April 16, 2010

Liveblogging Dr. Zeke Emanuel

Today the Rockefeller Center played host to Dr. Ezekiel "Zeke" Emanuel MD Ph.D, leading American bio-ethicist and elder brother of White House Chief-of-Staff/2nd most powerful man in America (and famous dirty-mouth) Rahm Emanuel. Dr. Emanuel came as part of the Nixon scholarship, awarded to scholars who intersect Jewish life and academic scholarship.

Zeke is more weathered and grayed than his younger brothers, but he is unmistakably their relation. He has that Emanuel restlessness (he was figiting in his platformed moccasins as he sat in front of me) and that same Chicagoian accent. He almost sounds like Christopher Walken, if he happened to be exceedingly over-educated. ("Sarry", "Prablem", "Aabout", "Nat", Absessed")

The form his lecture took is a series of "interactive" case studies examining various bioethical scenarios with the audience having to give consent or not. When he's done explaining, Zeke races up the stairs to talk with (and continuously interrupt) the speakers who venture their answers. Dr. Emanuel's time is valuable and he wants to get the answers out as fast as they can, a frustrating thing for him given that he speaks (and thinks) approximately three times as fast as everyone else. "What do you want to know?" "Why is that important?" "But we're just dealing with spit!" "I have a soft spot in my heart for government"

He tries to show that the IRB approach (jumping to "informed consent" as the default) is missing out on a long progression of ethical principles including informed consent, but occurring prior to it. As the event went on, the crowd continued to raise their hands, venturing their answers to the ethical dilemmas, but due to the constant interruptions, they did so with waning ferocity. This confused Dr. Emanuel, who wondered aloud "Do I bite!?" right after smacking his fists on the chalkboard (and smudging a few misspelled words)

His net point is that there are four principles we should use in treatment: (1) equality, (2) helping the worst off, (3) utility, and (4) social value. For equality, lotteries are fair, but the policy of first-come-first-served privileges the wealthy. How else did Steve Jobs get his liver so quickly? He put his name on many lists and could afford to traverse the country for treatment. Helping the worst off should favor the young, who are entitled to more life, but not the sickest as it would squander the good use of the organs. For utility, a person who needs both a liver and kidney deserves neither as two people could be saved with the same components that in him can only save one. The social value side of things refers to the benefit that continued life of the individual affords the community. This can be forward or backward looking. Forward looking policies would favor doctors, who would be needed to help save everyone else . To prevent a conflict of interest and the over-privileging of doctors, this should only be done in time of true pandemic catastrophe. On the backwards looking side, hospitals could privileged veterans or organ donors as a way to encourage such service in the future (though this should only be done if all other things are equal). It goes without saying that someone with drastic social benefit like the President should get priority.

The intensively interactive and challenging format of the lecture easily made Dr. Emanuel one of the most entertaining speakers I've seen as Rocky. It's a real achievement that the Nixon family were able to secure someone like him on their very first try.

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