Bio(un)ethical

#21 Bryan Carmody: Are doctor shortages real?

Mon, 14 Jul 2025 14:00:00 -0400

In this episode we speak with Dr. Bryan Carmody, pediatric nephrologist and associate professor of pediatrics at Eastern Virginia Medical School. We talk about whether America really faces a doctor shortage, why people in areas with plenty of doctors still struggle to access care, whether proposed solutions can address the access problems many patients face, and how AI may affect these problems in the near future.

(00:00) Our introduction

(04:03) Rethinking the doctor shortage narrative

(09:00) The AMA and the AAMC

(16:11) Shortage of 187,000 physicians by 2037

(25:20) Physician misallocation

(38:19) Financial incentives create barriers to care

(48:19) Why not train more physicians?

(56:18) How to make places more desirable for physicians to work in

(1:14:01) Profit over placement in hospitals

(1:25:12) The AI elephant in the room

Used or referenced:

Bryan Carmody’s Sheriff of Sodium YouTube Channel and Blog
Leah Pierson, “The AMA can help fix the health care shortages it helped create”
Medford-Davis et al., “The physician shortage isn’t going anywhere”
Walensky and McCann, “Challenges to the future of a robust physician workforce in the United States”
HRSA Health Workforce, Physician Workforce: Projections, 2022-2037
HRSA Health Workforce, State of the Primary Care Workforce, 2024
Gudbranson, Glickman, and Emanuel, “Reassessing the data on whether a physician shortage exists”
Connors, “2025 Doctor Job Outlook: Why Go Locum Tenens?”
Auerbach, Buerhaus, and Staiger, “Implications of the rapid growth of the nurse practitioner workforce in the US”
National Commission on Certification of Physician Assistants, “PA Profession Surges in Last Decade”

Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Ambedo Media (previous production support by Audiolift.co). Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

#20 Rachel Fraser: How your social world shapes what you know

Tue, 18 Mar 2025 05:00:00 -0400

In this episode we speak with Dr. Rachel Fraser, Associate Professor of Philosophy at MIT, about whether experiences of oppression can yield special insights, whether these insights can be shared with members of dominant groups, and what implications this has for policymaking.

(00:00) Our introduction

(03:39) Interview begins

(03:43) Historical roots of standpoint epistemology

(27:38) Situated knowledge: What kind of knowledge depends on social position?

(41:03) What kind of knowledge depends on social position?

(46:04) Does standpoint theory stereotype or essentialize people?

(53:19) Epistemic advantage: Does oppression give you special insight?

(1:01:20) Is standpoint theory objectionably self-fulfilling?

(1:10:51) Can members of dominant groups access the same insights?

(1:16:12) Does standpoint theory apply to moral knowledge?

(1:27:25) Implications: Should we defer to oppressed people about the social world?

(1:31:33) The value of diversity within epistemic communities

(1:37:58) Methods for democratizing decisions in bioethics

(1:41:20) The role of qualitative knowledge in policy making

Used or referenced:

Bio(un)ethical, “Emily Largent and Govind Persad: Is bioethics ok?”
Bio(un)ethical, “Danielle Allen: Should laypeople make health policy decisions?”
Bio(un)ethical, “Sarah McGrath: Are there moral experts?”
Kristen Intemann, “25 Years of Feminist Empiricism and Standpoint Theory”
Emily Tilton and Briana Toole, “Standpoint Epistemology and the Epistemology of Deference”
Kristina Rolin, “The Bias Paradox in Feminist Standpoint Epistemology”
The Good Fight with Yascha Mounk, “You Just Won’t Understand!”

#19 Emily Largent and Govind Persad: Is bioethics ok?

Thu, 27 Feb 2025 05:00:00 -0500

In this episode, we speak with two leading bioethics scholars about the state of bioethics today. Dr. Emily Largent is the Emanuel and Robert Hart Associate Professor of Medical Ethics and Health Policy and the Chief of the Division of Medical Ethics at the University of Pennsylvania Perelman School of Medicine. Dr. Govind Persad is an Associate Professor at the University of Denver Sturm College of Law and our first returning guest on Bio(un)ethical.

With Emily and Govind, we consider critiques of bioethics coming from inside and outside of the field. In light of our recent survey of US academic bioethicists, we discuss who bioethicists are, how they are trained, and how they can better promote ethical decision-making in medicine, science, and public health.

(00:00) Our introduction

(05:16) Interview begins

(09:27) Who counts as a bioethicist?

(20:18) The credentialing problem

(30:43) Critiques from outside bioethics: Why are people mad?

(42:17) Protectionist vs. progress-oriented bioethics

(53:26) The field’s major wins

(57:31) Critiques from inside bioethics: Variable research quality

(1:03:29) Financial barriers to entry

(1:05:18) Lack of demographic and ideological diversity

(1:11:53) Should bioethicists’ views mirror the public’s?

