44:05is obvious. It it's not
• 44:07gonna be possible,
• 44:08and it may lead to
• 44:09dangerous outcomes.
• 44:12So I don't mean that
• 44:13we need one voice, but
• 44:15at least a suspect rather.
• 44:18You know? Saying that many
• 44:20answers can can be true
• 44:23doesn't mean that there aren't
• 44:24wrong answers at the extremes.
• 44:28And if
• 44:30if policy is based on
• 44:32the notion that
• 44:33the only value is is
• 44:35individual freedom
• 44:37during the pandemic and nothing
• 44:39else matters,
• 44:40to me, that's a wrong
• 44:41in the extreme.
• 44:43And there may be another,
• 44:44wrong in the other extreme
• 44:46that says, if you're unvaccinated,
• 44:48you're not allowed to leave
• 44:49the house, which Austria did
• 44:51probably.
• 44:53That may not work for
• 44:54the United States either, but
• 44:56somewhere in between.
• 44:57It's not a consensus,
• 44:59but some
• 45:01ethically justifiable
• 45:03balance between
• 45:04freedom and common good,
• 45:07I think, should emerge as
• 45:08a bioethics voice. It won't
• 45:11be a total consensus on
• 45:13the details
• 45:14and how to respond to
• 45:15an evolving crisis, but it
• 45:17will be a set of
• 45:18values
• 45:18that tell us that the
• 45:20extremes
• 45:21shouldn't be part of the
• 45:22game.
• 45:23Thank you. I'd encourage anyone
• 45:25with questions to please come
• 45:26up to the mic. Doctor
• 45:27Siegel, please.
• 45:28I think if doctor Duffy
• 45:30was here, he would be
• 45:31the first to the microphone.
• 45:32So in his honor, I
• 45:33will
• 45:34I'll I'll take that. And
• 45:35I and, actually,
• 45:36Mark anticipated my question, but
• 45:38I wanna
• 45:39extend it a little bit.
• 45:40So you you talked about
• 45:42the impact
• 45:43of bioethics,
• 45:45and I think of it
• 45:46as as a frontline clinician.
• 45:47I I think of this
• 45:49very practically. Like, when when
• 45:51we we think about medical
• 45:53recommendations,
• 45:54we have consensus guidelines, we
• 45:56have pathways, we have
• 45:59grades of evidence.
• 46:01And so we can judge
• 46:02the quality of the medical
• 46:03care we provide
• 46:05to a great extent
• 46:06on whether we're meeting standards
• 46:08of of care.
• 46:10And it's not that people
• 46:11don't argue about that. It's
• 46:12just that, ultimately, people get
• 46:14into a room and publish
• 46:16a guideline.
• 46:17And and it seems to
• 46:18me that when we're talking
• 46:19about
• 46:20really fraud
• 46:22ethics decisions, like, who should
• 46:23we give the last ventilator
• 46:25to,
• 46:26we shouldn't be leaving it
• 46:28to
• 46:29individual hospitals so that
• 46:31the decisions are made by
• 46:33the luck of where you
• 46:34where your ZIP code is,
• 46:35if you as you mentioned
• 46:36before.
• 46:37So
• 46:38so I would actually argue
• 46:40that that we should try
• 46:41to find a way
• 46:43to have real practical
• 46:46implementable,
• 46:47ethics guidelines
• 46:49that that we can use
• 46:51when the next pandemic comes
• 46:53and when the next big
• 46:54decisions
• 46:55need to be made. Now
• 46:56my question for you is,
• 46:57is that feasible?
• 46:59Okay. It to me, I
• 47:00think the answer is we
• 47:01have to try in some
• 47:03way. But but can you
• 47:04get any leading emphasis into
• 47:06a room and come up
• 47:08with,
• 47:08a set of recommendations that
• 47:10they all agree with that
• 47:11that that people on the
• 47:13front lines can actually follow?
• 47:18I know you're gonna laugh,
• 47:19but the Hastings Center was
• 47:21the first
• 47:22place during the pandemic to
• 47:24issue guidelines,
• 47:26and they were picked up
• 47:27by many hospitals and even
• 47:28internationally.
• 47:30That was a very fast,
• 47:31nimble response
• 47:32to the crisis.
• 47:34Guidance was so desperately
• 47:36needed.
• 47:37People were looking for ethical
• 47:39justification
• 47:40for decisions that had to
• 47:41be made and they were
• 47:42not going to be easy.
• 47:44So I totally agree with
• 47:45you. It's also an opportunity
• 47:47opportunity for me to plug
• 47:48the famous hast Hastings,
• 47:51method. Some people call it
• 47:52the Hastings special sauce. They
• 47:54have all sorts of metaphors
• 47:55for the secret recipe.
• 47:58In one year, I've heard
• 47:59so many metaphors. And that's
• 48:01the notion of taking a
• 48:02really, really difficult topic
• 48:05that calls for guidance, for
• 48:07bioethical guidance,
• 48:09and collecting
• 48:10a truly diverse group
• 48:12of experts.
