Rationally speaking, is a presentation of New York City skeptics dedicated to promoting critical thinking, skeptical inquiry and science education. For more information, please visit us at NYC Skeptic's Doug. Welcome to, rationally speaking, the podcast, where we explore the borderlands between reason and nonsense. I'm your host, Masimo Appeal YouTube. And with me, as always, is my co-host, Julia Gillard. Julia, what are we going to do today? Today is a very special episode.

We're recording live at the third annual naughties conference on science and skepticism among. So the listeners of the missing. Right. This is the day of making me a little nostalgic, because this is actually the two year anniversary on which I met Martin. I was in the audience at Nexxus at the very first nexxus. That's how this whole shebang got started. So it's been it's been a great conference so far. A lot of interesting talks, a lot of sharp objects going in people's noses and mouths.

And and since this is the first Texas with double with twice the number of days we decided to celebrate, we have twice our usual number of guests. We have two excellent guests with us today, one old one new age wise. No, no, I definitely don't mean so. Let me let me introduce our guests. Jennifer Michael Hecht is our our first guest on Rationally Speaking, which is quite an honor. Usually with us it's all wham bam.

Thank you, ma'am. And we're we're on the next guest. But Jennifer was so good, we had to come back for more. So for those of you who don't know her, she is the author of three history books, Doubt a History The End of the Social, Scientific Modernity, Atheism and Anthropology and the Happiness Myth, as well as two volumes of poetry. Her prose and poetry appear in The New York Times, The New Yorker, The Boston Globe and The Washington Post.

Jennifer earned her Ph.D. in the History of Science from Columbia University in 1995 and now teaches in the MFA Program of Columbia University and the graduate writing program of the New School University. Also also with us today is Jacob Apel, M.D., JD Annville, an MFA who's a bioethicist based at the Mt. Sinai Hospital in New York City. He contributes frequently to academic publications including the Journal of Medical Ethics Journal, Journal of Clinical Ethics, and as well as mainstream media, including The New York Times, the New York Daily News.

He has recently held teaching appointments at Columbia University, New York University, Pace University and Brown University, where he was named Teacher of the Year by the undergraduate student body in 2003. Jacob is also the author of One Hundred and Fifty Published short stories in his fiction has been shortlisted for the O'Henry Award, The Pushcart Prize and the best American short stories on numerous occasions. Please welcome Jacob Bell. And now to the fun, not the fun. Yes, our podcast is going to be relatively freewheeling in addition to being as opposed to what?

That's way more than usual. I mean, our our two guests, as you've heard, are multitalented, multifaceted writers and teachers. And and there's a lot of interesting overlap in what they write and teach and think about, including topics like happiness and suffering and death and life and morality and other trivial things like that. So I'm sure we'll have a lot to talk about. We're going to leave 10 or 15 minutes for audience questions at the end. This will be a one hour show, which is another feature of our very special episode.

So shall we start with talking about it? Since the topic is bioethics, would you like to tell us something about what bioethics is and what is it supposed to be and how does it work? Sure. My first natural answer is to ask what is in bioethics, but that is my natural bias. I've been told to offer a simple explanation of what bioethics is and what bioethicists do. And I think one story sums up well on bioethics deals, mostly with the choices that have arisen from the new technologies in science as applied to medical settings.

In the early 1950s, when my grandmother was diagnosed with breast cancer, there were no choices that came to her husband. They they told her that she had rheumatism. They didn't even tell her she had breast cancer. It was a different world. And they asked my grandfather, do you want her to die in the hospital or do you want to die at home? So the only two choices available now, a patient in the same situation has not only hundreds of clinical choices, but also ethical choices to make.

Do they want therapy that will increase their odds of survival but decrease their odds of fertility? Do they want to stay alive and awake to the maximum possible moment? What do they want to reduce suffering as much as possible? So much of what I do as a bioethicist is helping patients navigate through those different choices. Jennifer, that sounds like something that you might want to comment about in sort of as a general topic from a different point of view, from a philosophical perspective, since your ethics, usually, I think philosophy, not bio.