Used or referenced:

Leah Pierson et al., “Bioethicists Today: Results of the Views in Bioethics Survey”
Leah Pierson, “Becoming a bioethicist is expensive. That’s a problem”
Leah Pierson, “We need to evaluate ethics curricula”
Tom Chivers, “How many lives has bioethics cost?”

#18 David Thorstad: Evidence, uncertainty, and existential risk

Tue, 11 Feb 2025 10:00:00 -0500

In this episode, we speak with Dr. David Thorstad: Assistant Professor of Philosophy at Vanderbilt University, Senior Research Affiliate at the Global Priorities Institute, and author of the blog, Reflective Altruism. We discuss existential risks–threats that could permanently destroy or drastically curtail humanity’s future–and how we should reason about these risks under significant uncertainty.

(00:00) Our introduction

(09:32) Interview begins

(14:32) The longtermism shift

(23:17) Framework for objections to longtermism

(29:47) Overestimating existential risk: population dynamics

(36:06) Overestimating existential risk: cumulative vs. period risk

(39:44) Overestimating existential risk: ignoring background risk

(42:14) The time of perils hypothesis

(46:11) When and where should philosophers speculate?

(1:09:02) Extraordinary claims require extraordinary evidence

(1:21:44) Regression to the inscrutable and the preface paradox

(1:30:07) The tendency to quantify

Used or referenced:

David’s blog, Reflective Altruism
Thorstad, “Three mistakes in the moral mathematics of existential risk”
Thorstad, “High risk, low reward”
Thorstad, “Against the singularity hypothesis”
Parfit, Reasons and Persons (p. 453)
MacAskill, What We Owe The Future
Ord, The Precipice
Berger, Open Philanthropy, “Our Progress in 2023 and Plans for 2024”
80,000 Hours, “What are the world’s most pressing problems?”
Maule (EA Forum), “Historical EA Funding Data”
Elsey and Moss (EA Forum), “EA Survey: Cause Prioritization”
Ord (EA Forum), “The Precipice Revisited”
Greaves and MacAskill, “The case for strong longtermism”
EA Critiques Podcast, “Astronomical Value, Existential Risk, and Billionaire Philanthropy with David Thorstad”
Forecasting Research Institute, “Results from the 2022 Existential Risk Persuasion Tournament”
Coleman et al., “Beliefs about the end of humanity: How bad, likely, and important is human extinction?”
Turner et al. (NeurIPS), “Optimal policies tend to seek power”

#17 Rochelle Walensky: How can we fix American public health infrastructure?

Tue, 28 Jan 2025 12:00:00 -0500

In this episode, we speak with Dr. Rochelle Walensky, former director of the Centers for Disease Control and Prevention (CDC). We discuss the state of American public health infrastructure, the challenges it faces, and what we can do to improve it.

(00:00) Our introduction
(03:45) Interview begins
(09:32) Core challenges: Maintaining and growing the workforce
(18:41) Core challenges: Standardizing and modernizing data systems
(28:01) Core challenges: Reorganizing laboratory systems
(30:32) The problem of fragmentation
(44:55) Tradeoffs in communication; “following the science”
(52:57) Biggest lessons learned
(1:00:37) Public health infrastructure in the US vs. elsewhere
(1:07:34) Paths forward: public investment
(1:09:42) Paths forward: H5N1 and the scope of CDC’s authority
(1:15:32) Advice for aspiring public health professionals

Used or referenced:

Lin et al., “A Single Mutation in Bovine Influenza H5N1 Hemagglutinin Switches Specificity to Human Receptors”
Johns Hopkins, “Bird Flu is Raising Red Flags Among Health Officials”
Walensky, “What I Need to Tell America Before I Leave the CDC”
Berger and Walensky, “Reflecting on ACP’s Position Paper for Public Health: A View From the CDC Lens”
Zhang et al., “Physician Workforce in the United States of America: Forecasting Nationwide Shortages”
Harvard Chan School Department of Epidemiology, “The 175th Cutter Lecture on Preventive Medicine with Rochelle Walensky, December 8, 2023”
Leonhardt, “Follow the Science?”
Mann, “NPR Exclusive: US Overdose Deaths Plummet, Saving Thousands of Lives”
Tin, “Obesity Rate in US Adults No Longer Growing, New CDC Data Suggests”
CDC Moving Forward report
(Howard Koh survey) Leider et al., “The Exodus of State and Local Public Health Employees: Separations Started Before and Continued Throughout”
New England Journal of Medicine: Uyeki et al., “Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in a Dairy Farm Worker”

#16 Quayshawn Spencer: What is race?

Tue, 14 Jan 2025 05:00:00 -0500

In this episode, we speak with Dr. Quayshawn Spencer, Robert S. Blank Presidential Associate Professor of Philosophy at the University of Pennsylvania, about what race is, why he’s a radical racial pluralist, and what this could imply in science and medicine.