• 48:13Now experts can be lived
• 48:15experience experts.
• 48:16It doesn't have to be
• 48:17academics,
• 48:20with different value systems
• 48:22and,
• 48:24you know, metaphorically locking them
• 48:25up in a room until
• 48:40understand each other's,
• 48:42cultural assumptions and terminologies,
• 48:44and then tackle the issue
• 48:47over an extended period of
• 48:48time. It's not a
• 48:51and come up with either
• 48:52a consensus
• 48:53or here's where we agree,
• 48:55here's where we can agree
• 48:57to disagree.
• 48:58But here are some here's
• 49:00a spectrum of guidelines
• 49:01that we really think
• 49:03are beneficial
• 49:04for everybody.
• 49:06And the Hastings Center has
• 49:07done that over and over
• 49:08again on issues of end
• 49:09of life,
• 49:10on issues of social behavior
• 49:12and genomics recently,
• 49:14on really controversial
• 49:15stuff.
• 49:16So I think that the
• 49:17notion of diverse voices
• 49:20in conversation
• 49:21based on trust,
• 49:23where you really kinda negotiate
• 49:26what matters to you the
• 49:28most and how we can
• 49:29come up with something that
• 49:30is not
• 49:31if it's each hospital, it's
• 49:32almost arbitrary.
• 49:34And you don't want patients
• 49:35to feel that they ended
• 49:37up with, you know, with
• 49:38a ventilator because they happen
• 49:40to be in that hospital.
• 49:41We see people shop around
• 49:43in productive technologies because everything
• 49:45you know, if I can't
• 49:46do it here, I'll just
• 49:46go to it elsewhere.
• 49:48I think there's value
• 49:50bioethical value in having
• 49:52those more generalized,
• 49:54guidelines.
• 49:55And I think there might
• 49:56be a method that helps
• 49:57us get it. You think
• 49:58just to follow-up, can can
• 50:00you see a situation where
• 50:01people would say
• 50:03that
• 50:04hospitals in general should adopt
• 50:06the Hastings
• 50:08recommendations
• 50:09as because that's supposed to
• 50:11do with community acquired pneumonia
• 50:13or, you know, just how
• 50:15to manage tuberculosis.
• 50:16Right? Like, there's there's a
• 50:17right way.
• 50:19And so I wonder if
• 50:20we leave it to individual
• 50:21hospitals to decide what their
• 50:23hospital policies are, even if
• 50:24they're
• 50:25informed by the Hastings guidelines,
• 50:27it still leaves you with
• 50:28perhaps too much variability.
• 50:29So the best example is
• 50:31the, Fenris Hastings guidelines,
• 50:33regarding end of life, decisions
• 50:35at the end of life
• 50:36that are now being revised
• 50:37for the third time. So
• 50:39for decades, they've been around,
• 50:40and they've been voluntarily adopted
• 50:42by hospitals,
• 50:43because they help families and
• 50:45they help clinicians.
• 50:47So I don't think it
• 50:47should be a top down
• 50:48approach, but I think if
• 50:49you have if you put
• 50:50guidelines out there and they're
• 50:51truly useful,
• 50:53people will gladly adopt them
• 50:56because they will help everybody.
• 50:59Sorry. I sound too optimistic.
• 51:02Just one thing to add.
• 51:03When they put them in
• 51:04the room and wait for
• 51:05the white smoke
• 51:06is is what doesn't happen
• 51:07is let's get fifty of
• 51:09you guys on a Zoom
• 51:10call and wait for the
• 51:11white smoke. I think it's
• 51:12a very different experience. When
• 51:13you talk about learn to
• 51:14trust each other, because while
• 51:15we're having these meetings in
• 51:16the room waiting for the
• 51:17white smoke, there's in there's
• 51:19times after that where I
• 51:19say, so tell me about
• 51:20your daughter. Yes. How are
• 51:21you doing? How are you
• 51:22feeling today? I noticed that
• 51:23your leg's hurting you. Those
• 51:24things that don't happen. And
• 51:26I think the idea of
• 51:26a group of people getting
• 51:27to trust each other, people
• 51:29who don't know each other
• 51:30beforehand,
• 51:31becomes that much more difficult
• 51:32when we're physically removed. So
• 51:35think about that when you're
• 51:35convening the the Vatican.
• 51:38We have this, this lady
• 51:39here, please.
• 51:41Thank you so much. I
• 51:42wanted to first, just thank
• 51:43you so much for such
• 51:44a grounded talk and such
• 51:45an optimistic,
• 51:47talk. I was thought the
• 51:49intentionality of language is amazing.
• 51:51But I'm coming as a
• 51:52graduate student who has a
• 51:54background in public health and
• 51:55integrative medicine and,
• 51:58very much like Siegel's work
• 51:59around flourishing. And now I'm
• 52:00studying social epidemiology
• 52:02and doing some research in
• 52:04care ethics under the mentorship
• 52:05of doctor Carol Gillier.
• 52:07And so I'm really curious
• 52:09about in terms of practicality.