What do you think? Well, yeah. I mean, as we all know, that the science has gone so fast in the past 50 years, that was very difficult for ethicists or people who just think about philosophy and think about what human beings should be doing to to catch up. And so we're really playing it. We're playing a sort of rearguard attempt to to try to do the right thing. And, yeah, the conversation is is very it's not very organized right now because there's just been so much happening in the world of science and and no way to assess the results yet.

So, yeah, I think I'll leave it at that until we get to more specifics. Well, one topic that we want to cover since we have both of you here is Jennifer, your your next book is going to be about the morality of suicide, is that it's about suicide. And and and sort of it sounds like a very scary subject. And so we don't think about it much. But there's a way in which looking at it expects a lot of other issues.

And so obviously end of life issues, I'm sure a big part of being a bioethicist. And I guess I'm wondering, is there sort of a consensus among the field of bioethics or sort of a standard way to deal with with people who wish to end their lives? And do you diverge from that consensus? There is. And I do think there actually is a great start to my thinking it's the wrong one. I also am a practicing psychiatrist and the dogma of psychiatry.

Suicide is both irrational and reflects an underlying pathology and should be stopped. And I'm not of that persuasion. I think as a physician, we have to balance restricting people's freedom with serving their welfare and particularly if somebody is with mentally ill people. I'm very reluctant to say that mentally ill people should never be able to kill themselves. I think we want to distinguish between the 17 year old girl who breaks up with her boyfriend and wants to overdose on Tylenol, which may feel much better a week later, versus the crime schizophrenic who been unhappy their entire life, which says, I don't want to go continue suffering like this and psychiatry hasn't been able to help me.

I wrote an article advancing this position about five years ago in the sent a report, I received over 200 very angry personal letters. So it's clearly a hot button topic. Jennifer, you just published an article about this and free inquiry. So what's your take on it? Yeah, I have a very unusual take for for an atheist and. Skeptic, I, I, I experienced some that I lost I lost two friends of mine in 2007 and one just about a year ago.

We wrote we were all getting our Ph.D. at the same time of the Columbia in the late 80s and early 90s. And and I am not free from the kind of darkness that that we were all close friends and we were all overachievers and we were all sort of running from in towards similar kinds of things. And for a person like myself who I go around, I give a lot of talks, and there are they are about activism and belief and also poetry and philosophy.

I started thinking about what The Dark Knight is the worst times for people who don't have religious beliefs. I read that book by Mary Karr Lette, where she starts out an atheist. And at the end of the book, she's a full blown Catholic because she just was so miserable and she explains the route she took. And it was always by this kind of default, she just couldn't take it by herself. I believe that almost everything that's in religion.

Well, I don't believe in God. So I believe we made it all up the human beings and a lot of it's still good. There's no reason it's tainted because we used to put it on a third party. I believe humanity invented morality and I'm very impressed, even though we don't usually live up to it on the way we would like to. But to put the perfection of it on this third party doesn't seem to help in any way. Truth is, I always ask people what could God come down and say life was for that would justify all the suffering you've seen.

It seems to me life has meaning. It seems to me the feeling of meaning is sufficient to the definition of meaning we feel meaning. So there's meaning because the human experience is what we're responding to. We're not responding to the universe at large. So I was thinking about people who could lean back into the arms of God in their most miserable moment and started to occur to me that we could lean back into the arms of humanity in the same way and realize human beings might not know how to help you, and they might not be willing, but they exist.

It's a good start, whereas hoping somebody, somebody else exists and that they'll help us look, it's an extra step. It's it's interesting to notice that you're lonely on a planet of seven billion. There are ways to turn on the light and find the other people. You don't always get to stay in your same identity. Sometimes you have to allow yourself to be a very weird person who's no longer keeping up all the standards of. But you don't have to jump out the window more.

I started thinking about this and researching it. I really found that the way that the secular community came to a suicide is OK. You have the right to it. With so much in a polemic with the church, the church said no to a lot of things. And so we said yes. But when you think about it, some of the aspects that is life is better than death and managing through is better. And what can we do to look at this in a way that changes the conversation?