(00:00) Our introduction
(11:23) Interview begins
(20:21) Methodology: What are philosophers of race trying to do?
(32:05) From aspiring physician-scientist to philosopher of race
(41:08) Becoming a realist about race
(44:44) Human continental populations and the OMB racial classification scheme
(1:00:43) The national meaning of “race” in US racial discourse
(1:12:35) Why not be a pure social constructionist?
(1:17:04) Implications: racial inequalities
(1:20:59) Implications: diversifying clinical trials
(1:39:46) Pluralizing race talk

Used or referenced:

Spencer, “A Radical Solution to...”
Spencer, “A More Radical Solution...”
Glasgow, Haslanger, Jeffers, and Spencer, What is Race?
Haslanger, Resisting Reality
OMB, “About OMB’s Interagency Technical...”
Schwartz et al., “Why Diverse Clinical Trial...”
AMA Press Release: “New AMA policies recognize...”
AMA Policy on Civil and Human Rights: “Elimination of Race as a Proxy...”
Wikipedia: “Blood quantum laws,” “Atlantic slave trade,” “Nazi racial theories,” and “Native American Genocide in...”
History: “How Native Hawaiians Have...”
Karp, “Redlining and Lead Poisoning”
Borrell et al., “Race and Genetic Ancestry...”
Jih et al., “Using appropriate body mass...”
Haam et al., “Diagnosis of Obesity”
Chang Sun et al., “Genetics of Body Fat Distribution”
Block, “How Heritability Misleads About Race”
Herrnstein and Murray, The Bell Curve
Ásta, Categories We Live By

#15 Jeff McMahan: On the ethics of choosing our children's genes

Tue, 17 Dec 2024 05:00:00 -0500

In this episode, we speak with Dr. Jeff McMahan, Emeritus Sekyra and White’s Professor of Moral Philosophy at Oxford University, about whether germline gene editing is ever morally preferable to embryo selection and whether and when we should control the genetic outcomes of our children.

(00:00) Our introduction
(06:48) Interview begins
(10:06) Same-child choices and different-child choices
(27:24) Against the comparative view
(31:25) Against the impersonal view
(38:33) In favor of the two-tier view
(45:47) Implications for genetic counseling
(50:08) Other objections to gene editing
(51:36) Treatment versus enhancement
(56:55) Is it morally permissible to control our children’s genes?
(1:02:44) Disability and wellbeing
(1:07:50) The social model of disability
(1:21:09) Reproductive technologies and injustice

Used or referenced:

Jeff McMahan and Julian Savulescu, “Reasons and Reproduction: Gene Editing and Genetic Selection”
Jeff McMahan, “Causing Disabled People to Exist and Causing People to Be Disabled”
Elizabeth Barnes, “Disability and Adaptive Preference”
Jan Narveson, “Moral Problems of Population”
Eric Lander et al., “Adopt a Global Moratorium on Heritable Genome Editing”
Francis Collins, “NIH Director on Human Gene Editing: ‘We Must Never Allow Our Technology to Eclipse Our Humanity’”
Inmaculada de Melo-Martin and Sara Goering, “Eugenics,” in the Stanford Encyclopedia of Philosophy
The Genetic Literacy Project’s Global Gene Editing Regulation Tracker: China and the United States
Sara Reardon, “Gene Edits to ‘CRISPR Babies’ Might Have Shortened Their Life Expectancy”
David Cyranoski and Heidi Ledford, “Genome-Edited Baby Claim Provokes International Outcry”
Gary Marchant, “Global Governance of Human Genome Editing: What Are the Rules?”
Rob Stein, “New US Experiments Aim to Create Gene-Edited Human Embryos”
American College of Obstetricians and Gynecologists, Committee on Genetics, “Preimplantation Genetic Testing”
Manuel Viotti, “Preimplantation Genetic Testing for Chromosomal Abnormalities: Aneuploidy, Mosaicism, and Structural Rearrangements”
Cleveland Clinic Health Library: Treatments & Procedures: IVF (In Vitro Fertilization)
Tom Hurka,

#14 James Diao: When should race be used in medical algorithms?

Tue, 10 Dec 2024 08:00:00 -0500

In this episode, we speak with researcher and physician Dr. James Diao about when and why race should be included or excluded from clinical algorithms. We focus on his work evaluating the implications of including race as a variable in two clinical algorithms: one used to assess lung function, and another used to assess cardiovascular disease risk.