• 52:10Like, I am gonna be
• 52:11the first to say I'm
• 52:12one of those master students
• 52:13with opinions on social media.
• 52:15And while
• 52:17LinkedIn
• 52:18second Instagram scouts have a
• 52:19place for that, there's also
• 52:21a place to kind of
• 52:22reign in a lot of
• 52:23ambition that I feel like
• 52:24a lot of young kids
• 52:25have in terms
• 52:26of channeling that while we're
• 52:28building up our expertise. And
• 52:30so how are we able
• 52:31to enter into these mixed
• 52:33methodology research spaces when the
• 52:34grants are so restricted,
• 52:36and things of that nature.
• 52:38So just open minded, like,
• 52:39questions in terms of,
• 52:41practical things for those, like,
• 52:43interdisciplinary
• 52:44connections that are so hard
• 52:45to foster and build and
• 52:46maintain through mentorship programs to
• 52:48better.
• 52:53I found,
• 52:54during my years as a
• 52:55university professor that the more
• 52:58my research team was diverse,
• 52:59the more successful we were
• 53:01in getting
• 53:02the good grants.
• 53:04So never never assume that
• 53:05you know everything.
• 53:06Yeah.
• 53:07And I think the the
• 53:09trick is to identify
• 53:11who you need around the
• 53:12table. I'm going back to
• 53:13the table
• 53:14as a researcher,
• 53:15not just as a group
• 53:16writing guidelines,
• 53:20what
• 53:21disciplines you need, what perspectives,
• 53:23and convene the right group.
• 53:24Now convening is not easy,
• 53:26especially when you're, an early
• 53:28career scholar.
• 53:29So what you need is
• 53:30mentors.
• 53:32And we're actually trying to
• 53:33build we have mentorship programs
• 53:35at at Hastings. We're trying
• 53:36to build a global one,
• 53:38to help, early career bioethicist
• 53:40in, countries where they don't
• 53:42have any support.
• 53:44But the way to
• 53:46develop convening power is through
• 53:48having powerful mentors.
• 53:50So if you're looking for
• 53:51practical advice, that's the best
• 53:53I got right now.
• 53:55That's amazing. Thank you.
• 53:57Thank you.
• 53:58That's a bit.
• 54:00I thank you very much
• 54:01for that talk. It made
• 54:02me think a little bit
• 54:02more about this question.
• 54:06The question is
• 54:07for me, can bioethics
• 54:09insert itself
• 54:11into a conversation
• 54:12that very much needs it?
• 54:14And that conversation
• 54:16is not even really occurring
• 54:18in this country over second
• 54:20amendment rights.
• 54:22It has all become
• 54:24something about
• 54:26individual
• 54:27rights.
• 54:28And as
• 54:29a bioethicist
• 54:31not born in this country
• 54:32and raised here,
• 54:33what is your perspective
• 54:36on hope of getting bioethics
• 54:39as part of this conversation
• 54:41because where it is right
• 54:42now, it can't get off
• 54:44the dime.
• 54:45It can't even research it
• 54:47without being harassed.
• 54:52Can I give you that
• 54:53one?
• 54:56Sure. You're
• 54:57asking me about respiratory failure
• 55:00in the newborn.
• 55:01And so
• 55:03let's take some time, doctor
• 55:04Viet.
• 55:05You wanna talk about second
• 55:06amendment rights and trying to
• 55:08insert bioethics into that conversation?
• 55:14Alright?
• 55:16Let me think about this.
• 55:17I think It's a tough
• 55:18one. It's really tough.
• 55:20And, you know, I just
• 55:22wish Tom were here. I
• 55:23could give it to him.
• 55:27Here's here's part of the
• 55:28situation, I would suggest,
• 55:30is that
• 55:31there is nobody
• 55:34who is trusted. You you
• 55:35talk so much about the
• 55:36polarization
• 55:37of our society,
• 55:39and and I and, certainly,
• 55:40no one here would disagree.
• 55:42We don't have
• 55:43a a Walter Cronkite.
• 55:45We don't have
• 55:46anybody
• 55:47who before your time, perhaps,
• 55:49but,
• 55:50universe almost universally trusted by
• 55:52America as kind of the
• 55:53voice of wisdom and reason
• 55:54and information.
• 55:55And so it's it's very,
• 55:57very difficult in the absence
• 55:58of that. So I don't
• 55:59know how we if there
• 56:01was an individual or group
• 56:02of individuals
• 56:03that were trusted
• 56:04by most
• 56:06not fifty one percent, but
• 56:07by most of the people
• 56:08in this country, then I
• 56:10would think perhaps that individual
• 56:11and and Howard Zonana has
• 56:13volunteered to be that person,
• 56:14which is great. So,
• 56:16I think that that individual
• 56:18then could speak to the
• 56:19issues. You talk about the
• 56:20data. I mean, we all
• 56:21live and die by the
• 56:22data, at least to start
• 56:23with. And as your point
• 56:24was, we can't even get
• 56:25a good look at the
• 56:26data because even that
• 56:28gets such fury about that
• 56:29we're so polarized about. So
• 56:31if there was an individual
• 56:32or group of individuals,
• 56:34that was trusted by, by
• 56:36a large majority of the
• 56:37country as speaking reasonably about
• 56:39these things, then I think
• 56:40we could get there. How
• 56:41we find
• 56:43those people and how they
• 56:44get to be trusted and
• 56:45accepted as
• 56:47because this is a bioethics
• 56:48issue. No doubt. I mean,
• 56:51gets to be trusted as
• 56:52part of that voice in
• 56:53bioethics.
