Transcripts For CSPAN2 Amy Gutmann And Jonathan Moreno Every

My name is paul, im a reporter with the washington post, and it is my pleasure to introduce this distinguished panel. We have one of americas greatest Television Journalists in conversation with two of americas most formidable intellectual, dr. S amy gutmann and jonathan moreno. They will be discussing their book, everybody wants to go to heaven but nobody wants to die. [laughter] subtitle, bioethics and the transformation of health care in america. Let me introduce this distinguished panel. Andrea mitchell, no introduction, Everybody Knows Andrea Mitchell. [applause] to come press the very extensive resume down, veteran chief Foreign Affairs correspondent, correspondent for nbc news, also host of Andrea Mitchell reports on msnbc, noon. Check local listings. [laughter] joined nbc in 1978 and has covered seven president ial administrations. Every president ial campaign since 1980. Youve seen her on nightly news, today show, meet the press, shes been everywhere. Conflicts in haiti, bosnia, kosovo, been to iraq, north carolina, pakistan, israel, the palestinian territories. The awards shes won would take me all day, so i will just go to one. She just won, this year, the women in washington journalism Lifetime Achievement award. [applause] andrea mitch em. Mitchell. [applause] dr. Amy gutmann is president of the university of pennsylvania and [applause] [laughter] and has been since 2004. When her current contract expires in 202 the2 2022, she will be the longest is serving president in penns 280year history. [applause] now again, a master resume, and they can get into it, but heres one stat that i really particularly like. Under her tenure with at penn, she has more than doubled the number of students from low income, middle income and First Generation College students. [applause] and shes only the author of 17 books. [laughter] dr. Jonathan moreno, philosopher, historian, bioethicist, he has written seminal works on sociology and the politics of biology and medicine. He is officially a professor of medical ethics and the history and sociology of science at penn. He has served on numerous president ial Commission Advisory commissions, and he has published more than 20 books, monographs, anthologies, textbooks, etc. Were honored and lucky to have this unique group with us today. Without further ado, as lester holt would say to Andrea Mitchell, over to you, andrea. I think first, though, we have a video. Enjoy. Today there are over seven billion of us on earth. Tomorrow there will be more. Each and every one of us is different, and yet all of us are the same. We are born, we age, we die. But today science is altering the equation of life. Modern medicine, advanced research, new testimonies are changing new technologies are changing how we live. Were now able to reengineer genes and blood cells. We can create babies with up to five parents. We can from long the lives of even the sickest patients. The question becomes, just because we can, should we . And if we do, how do we get it right . The doctor patient relationship has evolved. Who should decide ethics . Where do we draw ethical boundary for what medicine and science can do . How much power should governance and big business have over our health . Is health care a right for all or a privilege for some, and who pays the bills . These are the issues that every person, every family, every community will face. Everybody wants to go to heaven but nobody wants to die by amy gutmann and jonathan moreno, an eyeopening look at how bioethics is transforming health care in america. The reviews are in. Now you can read it for yourself. The choices we make today determine the future world well live in. Life as we know it is on the line. [applause] welcome, all, im Andrea Mitchell, as you know, and i cant tell you how exciting it is for me, i feel a little overwhelmed not just by this wonderful audience, but by the brain power next to me on this stage. And the fact that these are the questions were all asking in our families, in our, well, our political conversations. These are some of the questions that weve heard but havent fully been answered on the debate stage this primary season, questions of who has the right to health care. Many of us would argue everyone has the right to health care. Who pays, how do we pay. What about the advances in science, what expert challenges do we have as we, you know, face the issues of where science is going and where science has been. What is the role of the doctor in our society. All of these questions are addressed in this Remarkable Book with its Country Music title. [laughter] so i am thrilled to be here. Everybody wants to go to heaven but nobody wants to die. We think we should set it to music, amy and jonathan. But lets talk about the question that has been debated in the midterms most recently and now again in the general election. How do we address the challenge of insuring everyone in america deciding what to do about these hugely expensive advances . Then of course we wouldnt have written the book of that was the case. I think those of the right questions to ask. In the context is really an incredible moment in american history. Its been a long moment since the 60s. Where modern medicine gives us more choices than weve ever had before in human history. But with those choices comes more moral dilemmas. We could add questions about scarce organs for transplant. Who should get them if they are scarce. Would like to ask the larger question, which bioethics has sometimes neglected, which is, how do you create system in which encourages more people to be altruistic and donate their organs. We want to do is open up the conversation to everybody because if you look at these issues, every one of us in our lifetime faces almost every one of them actually, there are very few that we or our family or friends dont face up to and if we dont make the choices and we have a lot of power to do that