(00:00) Our introduction
(05:10) Interview begins
(09:47) Criteria for the inclusion/exclusion of race of clinical algorithms
(16:23) Inclusion of race in lung function equations
(27:04) Estimated racial disparities in lung disease classification
(31:37) Estimated racial disparities in access to social services and healthcare
(37:44) The PREVENT equations for cardiovascular risk
(47:44) Anticipated impact on statin recommendations
(57:22) Estimated changes in statin eligibility by race
(1:10:03) Whether we should exclude race from clinical algorithms by default
(1:20:36) Common themes and failure modes

Used or referenced:

Diao et al., “Implications of Race Adjustment in Lung-Function Equations”
Diao et al., “Projected Changes in Statin and Antihypertensive Therapy Eligibility with the AHA PREVENT Cardiovascular Risk Equations”
Nwamaka Eneanya, Wei Yang, and Peter Reese, “Reconsidering the Consequences of Using Race to Estimate Kidney Function”
MDCalc ASCVD risk calculator
MDCalc CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk calculator
MDCalc Preventing Risk of Cardiovascular Disease EVENTs (PREVENT) calculator
National Cancer Institute Breast Cancer Risk Assessment Tool
Darshali Vyas, Leo Eisenstein, and David Jones, “Hidden in Plain Sight–Reconsidering the Use of Race Correction in Clinical Algorithms”
Emma Pierson, “Accuracy and Equity in Clinical Risk Prediction”
CDC “Health, United States Spotlight: Racial and Ethnic Disparities in Heart Disease”
Roni Caryn Rabin, “Race Cannot Be Used to Predict Heart Disease, Scientists Say”

#13 Sarah McGrath: Are there moral experts?

Wed, 27 Nov 2024 14:00:00 -0500

In this episode, we speak with Dr. Sarah McGrath, professor of philosophy at Princeton University. We discuss whether and when it makes sense to defer to others about the answers to moral questions, whether moral deference is any less appropriate than deference in other domains, like math or science, and whether we have reason to think bioethicists are moral experts.

(00:00) Our introduction
(04:28) Interview begins
(08:02) Varieties of moral deference: pure versus impure
(12:39) Outline of Sarah’s view and argument
(20:58) The (ir)relevance of meta-ethics (what ethics is and where it comes from)
(41:13) How to identify moral experts
(50:37) Are utilitarians likely to be moral experts?
(52:32) Does education in moral philosophy make you an expert?
(1:01:18) Practical implications: endowing bioethicists with authority
(1:14:55) Why talk of optimism and pessimism is misguided

Mentioned or referenced:

Sarah McGrath, Moral Knowledge (especially Chapter 3)
Sarah McGrath, “The Puzzle of Pure Moral Deference”
David Enoch, “A Defense of Moral Deference”
Peter Singer, “Ethical Experts in a Democracy”
Christine Korsgaard, The Sources of Normativity
A.J. Ayer, Language, Truth, and Logic
Gilbert Ryle, “On Forgetting the Difference Between Right and Wrong”

#12 David Wendler: Are we overprotecting kids in research?

Tue, 12 Nov 2024 05:00:00 -0500

In this episode, we speak with Dr. David Wendler, Head of the Section on Research Ethics in the Department of Bioethics at the National Institutes of Health Clinical Center and philosopher by training. We discuss the ethics of pediatric research: how much risk we should expose kids to in research; what we should do when the federal research regulations don’t make sense; and what was and wasn’t wrong with the Kennedy Krieger Lead Abatement Study.

(00:00) Our introduction
(05:25) Interview begins
(13:56) How risky can pediatric research be?
(32:38) What counts as “minimal risk”? Risks of daily life standard
(45:28) Understanding research participation as a charitable activity
(49:48) Why the rules say we can expose kids to more risk when they don’t stand to benefit
(1:00:05) How to interpret research regulations when they are flawed
(1:03:42) Do kids need to understand altruism to assent to research?
(1:12:49) Should there be laws governing pediatric research?
(1:20:40) David’s take on the Kennedy Krieger Lead Abatement Study

Mentioned or referenced:

US pediatric research regulations: HHS/OHRP 45 CFR 46 Subpart D
NIH Inclusion Across the Lifespan
Creating Hope Act of 2011/2012
Pediatric Research Equity Act of 2003
Mott Poll Report: Is my child’s medicine FDA-approved?
Hwang et al., “Completion Rate and Reporting of Mandatory Pediatric Postmarketing Studies Under the US Pediatric Research Equity Act”
Grodin and Glantz, Children as Research Subjects: Science, Ethics, and Law
Wendler and Shah, “Should Children Decide Whether They Are Enrolled in Nonbeneficial Research?”
Shah et al., “How do institutional review boards apply the federal risk and benefit standards for pediatric research?” [note: we refer to this as a 2008 study, but it was actually published in 2004]
Wendler and Forster, “Why we need legal standards for pediatric research”
Grimes v. Kennedy Krieger Institute, Inc. (Court of Appeals of Maryland)

#11 Richard Leiter: Is a better death possible?