• 56:55Then I think that's the
• 56:56way they were I don't
• 56:57see how we that, I
• 56:58think, is one way to
• 56:59get there. I don't see
• 57:00who those individuals could necessarily
• 57:02be or how they get
• 57:03to that status. A pretty
• 57:05unsatisfactory
• 57:06answer, and I apologize that.
• 57:07But, wait, Pardis had a
• 57:08chance to think of Thank
• 57:10thank you for talking about
• 57:11trust. I was encouraged to
• 57:12see,
• 57:13articles in the New England
• 57:14Journal of Medicine that discussed
• 57:16gun violence as a public
• 57:18health issue.
• 57:19The the fact that they're
• 57:20included
• 57:21in the medical conversation to
• 57:23me
• 57:24was already something.
• 57:27And it goes back to
• 57:28what I talked about regarding
• 57:30COVID. It's the way freedom
• 57:31is understood in this culture,
• 57:34which is very unique.
• 57:36Again, you know, I I
• 57:37do bioethics in other countries.
• 57:39People look at the way
• 57:40freedom is understood here in
• 57:42this society,
• 57:43and they just don't get
• 57:44it.
• 57:45It's almost like an entire
• 57:46country doesn't understand what freedom
• 57:48means.
• 57:49No. What it's or
• 57:51many would argue that, no.
• 57:53No. This is the one
• 57:53place that has it figured
• 57:55out. And so the fact
• 57:57that when people say, listen.
• 57:59X is really a purely
• 58:00it's an American concept or
• 58:02an American conceit. To many
• 58:04Americans, that means, well, let's
• 58:05take a look at what
• 58:06the rest of the world
• 58:07is making. But to many
• 58:08others, it means, you see
• 58:09that? We're the only ones
• 58:10that get
• 58:11it. So,
• 58:13the the issue with data,
• 58:15yeah, it's true that it's
• 58:16hard to get the data,
• 58:17but we have data about
• 58:19what blocking access to abortion
• 58:21does to,
• 58:23to women.
• 58:24We have data about how
• 58:25it kills and what kind
• 58:27of women it kills more.
• 58:28But that data doesn't change
• 58:30the conversation. So
• 58:31it's it's it's a deeper
• 58:33issue than having access to
• 58:34the number.
• 58:37Excuse me. I just wanted
• 58:38to follow-up a little bit
• 58:39about the globalism. And
• 58:42for some of these questions,
• 58:45it seems to me there
• 58:46is a need for an
• 58:47underlying principle that you're gonna
• 58:49work with.
• 58:50And
• 58:51with with the abortion issues,
• 58:53it's one thing
• 58:55in this country,
• 58:57and with women in Afghanistan,
• 58:59for example, when you go
• 59:00in and try and work
• 59:01out something.
• 59:04How do you get around
• 59:06the bedrock principles
• 59:07that you work under,
• 59:09or do you accept
• 59:11what the culture,
• 59:14says their guidelines
• 59:16are and try to do
• 59:17your best within that?
• 59:19Or, you know, how does
• 59:20it work? Because you see
• 59:22what's happening in this country
• 59:23with the abortion issue
• 59:25is,
• 59:26our health care has gone
• 59:28way down
• 59:29in those areas, and the
• 59:31politics are pushing it just
• 59:33the other way
• 59:34to to make it worse.
• 59:36I'm really grateful for this
• 59:37question comment because it allows
• 59:39me to clarify. When I
• 59:41talk about taking diversity seriously,
• 59:43I do not
• 59:44advocate for ethical relativism.
• 59:47That is not where I'm
• 59:49heading.
• 59:51I think we need to
• 59:52take human rights
• 59:53as a universal framework
• 59:56and then leave space
• 59:58for cultural norms
• 01:00:01as long as they do
• 01:00:02not violate
• 01:00:03fundamental human rights. So, of
• 01:00:05course, I draw lines. Female
• 01:00:07genital mutilation,
• 01:00:08no.
• 01:00:09Girls not having access to
• 01:00:11education,
• 01:00:12no. Women not having access
• 01:00:14to productive care, no. This
• 01:00:16is not a free for
• 01:00:17all, you know, tell your
• 01:00:18values and we'll we'll play
• 01:00:19with them. No.
• 01:00:21But on the basis of
• 01:00:23a framework of respect for
• 01:00:25human rights, I think there's
• 01:00:27a lot of place for
• 01:00:28having conversations
• 01:00:30in different ways,
• 01:00:31different tones,
• 01:00:33a lot of place to
• 01:00:34build trust that I understand
• 01:00:36where you're coming from,
• 01:00:38and we can at least
• 01:00:39talk about it,
• 01:00:41but it's not ethical relativism.