collectively as well as individually. Other people are making them for us. Big ab since the 1970s at least, economists have said we are on an unsustainable course in terms of amount of gdp spent with healthcare yet we are not getting enough bang for our buck. This is not a new problem. We kind of punted on it. You mentioned the right to healthcare. In 1980s the president ial Bioethics Commission avoided the question. We dont pick it avoidable anymore. We believe there is a right to a decent level of healthcare. For everybody. And part of the book is we cant just idealize these things we actually have to grapple with the problems ahead of us. We have kind of not done that historically. So with regard to the right to healthcare for everyone, the hard question is, how are we going to afford it . What kind of a plan will actually allow us to provide affordable healthcare to all americans . Lets just talk about the u. S. That prompted us to write the New York Times oped, which advocated for revising and reinforcing the Affordable Care act because all reviews are very reluctant to take away effective healthcare from people who already have it but we have to give it we need a public option. We need medicare for more for those people who would prefer medicare over their own private insurance or who dont were not now covered. This is something we all have to as americans, i think the billy the optimistic part is, healthcare is ranked as the number one sensitive issue on voters minds. When we look at cost we know that we in america are spending more on healthcare and getting less. We see political figures showing graphically literally that you can drive a few miles from detroit to windsor canada and get insulin that you cannot afford. We see stories on my network and other networks of people rationing their insulin. Which is dangerous and potentially fatal. Just so people know, you all may know this but i think all americans need to know this, we spend about twice as much as any other affluent democracy on healthcare per person and we have lower Life Expectancy Life Expectancy has actually gone down in this country since 2015. It is totally unacceptable. Thats the risk of both worlds. We have Great Innovation and we can keep it going only if we start controlling drug pricing and other medical costs. Is not just mortality and more ability its the quality of life. We have a chapter on Public Health, which is somewhat neglected in our field of bioethics, bioethics tends to be in this country focused on a very high tech questions. We have a section on Public Mental Health which has been horribly neglected. He just walk around here and you can see whats happened to our streets have become day rooms as the old mental institutions were. There is a sculpture my wife and i never noticed before a sculpture of homeless person on a bench. We asked the question, is that sculpture they are to recognize he there are Homeless People in our midst or keeping one of them from sitting on the bench. We have moral failures we have addressed. Speaking a moral failures come i want to ask about something you wrote in the book. Which i find fascinating as we experience all these advances today. Human experimentation. He went to this history and i found it rather shocking we now know about pe and other experience decades earlier. I found what you wrote about Henry Beecher and the 1964 paper about what happened in Brooklyn New York where elderly disabled Senior Citizens were being experimented upon with live cancer cells from institutions that celebrated as memorial kedric. And then in 1966 i believe another exposc. Talk to us a bit about human experimentation and what safeguards there are now . Whats the most important single document in the history of human experiments is called by posterity the nuremberg code written by the judges at the end of a trial of nazi doctors. When he was a medical student at harvard in the late 40s during this trial of the nazi doctors in the decision by the judges that included an amendment to the nuremberg code. The famous first tents in the voluntary consent of the human subject is absolutely essential. Jay said the reaction harbored for pastors was, thats a really good ethics code for barbarians. But we are not nazis. The most 20 years later harvard professor in anesthesiology that shook things up in an exposc that included a couple dozen cases of said what he said were unethical human experiments. This is a part of the bigger story about we tell in the book about the change in doctorpatient relationships from the late 40s to 1960s. Thats where i was going with that. And the way that the patients and we as voters, one hopes, have insisted on getting more control over the power in that relationship. And how do patients get more control as a patient myself i dont know whether im getting it right information or told to get a second opinion. Im a cancer survivor, as you know. And all of us as consumers feel a little bit intimidated by the doctorpatient relationship. Because of the gap in our knowledge. Its intimidating and if you look at the economics of practicing medicine, most clinicians really wring their hands at how little time they have to actually sit down and talk with the patient. And no matter how many how automated how technologically advanced medicine becomes or has become, there is no substitute for the knowledge you can get in a two way conversation with a patient doctor. We went from doctor does best with marcus welby being played by robert young, fathers knows best. Those of you laughing, have to be either of a certain age or maybe no tv history but i remember it well. That was the culture it was not just the practice. We have an ethos now that the patients should have be able to give informed consent and should have control over our own lives medical lives but the actual practice of medicine has not caught up to the east coast. There are three things we think in your position and my position be open about what your alternative