And I also started looking at what it does to a community. And there's no question that there is that suicidal influence, either call it suicidal model or contagion, suicidal clusters. It matters what you do. Suicidal influence is such a profound factor in what goes on that it really is reasonable to say that a suicide is also a delayed homicide. You very likely take somebody with you if you can make it through your dark night of the soul. Your niece may also and also somebody who doesn't even know you, but was also depressed, 50 year old woman on her own after a first divorce.

That is, people connect with other people and when they see them not living through, they also take those kinds of choices. And I realize that all of us think it's all a little odd. But when you start to think about individual people, you want to save them and you want to think through these issues and realize that there are secular reasons that we might be able to argue that we owe each other our lives, that we ought to stay alive for each other, that we ought to speak these things out loud and find a way to comfort each other, because I think that we have sufficient tools for it.

Just as a quick follow up. Just to clarify, are you are you saying that even if for the person who wants to end their life, even if their remaining life had sort of negative expected utility, that they would be suffering and would want to die for the rest of their life, that it's still sort of an obligation for them, for other people? Well, I'm a little bit, but the truth is that I think a lot of the reasons one wants to die is because one thinks one is a burden.

All I do is cryin and moan. Well, you know, a lot of people ought to know that crying and useless is a million times better than dead for your parents, your friends and crying. And you we don't have a culture right now that lets people understand that human beings can absorb the wounded. We can take care of them. And we're often it's a gift. We don't have a language for talking about that, though. I have to say, once I started looking into because I was always saying, well, look, if you're really dying, what's the difference?

Take the morphine if you want to. Sure. But when I started looking into it a little bit, I found that a lot of people who are living in very handicapped ways because of sickness, there's a there's a group called Not Dead Yet from the Monty Python scene. And they're saying, you know, there's just a little bit too much. Well, people thinking to be sick must be so awful. You want to die and sick people thinking I'm a burden.

And so if we don't articulate these things, sometimes things happen that maybe aren't the best things. So if everybody agrees, obviously I can't even do anything about it, but why not have the conversation and at least suggest that love is sufficient to answer some of this. So let's have that conversation. What would sure, as someone who is unfortunately feuded publicly for many years, was not yet dead. I think for some people, I certainly don't want to go around handing out shotguns and overdose pills to people.

But for some, there are a lot of guns in this country that absolutely are. That would be cheap. Nevada has the highest suicide rates to there clearly is a correlation. But I do think for some people there is no light at the end of the tunnel and they come to psychiatry. They're hospitalized dozens or even hundreds of times, and we have no tools to help them. And they say, I've tried it your way. It's not that I'm a burden to the world.

I'm a burden to myself. I'm not saying they're making the right choice or the wrong choice. I'm just very loath to have the state or institution make that choice for them. And we want to give them the tools to help them to the degree we can and then let them make an autonomous decision. That's all I psychiatrists really as to the status of my patients and certainly in response to a religious group that would say no to that, I'm entirely on your side.

I just want to make sure that we're not missing something that could help us all to just even for those who are not suicidal, to realize how much we need each other and to be able to see some of that aspect that does that isn't visible otherwise. I'm so struck by one comment that Jennifer made right at the beginning of your earlier intervention, which was that you think that sometimes the secularists, particularly the atheist community, gets its values as basically a reaction to whatever the church says, eh, I'm going to be saints.

So, you know, what else would we want to do intelligently get our families as opposed to just as a reaction? Well, certainly in the Enlightenment, the idea that we should free sex from all marital and and religious rules was a very big one. There are all sorts of dirty books written by Dederer and everybody else about what might go on without rules. But what happens is it's not just religion. It's also romantic love, the happiness of children.

There are other issues that come in and make people behave in ways that that would have surprised the Enlightenment people. But the thing is, we forget how much the church was in your bedroom, how much the church made rules about what you could do and how they embarrassed people and how they punished people so that when we're looking at what, yeah, you can find him and you can find the whole back saying that the church is crazy to be saying that you can't kill yourself because there is no God.