• 01:00:43How did Qatar work out?
• 01:00:45How what? How did Qatar
• 01:00:48work out where you're gonna
• 01:00:49have the meeting?
• 01:00:54Wow.
• 01:00:58So,
• 01:00:59we were afraid of a
• 01:01:00general boycott
• 01:01:02and that it would be
• 01:01:03either poorly attended or become
• 01:01:05a regional meeting of hundreds
• 01:01:07of,
• 01:01:08Arab bioethicists,
• 01:01:10and that it would be
• 01:01:11purely a Muslim
• 01:01:13conference
• 01:01:14about, you know, Muslim bioethics.
• 01:01:16And that didn't happen. Hundreds
• 01:01:18showed up,
• 01:01:19from all over the world,
• 01:01:21and it was a very
• 01:01:22successful conference.
• 01:01:24And I think that's because
• 01:01:26many bioethicist
• 01:01:28recognized
• 01:01:29that to,
• 01:01:30again, to support human rights,
• 01:01:32you sometimes need to go
• 01:01:33there,
• 01:01:34and you need to work
• 01:01:35locally. And the people that
• 01:01:36we collaborated
• 01:01:37with on organizing it
• 01:01:41share
• 01:01:42that general
• 01:01:43bioethical framework that we could
• 01:01:45work within.
• 01:01:46And so it ended up
• 01:01:47being a very successful,
• 01:01:49conference and Harl Schmidt, who
• 01:01:51was on our board, just
• 01:01:52just published a paper that
• 01:01:54showed that it was the
• 01:01:55most diverse conference
• 01:01:57in the history of the
• 01:01:58IAB.
• 01:01:59So
• 01:02:01it is what it is.
• 01:02:02It's complicated.
• 01:02:04And perhaps it was also
• 01:02:06a little bit of vote
• 01:02:07of confidence in
• 01:02:08you and the leadership of
• 01:02:09the organization, which is to
• 01:02:10say that maybe many bioethicists
• 01:02:13said, boy, I wouldn't have
• 01:02:14picked that place. I don't
• 01:02:15think that's even a good
• 01:02:16idea. But you know what?
• 01:02:17We've got a good leadership.
• 01:02:18They've made this decision. We've
• 01:02:20obviously gotta try and stick
• 01:02:21together on this stuff, so
• 01:02:22let's go. There might have
• 01:02:23been a bit of that
• 01:02:23too, a vote of confidence
• 01:02:24in the leadership itself.
• 01:02:27Please.
• 01:02:28Thanks so much,
• 01:02:29for your talk.
• 01:02:31Sayed Ahmed, I'm a pediatrician.
• 01:02:33I work in global health
• 01:02:34and HIV. And what originally
• 01:02:36brought me into that work
• 01:02:37was an ethical argument that
• 01:02:40a lot of the countries
• 01:02:41we were working, adults were
• 01:02:42being treated but children were
• 01:02:44not. And that that was
• 01:02:45an unethical
• 01:02:46situation and,
• 01:02:48resulted in sort of the
• 01:02:49deployment of pediatrician to kick
• 01:02:51start that process. But since
• 01:02:53then there hasn't been a
• 01:02:54lot of input in our
• 01:02:55work,
• 01:02:56from bioethicists
• 01:02:58and
• 01:02:58was curious
• 01:03:00on your thoughts about how
• 01:03:01to bring that in because
• 01:03:02there are many critical issues,
• 01:03:05in terms of
• 01:03:06how we're
• 01:03:07spending our resources,
• 01:03:10how we continue
• 01:03:11providing care for the many
• 01:03:13people who are in care
• 01:03:14now.
• 01:03:15And I think, you know,
• 01:03:16most of our,
• 01:03:18grant work and
• 01:03:20is focused on regulatory issues,
• 01:03:22IRBs, and things like that,
• 01:03:24but not the broader ethical
• 01:03:25questions of, you know, how
• 01:03:27much money we're spending on
• 01:03:28HIV versus malnutrition versus other
• 01:03:31conditions.
• 01:03:32And I think it would
• 01:03:32benefit, but I'm not quite
• 01:03:34sure
• 01:03:36how to how to bring
• 01:03:37that into our brands, into
• 01:03:39the conversation, and into the,
• 01:03:41kind of our work there.
• 01:03:44Thank you for this because,
• 01:03:45first of all, I think
• 01:03:46you're actually supporting my argument
• 01:03:49about how underdeveloped
• 01:03:51our theories of justice and
• 01:03:53resource allocation frameworks are.
• 01:03:55We're not looking at these
• 01:03:56issues systemically. It was like,
• 01:03:58here's a kidney. Who gets
• 01:03:59the kidney? Here's a ventilator.
• 01:04:01Who gets the ventilator?
• 01:04:02But we're not asking
• 01:04:04at the higher level,
• 01:04:05what research are we funding?