Tue, 29 Oct 2024 05:00:00 -0400

In this episode, we speak with Dr. Richard Leiter, senior palliative care physician at Dana-Farber Cancer Institute and Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School. We discuss the state of end-of-life care in the US today, why patients often receive care that doesn’t align with their values, whether some of the care that doesn’t seem to promote the things patients’ care about actually is aligned with their values, and whether doctors put too much pressure on patients to make end-of-life decisions autonomously.

(00:00) Our introduction
(08:46) Interview begins
(13:47) Do early conversations make a difference?
(20:46) Challenges in doctor-patient communication
(35:47) Advice for listeners on being a healthcare proxy
(41:47) What if the care people receive is value-concordant? Hindsight is 20/20
(47:40) Trade-offs between living long and living well
(52:04) Trade-offs between living well and dying well
(54:12) Value-change over time and advance care directives
(1:01:03) Can doctors better respect autonomy by limiting options?
(1:08:49) Code status, CPR, and framing patients’ options
(1:20:16) Supporting family members’ decision-making and narratives

Mentioned or Referenced:

Atul Gawande, Being Mortal
Elisabeth Kübler-Ross, On Death and Dying
The Serious Illness Care Program (Ariadne Labs)
Dattani et al., “Child and Infant Mortality” (Our World in Data)
Kaldjian et al., “Code Status Discussion And Goals Of Care Among Hospitalized Adults”
Penketh & Nolan, “In-Hospital Cardiac Arrest”
French et al., “End-of-Life Medical Spending in Last Twelve Months of Life is Lower than Previously Reported”
Pierrotti, “Playing God”
Temel et al., “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer”
Diem et al., “Cardiopulmonary Resuscitation on Television — Miracles and Misinformation”
Portanova et al., “It Isn’t Like This On Tv: Revisiting Cpr Survival Rates Depicted On Popular Tv Shows”
Sophocles, Antigone

#10 Danielle Allen: Should laypeople make health policy decisions?

Tue, 16 Jan 2024 05:00:00 -0500

In this episode, we speak with Dr. Danielle Allen, professor of political philosophy, ethics, and public policy at Harvard and Director of the Allen Lab for Democracy Renovation, about the extent to which we should involve laypeople in decisions about health and science policy through democratic, participatory processes.

(00:00) Our introduction
(08:47) Interview begins
(12:23) Power-sharing in the domains of health and science policy
(16:23) Is representative democracy enough?
(21:03) Does power-sharing always require democratic mechanisms?
(24:13) What role should professional ethicists play in shaping policy?
(31:03) Does power-sharing produce other substantive benefits?
(32:56) Trade-offs between power-sharing processes and good outcomes
(39:38) Is respectful civic engagement a realistic goal in our polarized society?
(47:46) The problem of regulatory capture
(52:31) Worries about overburdening laypeople

Mentioned or Referenced:

Danielle Allen, Justice by Means of Democracy
Danielle Allen, Democracy in the Time of Coronavirus
The Ezra Klein Show, Transcript: Ezra Klein Interviews Danielle Allen
Commission on the Practice of Democratic Citizenship, Our Common Purpose: Reinventing American Democracy for the 21st Century
Educating for American Democracy, Roadmap to Educating for American Democracy
Medical University of South Carolina, Community-Engaged Research
STAT, Expert panel votes down Biogen’s Alzheimer’s drug, and rebukes the FDA in the process
The New York Times, Inside a Campaign to Get Medicare Coverage for a New Alzheimer’s Drug
The New York Times, How an Unproven Alzheimer’s Drug Got Approved
Fierce Pharma, Big Pharma's shelling out big-time to patient organizations. Is there any quid pro quo?
The San Francisco Chronicle, 87 permits, 1,000 days of meetings and $500,000 in fees: How bureaucracy fuels S.F.’s housing crisis

#9 Marc Lipsitch: How to ethically prevent the next pandemic

Tue, 02 Jan 2024 10:00:00 -0500

In this episode, we speak with Marc Lipsitch, epidemiologist and professor at the Harvard T.H. Chan School of Public Health and Director of the Center for Communicable Disease Dynamics, about what lessons we should take from the COVID-19 pandemic, what role research should play in mitigating and preventing future pandemics, and how we should regulate research on potential pandemic pathogens.