And so we can't say God owns your life. And that's what the church was mostly saying. The church also burned the bodies of suicides and and took all the property and took it away from their family. So it was very reasonable to be angry at the church for its stance. But then if that runs you directly in the opposite way, either for suicide or for this, the marriage thing, we have a much freer sexual world than they did.

But nevertheless, lots of secular couples just keep lining up and getting married. It's clearly hasn't been it didn't pan out that the church was wrong about everything. And certainly the idea of some behaviors of morality that we thought were. Totally random, and the church just made them up turn out to be how people want to live, at least in this culture now. So sex is another big one where you can see that was always a big one. Yes.

I kind of like to turn to some of the more recent bioethical issues that must have arisen with the development of new technologies. So I'm going to throw out a question to you, Jacob and Jennifer. If you have comments, feel free to chime in. So the the possibility that couples might be able to choose not just the sex of their baby, but the sexual orientation of their baby. Is this on the horizon? And if so, do you have any thoughts about how it should be dealt with legally, morally, etc.

? I wouldn't even say it's on the horizon. I say hear there. There are studies done by Professor Knew at my institution in Mount Sinai I that I don't know her personally, but she's demonstrated that certain hormonal injections in utero increase the likelihood that female babies will be straight as opposed to gay. So this technology will be accessible to us very soon as it relates to a larger question of whether or not you should be able to design your own child.

And I have long think of the theory that if you wish to enhance your child in a way that is socially helpful to the child, you want to make your child smarter, more athletic, more talented. I see no concerns in that any more than buying the tennis lessons or an tutor. But if you want to give your child something we would view as a handicap, like you want to blind your child or create a deaf child, be deaf couple times in public you want to do in England, I'm much more concerned about that.

What are the couple who says I'm not homophobic, I have nothing against homosexuals. But the reality is straight children have more opportunity in life. There's less stigma. I don't have an answer to that, but I think that's the question we're going to be grappling with. But but there are two obvious sort of concerns, if not certainly not Knock-down objections, but concerns. One is the possibility that if we start doing that sort of thing, especially on a large scale and especially without, you know, sort of restrictions about what kind of enhancements we can do, that quickly leads to a sort of a commodification of having babies, that the babies become just like another accessories, like, you know, I'm going to on a car that it's right instead of yellow or whatever that thing.

That might be the first that's the first concern. The second obvious concern is one of access, right? I mean, especially the beginning. These technologies are always expensive, which means that, you know, the top one percent of the people in this country who already own 50 percent of the wealth, whatever it is, the exact statistic will have access to those things, which means that they will be able to make, for instance, their children a little smarter or a little better looking and so on and so forth, which is the only thing that's going to do is to increase their wealth and power even further.

You don't see that as a those are as concerns. I think there's certainly things we should think about. The reality is certainly living in upper middle class life in New York City. Everything we do creates those disparities. If we were serious about creating jobs for children, we would shut down private schools, we would ban tennis lessons we execute. Here's the reality is this may actually be the gateway to the cheap enough for parents with less opportunity to equalize their children.

The parents who can't afford the city tutor can make it smarter. Baby, that's a long way down the line. But if these things are free and equal to all to be my goal, that may be where we end up. But I can hear somebody making the same argument much earlier in the last century and some of as well. Yes, that's why we want to see more funding and more opportunities for private schools, because eventually that's going to be the way to equalize things.

Didn't turn out that way, did it? Absolutely not. It's I consider myself primarily what should be available to people. My concern is not for not restricting people from making autonomous choices. Unfortunately, society often makes poor choices collectively. That's the tradeoff. And are you concerned at all with the question of whether if people could choose not to have homosexual children, that the percentage of homosexuals would dwindle? And the statistic answers that question. Presumably, if people could also choose to have gay children and even a reasonable plurality of gay couples wanted to have gay children, the number of society would increase substantially, not decrease.

We might end up with a far more more diverse rather than less diverse society. Wow. Yes. Jennifer, please. Well, I mean, yeah, right from the beginning of the idea that we could even just look at embryos before implanting them, just just the idea there was already people talking about the idea that we would end up with a class difference, which was actually biologically visible. Right. This tall blonde people with good forearms would be walking through the room and you would know who has the money.