• 01:04:07How are we prioritizing research
• 01:04:08questions?
• 01:04:09How do we prioritize disease,
• 01:04:12investigation or disease treatment? These
• 01:04:14are daunting questions that we've
• 01:04:17historically kinda stayed away from
• 01:04:19because I think they're too
• 01:04:20scary. I think they're too
• 01:04:22complicated, but I think we
• 01:04:23can do good work on
• 01:04:24them. So first of all,
• 01:04:26yes.
• 01:04:27I think,
• 01:04:28the vision that I was
• 01:04:29trying to promote, if we
• 01:04:31if we do more intellectual
• 01:04:33conceptual work
• 01:04:35on justice, fairness, and allocation,
• 01:04:38I think we will gradually
• 01:04:39be able to address these
• 01:04:40issues at a more systemic
• 01:04:42level, but we need to
• 01:04:43do more work.
• 01:04:45On your issue about, you
• 01:04:46know, investing so many of
• 01:04:47our health care, dollars at
• 01:04:49the very end of life,
• 01:04:50and in some cultures, it's
• 01:04:50the children who don't get
• 01:04:50treated. There's research that shows
• 01:04:52that preemies and newborns don't
• 01:04:53get treated the same way,
• 01:05:00persons
• 01:05:01do.
• 01:05:02That speaks to me, that
• 01:05:03speaks to culture,
• 01:05:05how we can't do bioethics
• 01:05:06without understanding cultural contexts.
• 01:05:09There are countries where, you
• 01:05:10know, the elderly
• 01:05:12would get the priority, others
• 01:05:13where the kids get the
• 01:05:15priority. Think about how age
• 01:05:16played out during COVID.
• 01:05:19Some of those triage protocols
• 01:05:20talked about age
• 01:05:22almost as a cutoff
• 01:05:24almost as an independent
• 01:05:26criterion
• 01:05:27regardless of clinical
• 01:05:29state. It was fascinating that
• 01:05:31in Quebec, where I was
• 01:05:32working at the time, they
• 01:05:33didn't want to include age
• 01:05:35because that's ageism,
• 01:05:36so they called it life
• 01:05:38cycle.
• 01:05:39It's not about the number
• 01:05:42of years you've been on
• 01:05:43this earth. It's where are
• 01:05:44you in your life cycle.
• 01:05:46And if you had your
• 01:05:47chance, you should give somebody
• 01:05:49else a chance to get
• 01:05:50to your point in the
• 01:05:52life cycle. To me, that
• 01:05:53was just word washing.
• 01:05:55It was still an ageist
• 01:05:56protocol that was adopted by
• 01:05:58the government.
• 01:05:59Now maybe in some situations,
• 01:06:01you it's okay to be
• 01:06:03or ethically justified
• 01:06:05to be,
• 01:06:06somewhat ageist, but be honest
• 01:06:08about
• 01:06:09and take into account the
• 01:06:10cultural forces that surround the
• 01:06:12polarization
• 01:06:13and ask yourself, does this
• 01:06:14violate human rights?
• 01:06:17So,
• 01:06:18justice, allocation, culture, to me,
• 01:06:21these are the notions we
• 01:06:22need to lean into
• 01:06:24in order to develop the
• 01:06:25tools we're gonna need.
• 01:06:29Right.
• 01:06:30Please. Hi. In your talk,
• 01:06:32you mentioned intergenerational
• 01:06:34justice. I'm hoping you can
• 01:06:36talk a bit more about
• 01:06:37that. And, specifically, I'm curious,
• 01:06:39to hear what you think
• 01:06:40about what exactly we owe
• 01:06:41future generations, especially when,
• 01:06:44like, in the tricky situations
• 01:06:45where our current immediate interests
• 01:06:48are maybe in conflict with
• 01:06:49the interests of future generations.
• 01:06:53Do you have that in
• 01:06:54a, like, more complicated,
• 01:06:57format?
• 01:06:58Because that wasn't challenging enough.
• 01:07:00What what do we owe
• 01:07:01people in in the future,
• 01:07:02and how far in the
• 01:07:03future?
• 01:07:05I think you just asked
• 01:07:06one of the most complex
• 01:07:08questions
• 01:07:08in
• 01:07:09general, in ethics and philosophy,
• 01:07:12and definitely for bioethicist,
• 01:07:15because there's so much writing
• 01:07:16now about existential
• 01:07:18threats and long termism
• 01:07:20and how these terms are
• 01:07:22I don't know if I'm
• 01:07:23I don't wanna get into
• 01:07:24this, but there's a huge
• 01:07:25literature
• 01:07:26emerging
• 01:07:27about how some groups are
• 01:07:29actually,
• 01:07:31using
• 01:07:32these notions in order to
• 01:07:34make decisions that are self
• 01:07:36serving.
• 01:07:37So I think it's a
• 01:07:38hugely complex area,
• 01:07:40not fully my field.
• 01:07:43But I have to say
• 01:07:44that when I look at
• 01:07:44what our society is doing
• 01:07:46about climate not doing about
• 01:07:47climate change, I mean, we're
• 01:07:49just emerging from the disaster
• 01:07:50in Florida.