(00:00) Our introduction
(11:26) Interview begins
(12:35) The role of surveillance in preventing pandemics
(23:05) What policymakers got wrong during the COVID-19 pandemic and why
(26:23) Could we have prevented backlash to COVID-19 mitigation policies?
(30:34) How to communicate uncertainty to the public during a pandemic
(35:32) What role human challenge trials should play in reducing harm
(40:02) How should we mitigate research risks to non-participants?
(48:02) How socially valuable is research on potential pandemic pathogens?
(53:21) The role of research funders and other non-regulatory bodies
(59:34) The role of bioethicists

Relevant readings:

The Covid Crisis Group, Lessons From the Covid War: An Investigative Report
The Guardian, “Factory Farms of Disease: How Industrial Chicken Production is Breeding the Next Pandemic”
Our World in Data, Excess mortality during the Coronavirus pandemic (COVID-19)
Wikipedia, Black Death
The Guardian, Factory farms of disease: how industrial chicken production is breeding the next pandemic
World Health Organization, Human infection with avian influenza A (H5N8) - Russian Federation
CDC, Ferrets
Friedrich Frischknech, The history of biological warfare
Kevin Esvelt, Mitigating catastrophic biorisks
USA Today, Lab-created bird flu virus accident shows lax oversight of risky 'gain of function' research
Wikipedia, 1978 smallpox outbreak in the United Kingdom

#8 Sally Haslanger: How social contexts shape our moral norms

Tue, 12 Dec 2023 05:00:00 -0500

In this episode, we speak with Dr. Sally Haslanger, Ford Professor of Philosophy and Women’s and Gender Studies at MIT, about what norms are, how we can know when they need to be changed, and how we should change them.

(00:00) Our introduction
(5:12) Interview begins
(16:07) What grounds social norms
(18:56) How we can know a moral norm is problematic
(23:11) How social and moral norms relate
(29:49) What is social critique?
(35:54) Social critique without situated knowledge of a social practice
(50:06) Are structural solutions always better?
(52:21) The role of philanthropy and expertise
(1:05:18) What makes some norms coercive
(1:07:47) How to change the social world
(1:12:46) Who’s responsible for disrupting social norms?
(1:15:18) Should bioethicists be activists?

Relevant readings:

Elizabeth Anderson, “Beyond Homo Economicus: New Developments in Theories of Social Norms”
Sally Haslanger, “Political Epistemology and Social Critique”
Sally Haslanger, “Methods of Social Critique”
Sally Haslanger and Clare Chambers, “Ideology and Critique”
Wolfgang Streeck and Kathleen Thelen, Beyond Continuity: Institutional Change in Advanced Political Economies

#7 Jennifer Blumenthal-Barby: Is nudging ethically required?

Tue, 14 Nov 2023 05:00:00 -0500

In this episode, we speak with Dr. Jennifer Blumenthal-Barby, a philosopher and bioethicist at Baylor College of Medicine, about why she thinks clinicians are often permitted, and even required, to use insights from behavioral economics and decision psychology to shape patients’ medical decisions.

(00:00) Our introduction
(05:50) Interview begins
(07:57) What is a nudge?
(15:15) Is there any such thing as pure rational persuasion?
(18:12) What makes a decision good or bad?
(23:15) Can nudges make patients’ medical decisions better?
(42:40) How credible are the findings of decision science?
(45:21) Do nudges disrespect autonomy?
(56:16) Justifying nudges as instances of soft paternalism
(59:08) Are pro-social medical nudges also justified?
(1:01:30) How the doctor-patient relationship affects the ethics of nudging
(1:05:51) Is nudging ever wrong?

Relevant readings:

Jennifer Blumenthal-Barby, Good Ethics and Bad Choices: The Relevance of Behavioral Economics for Medical Ethics
Jennifer Blumenthal-Barby, “Between Reason and Coercion: Ethically Permissible Influence in Health Care and Health Policy Contexts”
Moti Gorin, Steve Joffe, Neal Dickert, and Scott Halpern, “Justifying Clinical Nudges”
Robert Noggle, “Pressure, Trickery, and a Unified Account of Manipulation”
Sophie Gibert, “The Wrong of Wrongful Manipulation”

#6 Jeff Sebo: Why we’re wrong about who matters

Tue, 31 Oct 2023 05:00:00 -0400

In this episode, we speak with Dr. Jeff Sebo, a philosopher and bioethicist at New York University, about what it would mean to take seriously the possibility that non-human animals (including insects) and future AI systems might matter morally.

(00:00) Our introduction
(05:56) Interview begins
(07:21) The moral circle vs. the legal and political circles
(13:18) Why has the moral circle expanded over time?
(20:53) How should we trade off human and non-human welfare in practice?
(33:40) How should we treat non-human animals in research?
(37:25) How should we treat current AI systems, given that we’re not certain that they’re not sentient?
(46:22) Philosophical underpinnings: What grounds moral status?
(52:09) Philosophical underpinnings: What is sentience?
(56:20) Philosophical underpinnings: Interspecies welfare comparisons
(1:00:22) Philosophical underpinnings: Moral uncertainty and humility
(1:10:35) What causes should you prioritize if you care about non-human animal welfare?
(1:19:09) Is the total welfare in the world net negative; and if so, should this affect which causes we prioritize?

Relevant readings:

Bob Fischer and Hayley Clatterbuck, “The Risks and Rewards of Prioritizing Animals of Uncertain Sentience”
Ben Goldfrab, “Animals need infrastructure, too”
Kyle Fish, “Net global welfare may be negative and declining”

#5 Chris Robichaud: Can we teach people to be more ethical?

