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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 (5)

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

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