treatments are and know your goals. For some people its extremely important to get through a wedding in the family or bat mitzvah or bar mitzvah and not go directly into treatment. Doctors are experts in medicine but not experts in us. Its not good to be able to make decisions all on your own. I think a patient shouldnt be i shouldnt be my own doctor. Or my own nurse. But we should make Healthcare Providers earn their trust. Our trust. One of the more provocative questions that you raise in the book is what legal means are appropriate for endoflife decisions . Doctor marino do you want to speak to that . Is headed by students the last two years, other than gay marriage, the most amazing change in the culture about these kind of value issues is the changing attitudes toward physicianassisted death. I gave a talk in kansas city a couple weeks ago and i was getting ready, once in a while i look at my slides before i give a talk. I realized i had a slide that was out of date in terms of the number of jurisdictions in the u. S. That permit physicianassisted death. Seven only a couple years ago now if you include montana which has made legal judgment about this, not a statute, its 10. Its really a remarkable change in attitudes and whether you approve it or not, something is happening that we think also reflects the change and balance in the nature of the doctorpatient relationship. I think what is a great example of why its important for all of us to be informed and involved. And informed in broad ways. The question of physicianassisted death is so controversial that we dont even agree on what to call it. Opponents tend to call it physicianassisted suicide. Whatever you call it, a very small number of people, even in the states where it is legalized, use it, where its a huge, millions of people use hospice care and many more millions would if only it were known, accessible and affordable. Its very important that we understand that the things that are most controversial arent necessarily the most important things. Even though we need to discuss them abi think its really important. The culture is shifting as the physicianassisted death is the tip of the iceberg of how much patients have been taking healthcare into our own hands. 2 and a half years ago my mother died in a nursing home in rockville, we had hospice, Montgomery County hospice, they were terrific. Anybody who is ab its another way that we have kind of is a political culture avoided getting arms around the issue. I dont know, i saw zeke emanuel before but hes written extensively on this. Its been totally distorted but really by people who want to make just a craft political issue but in fact, we talk about this in the book, there is broad agreement on endoflife care but not a recognition of peoples rights to end their lives in a way that they have some control over the pain and the suffering and the dignity of how they perceive it. There is also probably the care at home where there are hospital visits and doctors and nurses visiting nurses decisions that are made with informed consent over not being brought into the hospital and emergency. If you have the wherewithal to access the services. We were fortunate we were able to in my mothers case but its a system you have to be able to figure out and have the time and the energy to address. Which is why its so important to face up to these kinds of issues before there is an urgent situation and you really dont have the time. This is the time when i think the American Public putting healthcare at the top of their issues with concern should spread far beyond the politics of it to how we inform ourselves in our daily lives. Both to ourselves and our families. You alluded to your New York Times oped, which was great and talked about medicare for more. To define the term, how are you envision medicare for more adding on to the Affordable Care act because the debate of course is great variations of medicare for all and other options. I think when we started to write the book we didnt really think about the election cycle. Now we find ourselves in the thick of it in the book is so relevant in that respect. Although there are a lot of other issues in the book. What we are most concerned about is making sure people who are running for office and the incumbent are very clear about what they are going to do and that we not throw the baby out of the bathwater. We think there have been some important advances as a result of the Affordable Care act. There is a way to go but millions of more people are covered now. There are problems, there is a a theres problems with deductibles, problems with copayments, we would like to see the candidate meet very specific about how they are going to address those details and what they propose to do. We have our own views in the book, but ultimately we want to make sure that everybody has basic healthcare coverage. It is a right not a privilege that if you suffer from insulin dependence, diabetes you should have access to affordable insolence. In this country it isnt true right now. Its just not true. The same is true for asthma patients. The fact that asthma abany program that builds on the Affordable Care act and enables everybody in this country to have basic healthcare and affordable rates. It is something that we would defend and i believe from everything weve seen in the pose, a vast majority of americans would defend it. With regard to the candidates we should hold our feet to the fire. For those that want to place results is to repeal and replace movement had no replacement. Now with the democratic candidates, we ought to ask ourselves and them, if you are going to scrap the aca, how are you going to enable any fraction of the one 60 a160 million americans where private Employer Healthcare coverage who want to keep it, how are you going to be sure they have as effects of healthcare coverage and for the ones who want to leave their employer coverage because there is some employer coverage that isnt ef