Tue, 17 Oct 2023 05:00:00 -0400

In this episode, we speak with Dr. Christopher Robichaud, Director of Pedagogical Innovation at Harvard’s Edmond and Lily Safra Center for Ethics, about whether and how we can teach scientists, doctors, and other professionals to be more ethical, what the goals of ethics education ought to be, and how we can know we’re achieving them.

(00:00) Our introduction
(13:18) Interview begins
(17:39) Does ethics education miss the point?
(22:05) Four goals of ethics education
(30:05) Goals: Improving moral reasoning
(32:39) What drives the focus on moral reasoning?
(36:05) Does focusing on moral reasoning promote moral relativism or nihilism?
(39:24) Goals: Promoting good behavior
(41:49) Goals: Cultivating moral perception
(47:43) Goals: Helping students live good lives
(51:33) Strategies for teaching ethics to practitioners
(53:43) The Applied Model for teaching practical ethics
(57:29) Measuring the effectiveness of ethics education
(1:04:46) Chris’s take on Effective Altruism
(1:07:38) Philosophical underpinnings: Williams and Murdoch

Referenced:

Daniel Callahan, “Chapter 2: Goals in the Teaching of Ethics” in Ethics Teaching in Higher Education
Leah Pierson, “Ethics Education in U.S. Medical Schools’ Curricula”
Rachel Mintz, Leah Pierson, and David Gibbes Miller, “Rethinking Professionalism Assessments in Medical Education”
Leah Pierson, "Ethics Education in U.S. Medical Schools' Curricula"
Derek Bok, “Can Ethics Be Taught?”
Anthony Burgess, A Clockwork Orange

#4 Holly Fernandez Lynch: Do IRBs do more good than harm?

Tue, 03 Oct 2023 05:00:00 -0400

In this episode, we speak with Professor Holly Fernandez Lynch, a lawyer and bioethicist in the Department of Medical Ethics and Health Policy at the University of Pennsylvania and founder and co-chair of AEREO, an organization that aims to understand and measure the benefits and drawbacks of the IRB system. With Holly, we discuss what we currently know about the benefits and costs of IRBs, why it’s so hard to measure them, and whether justifying the IRB system requires establishing that it produces good outcomes, or just that it follows good procedures.

(00:00) Our introduction
(04:58) Interview begins
(05:41) Do IRBs protect the rights and welfare of research participants?
(11:20) Why not restrict the scope of IRB review to the most risky research?
(26:49) Do IRBs promote justice?
(33:32) Do IRBs foster a culture of ethical concern?
(41:20) Do IRBs maintain and promote trust in the research enterprise?
(47:18) Do IRBs promote socially valuable, scientifically valid research?
(50:54) Given their costs, financial and otherwise, might IRBs do more harm than good?
(1:00:52) Why haven’t we been able to develop clear standards for measuring IRB outcomes?
(1:05:42) Should we expect IRBs to offer more than procedural protections?
(1:09:27) Developing a system of IRB precedent
(1:16:48) Why is it so hard to reform the IRB system?

Mentioned:

Alex John London, For the Common Good: Philosophical Foundations of Research Ethics
Jonathan Kimmelman, “Better to be in the Placebo Arm for Trials of Neurological Therapies?”
Richard Beigi et al., “The Need for Inclusion of Pregnant Women in COVID-19 Vaccine Trials”

#3 Marie Nicolini: Should people with mental illness have access to medical aid in dying?

Tue, 19 Sep 2023 06:00:00 -0400

Content warning: This episode contains discussions of suicide, suicidal ideation, and symptoms of mental illness. If you or someone you know or love is struggling, please seek help. You can call or text 988 to reach the suicide and crisis lifeline.

In this episode, we interview Dr. Marie Nicolini, a psychiatrist and bioethicist who testified to the Canadian Parliament as an expert witness on the issue of medical aid in dying (MAID) for mental disorders. With Marie, we discuss whether we should legalize MAID for mental illness, what practical and conceptual challenges we face in constructing appropriate safeguards, and how legalizing MAID might interact with efforts to prevent suicide and improve psychosocial services for people with mental illness.

(00:00) Our introduction
(13:02) Interview begins
(14:07) Safeguards: The voluntariness requirement
(23:16) Safeguards: The unbearable suffering requirement
(33:01) Safeguards: The incurability requirement
(42:38) Safeguards: Retrospective oversight
(46:07) Is MAID for mental illness at odds with suicide prevention?
(1:01:08) Does legalizing MAID disincentivize improving psychosocial services
(1:06:13) What does MAID express about how we value people’s lives?
(1:12:44) The future of MAID policy

#2 Govind Persad: How (not) to allocate resources during a pandemic

Tue, 05 Sep 2023 06:00:00 -0400

In this episode, we interview Dr. Govind Persad, an expert on resource allocation whose work influenced COVID-19 allocation policies, about how we should allocate scarce medical resources, what stood in the way of optimal allocation during the covid pandemic, and how we can improve resource allocation within the US healthcare system.

