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RS 160 - Live at NECSS -- Jacob Appel on "Tackling bioethical dilemmas"

Release date: May 29th, 2016

Jacob Appel and Julia Galef at NECSS

It's the annual live Rationally Speaking episode, taped at the Northeast Conference on Science and Skepticism in NYC! This year features returning guest Jacob Appel, a bioethicist (and lawyer, and psychiatrist). Jacob and Julia discuss various bioethical dilemmas, such as: How do you handle parents who want to withhold medical treatment from their child for religious reasons? Is it unethical for American doctors to test new medications in the third-world? And what kinds of principles does a bioethicist use to justify their decisions, beyond "that's just my personal opinion"?

Photo by Larry Auerbach. More NECSS photos from Larry can be found here.

Podcast edited by Brent Silk

 Full Transcripts 


Reader Comments (7)

max tegmark keeps stealing Julia's joke about living interesting lives so that if we are living in a simulation they creator won't shut us down.
June 3, 2016 | Unregistered CommenterDarren
An excellent episode with a great guest. These moral and ethical issues are why I think philosophy is important. As I see it, there are no right and wrong answers to moral and ethical issues, but we all have to make moral and ethical choices in our lives regardless.

Should I eat meat or not? be in favour of euthanasia or not? get away with not paying taxes or pay them anyway? go out for an expensive meal or give to charity? More widely, what’s a good life? and how should I live my life?

I imagine most people do what’s normal, acceptable and convenient in their culture, without thinking too much about it. That’s often what I do. Sleepwalking perhaps. However, we can't avoid taking a position of some of these things, especially if we’re directly faced with them. You either eat meat or you don't. You either pay your taxes when you can get away with illegally not paying them, or you don't. This is where philosophy can help. It helps us to be more aware of what we’re doing, what the consequences are of the positions we take, where we might be inconsistent and what other people have said over the years. Philosophy may not be able to tell us what we should do, I don’t believe there are right and wrong answers, but it can help us come to a more informed position of our own. If we care about these kinds of things.
July 29, 2016 | Unregistered CommenterSleepwalker
On the point about Slim Watson, does anyone know where he got the figure of 2 million missed flu shots and 500,000 missing mammograms? I am assuming he simply took $5 million and divided it by the cost of a flu shot and mammogram, but I am guessing those are more expensive procedures. In any case, healthcare financing is much more nuanced as anyone who has studied it can tell you but he does not seem to take that into account. I dug up the Wall Street Journal article he referenced and nowhere does it say that the senior administrators had to make severe cutbacks the next year solely due to that one patient:

Now the blood factor supply was threatened and that had the potential to be a problem, but no where did it say that they weren't able to replenish the supply so it does not seem like other patients on blood factors were directly affected by Slim Watson.

With healthcare resources that are definitively limited we already have a set of rules. Organs are the best examples of this. He should have used the rules behind who gets the organ donation and started from there about the ethics of healthcare resource distribution. The resource distribution question is such a difficult one that we should at least start with how others have tackled the problem. As it turns out, the factors that determine your wait time for an organ are published online:

With financing in healthcare it is not so transparent that we can easily conclude that other patients collectively did not receive $5 million worth or care. For one thing, the $5.2 million bill was probably from the Chargemaster ( ) which everyone knows is not actually the cost to the hospital, but an inflated amount since the hospital expects less than that from insurance. His care was definitely costly in terms of doctor and nurse time but these professionals are quite experienced in triaging their time effectively so I doubt you could easily find that other patients were severely affected.

The point is that before we debate healthcare finance, we should have the actual facts and this guy does not seem to actually know how the system works which is disappointing. So I implore people that as we debate the issue of healthcare finance, let's give ourselves a basic education in it as it will appear in the news for the foreseeable future quite often and 90% of people seem to interpret things wrong.

Interestingly, one of the biggest ethical questions around healthcare finance is whether or not it is ethical to require people to have health insurance. Before Obama, nearly everyone would have said no. After Obamacare though there is a split on that question.
August 19, 2016 | Unregistered CommenterZachary DeStefano
I came into this having heard that bioethicists are not actually very clear thinkers. More likely to justify the status quo than to actually apply reason.

After listening to this, I think there is some truth to this story. The best example is his defense of opt-in organ donation. It's very frightening that our experts on this issue even entertain the idea that this is difficult case.

His willingness to entertain the idea of using lithium is good though.
October 30, 2016 | Unregistered CommenterPeter
A bioethicist who makes decisions about actual patients should have a M.D., a license to practice medicine, and a lot of clinical experience.

The US Supreme Court also gives preference to long established religious traditions. However, new religions, or newly adopted religious beliefs, or simply prejudicial beliefs should get just as much deference as any other belief since only that standard can work universally. If a patient makes a ridiculous request, due to any preference, the hospital should simply deny the request.

Deliberately choosing an embryo with a deafness trait is ethically equivalent to surgically deforming a newborn to remove hearing. The British authorities got the right answer, and the hospital should refuse to perform either procedure.

Double blind drug trials that deny one group of patients treatment, or give one group of patients a treatment known to have less efficacy, while giving another group the newer more effective treatment violate ethics. Instead of double blind drug trials, we should just study the old treatment with rigor, then study the new treatment with rigor and compare results. The US FDA also takes ten times longer than any other industrial country to approve a new drug or medical device, and this kills a lot of people in the USA.

Conducting a drug trial in a poor country where the patients would otherwise receive NO treatment makes perfectly good sense and the medical journals should publish the results. This case does not compare to providing a child with a mildly abusive home and subsistence diet instead of leaving that child in an abusive hone with starvation. The experimental treatment has a known likely beneficial effect, whereas letting a child starve to death might actually involve less cruelty than leaving that person hungry throughout all of childhood.

If your patient comes to you and requests you to remove a healthy limb, send that patient to the mental asylum. If the parents of a girl come to you and request FGM, have the parents arrested, send the girl to social services, and hope for her adoption into a reasonable family.

If you have a habitually drunk school bus driver, give the driver sick leave, put the driver in therapy and take her or him off the road. Her or his hard drinking friends will then accept treatment more willingly.

We should have an opt out organ donation system everywhere.

The US has absurdly high pharmaceutical prices. We need a compulsory patent licensing system such as the system Germany has, or another cost effective system.

We should end opium/opiate prohibition. Just sell opiates over the counter without a prescription, end illicit trade, defund criminal gangs, and let people have their pain relief.

We should allow people to sell their extra kidney, and to donate their organs at death and have the proceeds go to their estate.
December 11, 2017 | Unregistered CommenterJameson
Great guest to have. Really tried to break things down for us even throwing in the occasional joke. =p
May 24, 2018 | Unregistered CommenterErnesto

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