• 01:07:52It's heartbreaking.
• 01:07:53We're literally,
• 01:07:56sacrificing your grandchildren
• 01:07:59if we don't do something
• 01:08:00now. Again, not not my
• 01:08:02not my field that I
• 01:08:03wanna speak, out of scope.
• 01:08:06But here again, I think
• 01:08:08we're
• 01:08:09we're thinking too short term.
• 01:08:11And if all of those,
• 01:08:13theories of allocation and fairness
• 01:08:15that we're developing don't address
• 01:08:17the impact on the future,
• 01:08:19which is always difficult to
• 01:08:20predict, but we're now seeing
• 01:08:21some evidence,
• 01:08:23they won't be complete.
• 01:08:24It's a very fuzzy, unsatisfying,
• 01:08:34Thank you. Doctor Kostel, I'm
• 01:08:36gonna ask for your patience
• 01:08:37for one minute because I
• 01:08:39want you to ask the
• 01:08:39final question tonight.
• 01:08:41So before we get to
• 01:08:42that, I wanna ask, there's
• 01:08:43a couple of questions that
• 01:08:44came through,
• 01:08:45from the Zoom audience, and
• 01:08:47I I think I can
• 01:08:48kind of combine these questions
• 01:08:50or comments into one.
• 01:08:52Another scope,
• 01:08:54issue,
• 01:08:55is bioethics broader than medical
• 01:08:57or biomedical ethics, or is
• 01:08:59it broader even than human
• 01:09:00flourishing? In particular,
• 01:09:02does it include,
• 01:09:04issues about how human behavior
• 01:09:06impacts
• 01:09:07nonhuman
• 01:09:08animal
• 01:09:08flourishing?
• 01:09:10And, and and the second
• 01:09:11question, I think, asks a
• 01:09:12similar question, but talks about
• 01:09:14the moral scope
• 01:09:15and our responsibilities,
• 01:09:17to the planet. So is
• 01:09:18human flourishing itself even too
• 01:09:20narrow? Should bioethics also be
• 01:09:22about nonhuman
• 01:09:23animal flourishing?
• 01:09:25Great question.
• 01:09:27One of the things that
• 01:09:28Hastings,
• 01:09:29addresses is humans in nature.
• 01:09:33We actually have,
• 01:09:35projects, for example, about how
• 01:09:37to use,
• 01:09:38genomics technologies
• 01:09:39to
• 01:09:41to bring back,
• 01:09:43species that are extinct or
• 01:09:44to cause the extinction of
• 01:09:46species.
• 01:09:47And I'm going back to
• 01:09:48my original point. These are
• 01:09:50bioethical issues to the extent
• 01:09:52that
• 01:09:54we need to think of
• 01:09:56one health, the concept of
• 01:09:57one health, that planetary health
• 01:09:59and animal welfare are all
• 01:10:01connected
• 01:10:02at the end of the
• 01:10:03day to our health. So
• 01:10:05I don't think bioethics should
• 01:10:06become
• 01:10:08environmental ethics or
• 01:10:10tackle
• 01:10:11climate change or animal,
• 01:10:13welfare as an independent
• 01:10:16topic. But as it relates
• 01:10:18to human flourishing,
• 01:10:20it should be included.
• 01:10:22Thank you.
• 01:10:24One more second if you
• 01:10:25please contact us. It gives
• 01:10:26me a chance to get
• 01:10:27a brief commercial announcement to
• 01:10:28the students and to everybody
• 01:10:29else who was kind enough
• 01:10:30to follow our program here,
• 01:10:32which is the the program
• 01:10:33for biomedical ethics. But many
• 01:10:35of you are aware, some
• 01:10:36of you might not be,
• 01:10:36that we have a sister
• 01:10:37program on the main campus
• 01:10:39whose name is very telling.
• 01:10:40It's the Interdisciplinary
• 01:10:41Center for Bioethics, where animal
• 01:10:43ethics, where environmental ethics, certainly
• 01:10:45get more attention. We are
• 01:10:47somewhat focused on medical ethics,
• 01:10:48and we certainly take your
• 01:10:50point that if we're focused
• 01:10:51even on medical ethics,
• 01:10:53issues of poverty and racism,
• 01:10:55etcetera, all these things clearly
• 01:10:56influence medical ethics and bioethics
• 01:10:58even if we have a
• 01:11:00somewhat narrower view. But that
• 01:11:01broader view that I think
• 01:11:02this question is asking and
• 01:11:03that you're endorsing,
• 01:11:05is addressed,
• 01:11:07wonderfully by the program run
• 01:11:08by my friend Steve Latham
• 01:11:10and Laurie Bruce over on
• 01:11:11the main campus.
• 01:11:12So something to think about
• 01:11:13to the students who just
• 01:11:14can't get enough ethics. I'll
• 01:11:16take a look at what's
• 01:11:16happening on the main campus.