(00:00) Our Introduction
(04:05) Interview begins
(12:06) What is a “framework” for allocating health resources?
(14:20) What normative assumptions are baked into allocation frameworks?
(19:36) What principles are included in allocation frameworks?
(20:24) Overview of first two principles: Maximizing benefits and favoring the worst off
(26:11) Overview of second two principles: Equal treatment and rewarding social usefulness
(39:37) Which benefits matter when allocating health resources?
(43:33) Should we account for quality of life?
(49:22) Should we prioritize the youngest first?
(53:29) When does reciprocity matter?
(57:32) Putting principles into practice
(1:02:22) Legal considerations
(1:07:25) Improving resource allocation in the US healthcare system
(1:13:16) How living through the pandemic influenced Govind’s research

Mentioned:

“Principles for Allocation of Scarce Medical Interventions” by Govind Persad, Alan Wertheimer, and Ezekiel Emanuel (2009)
“Fair Allocation of Scarce Medical Resources in the Time of COVID-19” by Ezekiel Emanuel et al. (2020)
“The Rebugnant Conclusion” by Jeff Sebo (Draft)
“Equality and Priority” by Derek Parfit (1997)
“Should the Numbers Count?” by John Taurek (1977)
“In the Line For Scarce Covid Treatments, Immunocompromised Americans Should Go Before the Unvaccinated” by Govind Persad and Emily Largent (Opinion in The Washington Post, 2022)
“How COVID-19 Hollowed Out a Generation of Young Black Men” by Akilah Johnson and Nina Martin (ProPublica, 2020)

Thoughts? Guest suggestions? Email us at biounethical@gmail.com

You can find more episodes of Bio(un)ethical at biounethical.com. Sign up for our email list at biounethical.com to receive episode alerts and submit questions for upcoming guests.

To support us, please subscribe, rate, and review our show wherever you get your podcasts, and recommend it to a friend. For updates, follow Leah and Sophie on Twitter (leah_pierson and sophiehgibert).

#1 Robert Steel: Can research be too risky?

Mon, 21 Aug 2023 05:00:00 -0400

In this episode, we interview Dr. Robert Steel about how we should assess the risks and benefits of research, what justifies research oversight, and whether there should be upper limits on the amount of risk research participants are exposed to.

(00:00) Our introduction
(05:06) Start of interview; IRB background
(13:34) The notion of minimal risk
(24:49) Justifying IRB risk evaluation: Initial discussion
(37:07) Justifying IRB risk evaluation: Group soft paternalism
(45:57) Justifying IRB risk evaluation: Maintaining social trust
(54:13) IRB assessment of social value
(56:25) Alternative justifications (beneficence, non-maleficence, non-exploitation)
(01:02:36) Implications: Benefits to society count; No upper limits on risk
(01:15:07) Robert’s future work on government policy trials

Mentioned:

Survey of pediatric IRB chairs: “How do institutional review boards apply the federal risk and benefit standards for pediatric research?” by Shah et al. (2004)
Exploitation by Alan Wertheimer (1996)
“Facing up to paternalism in research ethics” by Franklin Miller and Alan Wertheimer (2007)
Public Trust: “Is there an ethical upper limit on risks to study participants?” by Nir Eyal (2020)
“What makes clinical research ethical?” by Ezekiel Emanuel, David Wendler, and Christine Grady (2000)
“Reconceptualizing Risk-Benefit Analyses: the Case of HIV Cure Research” by Robert Steel (2020)
“A framework for risk-benefit evaluations in biomedical research” by Annette Rid and David Wendler (2011)

Thoughts? Guest suggestions? Email us at biounethical@gmail.com

You can find more episodes of Bio(un)ethical at biounethical.com and sign up for our email list to receive episode alerts and submit questions for upcoming guests.

Bio(un)ethical is written and edited by Leah Pierson and Sophie Gibert, with production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

#0 Welcome to Bio(un)ethical

Thu, 17 Aug 2023 08:00:00 -0400

Welcome to Bio(un)ethical, the podcast where we question existing norms in medicine, science, and public health.

In this episode, we (Leah Pierson and Sophie Gibert) introduce the podcast and talk about why we started it and what we hope to achieve.

If you want to support us, the best way is to subscribe, rate, and review our show wherever you get your podcasts, and recommend it to a friend. You can find more episodes at our website, biounethical.com, and can also join our email list to receive episode alerts and submit questions for upcoming guests.

Thoughts? Guest suggestions? Email us at biounethical@gmail.com

For the latest updates, follow us on Twitter (leah_pierson and sophiehgibert)