• 01:11:18And now, doctor Kunsip, if
• 01:11:20you would, answer the last
• 01:11:21ask the last question. Thank
• 01:11:22thank you so much. What
• 01:11:23an inspiring talk to give
• 01:11:25to all of us and,
• 01:11:27you know, to kinda look
• 01:11:27forward to the future. I
• 01:11:29was one comment and one
• 01:11:30question. So my comment has
• 01:11:32to do with what you
• 01:11:33were,
• 01:11:35your
• 01:11:35about the discussion regarding freedom
• 01:11:37in the United States. And
• 01:11:38I would just add thinking
• 01:11:40about self determinism in the
• 01:11:42United States and how it's,
• 01:11:43like, just a fabric of
• 01:11:45our history and sort of
• 01:11:46what made this nation and
• 01:11:48why I feel like I
• 01:11:49don't know. As somebody who
• 01:11:50grew up to immigrant parents
• 01:11:52who are not, you know,
• 01:11:53not from from Eastern Europe,
• 01:11:55but just a very different
• 01:11:56attitude towards
• 01:11:58the communal good and and
• 01:12:00just, like, kind of fighting
• 01:12:01the ancestors. That would just
• 01:12:02be my and then that
• 01:12:03kinda gets me to my
• 01:12:04question. And it has to
• 01:12:05do with
• 01:12:06how ethical principles
• 01:12:08almost
• 01:12:09if there if there is
• 01:12:10a if there is a
• 01:12:11universality to an ethical principle
• 01:12:14that it could be adopted
• 01:12:15to work in different
• 01:12:16in different cultures, in different
• 01:12:18countries.
• 01:12:19If there is a common
• 01:12:21thread
• 01:12:22or, like, almost maxims
• 01:12:24that that you think are
• 01:12:26successful at driving things forward,
• 01:12:29it almost to me verges
• 01:12:30on philosophy
• 01:12:32in in some ways as
• 01:12:33opposed to a response to
• 01:12:35something.
• 01:12:38Yes.
• 01:12:41When I go and reread,
• 01:12:43Beecham and Children's
• 01:12:45principles of biomedical ethics,
• 01:12:47the more recent versions,
• 01:12:49they definitely make that distinction
• 01:12:51between, you know, different levels
• 01:12:53of principles,
• 01:12:54some that can be more
• 01:12:55tailored,
• 01:12:57to cultural contexts and other
• 01:12:59that are higher level.
• 01:13:00It's not all one thing.
• 01:13:02I just rejected relativism
• 01:13:04philosophically
• 01:13:06and, and and stuck to
• 01:13:07human rights as a as
• 01:13:10a universalist
• 01:13:11foundational
• 01:13:11framework.
• 01:13:12But, again, within that, of
• 01:13:14course,
• 01:13:15I'm definitely preaching for more
• 01:13:17than cultural sensitivity
• 01:13:18for making a lot of
• 01:13:19space
• 01:13:20for the way that cultures
• 01:13:22approach
• 01:13:23the management, the delivery of
• 01:13:25health care, the relation the
• 01:13:26clinical
• 01:13:27individual. For all of that,
• 01:13:28I think we can make
• 01:13:28a lot of, space and
• 01:13:29be very flexible within frameworks
• 01:13:30of human rights.
• 01:13:39So I'm not sure if
• 01:13:41I'm answering the question, but
• 01:13:42I think this goes back
• 01:13:43to, you know, theoretical ethics
• 01:13:46and to the conceptual work
• 01:13:48that sometimes we need to
• 01:13:49do in order to get
• 01:13:50to reasoned,
• 01:13:52wise, and responsible pragmatic solutions
• 01:13:55that stem from solid,
• 01:13:57conceptual foundations.
• 01:14:02Thank you so much.
• 01:14:04This has been an extraordinary
• 01:14:05evening. Before I wrap it
• 01:14:07up,
• 01:14:08just to let you know,
• 01:14:09and I know you know
• 01:14:09this very well,
• 01:14:11that that we run the
• 01:14:12program that's got a number
• 01:14:13of things going on, and
• 01:14:15our program manager,
• 01:14:16does a wonderful job of
• 01:14:18keeping these these things running,
• 01:14:19the way they should. And
• 01:14:20that's Karen Cole.
• 01:14:28I'm not sure where where
• 01:14:30Karen's hiding. She gave me
• 01:14:31this laptop as a as
• 01:14:32a house gift, and then
• 01:14:34she left.
• 01:14:36And, also, mister Amir Glenn,
• 01:14:37who's often here. Oh, there's
• 01:14:38Karen in the back waving
• 01:14:39at you.
• 01:14:45And mister Amir Glenn, who's
• 01:14:46always here to make sure
• 01:14:47that, that we're running technically,
• 01:14:49without a glitch. Thank you
• 01:14:51so much, Amir.
• 01:14:57Professor Levitsky, this has been
• 01:14:58a real gift to us,
• 01:14:59and we thank you so
• 01:15:00much. It's been a wonderful
• 01:15:01night. Thank you all for
• 01:15:02coming. We will see you
• 01:15:03again soon.