And yeah, there's a wow thing in there. But I got to say that people who are thinking about things like that are just probably not going to be the most attentive parents. Those are going to see some tall, angry kids. And I'm not sure they're going to be such overachievers because I do think that the personality that would be making those choices is just not the same personality who's going to be going to be allowing that person to grow up, whoever they want to be, which means they're going to grow up pissed and a little crazy.

And I don't think we need to worry too much about them taking over, but it is a very problematic thing. The other thing I want to say, and I don't know what the answer to this is, but it's really curious that just as our culture has become more tolerant to adult difference in terms of disability weirdness, social differences, we've become less tolerant to difference in babies. So you come out with two different genitals and it's confusing. They will pick one for you.

And and there's not I mean, this one's a little silly, but a six finger for a piano player might be a good thing. But forget about it. Every baby, that's one of the six finger titles we look for ways to fix the babies. And of course, it's with the best intentions. And and it's just it's disturbing to realize that the culture's gotten so, you know, tripped over itself trying to make a difference, OK for adults, but is willing to take out the scalpel to to make the babies fit into to the norm.

And as a person who feels like a weirdo inside all the time, I've always just loved the difference in humanity. And, well, you know, you live in Brooklyn, you get a certain amount of difference anyway. But still, it seems it breaks my heart a little bit how much we try to get it out of the the culture. I also think that homosexuality is something which is embraced for a lot of different reasons. And the idea of doing it medically one way or another, I think that would bring up a whole lot of new things nobody's ever thought about.

I guess I'm gambo. Just as a quick follow up for you, Jennifer, would you object to parents, say, getting braces for their child? I mean, it is it's one of those differences that does tell you who has the money to have to afford it. And it's sort of a permanent thing that the parents make the choice for the child the same way before the child's born makes that choice right to choice to right and and school differences and all these different things about kids who are overactive in kids who are shy, that were struggling through their childhood so that they can sit at the kid's desk, which is successful if your idea of life is what happens in grammar school desks.

But then throughout history, people have grown up with very weird childhoods, will become very interesting people. But I think your question about racism is a really good one to start trying to tease out. Where are we going to draw these lines? I don't know. I do know we live in a in a country where we are going to you know, it's a capitalist country where we are going to pay for what is available. And and I don't think anybody's in the position to make rules about it.

The things people get upset about, like cloning. You know, people got upset about cloning because of that movie boys from Brazil, they don't want a million Hitlers coming round. I mean, people get their heads around these various cloning is just twins at different times and they don't even seem to pan out and turn you in. I mean, it seems like a non-issue. It's not a very worrisome problem. We're not going to clone some big guy who's going to turn into the army.

First of all, we can't do anything without womb's. We don't know how to make a baby. We just know how to set it up. And then you you need a woman who's willing to do this. You can find a few women who are willing to do a lot of weird things, but not that many. You're not going to make an army, right? You're just not going to make an army. So cloning not a problem. And we may want to get all this attention.

So who would I trust to be making the rules about what's OK and what's not OK? The truth is, I think I trust people, parents mostly. I think some will do dumb things, but I guess I kind of am willing to instead of put together some forward who is going to make these decisions, stand back and let doctors and patients make decisions for a while until we see something going on that really seems untenable. But it seems to me like a whole part of important.

They point out that this discussion is, for instance, that that hinges on this difference between Julia's example of the bracelets and what we're talking about in terms of dancing babies, is that we actually talk about modifying the human genome and therefore modifying the human genetic line essentially permanently. So, in other words, that's sticking in your hands, evolution. Now, I have no objection in principle to anything like that. We we've taken our fate in our hands plenty of times as soon as we started mucking around with technology.

On the other hand, we do know that evolution is an incredibly complicated process, that the human genome is an incredibly complicated thing which interacts in much, much more complicated, nonlinear ways with the environment and so on. Development, epigenetics. So I'm a little concerned, I guess, about the idea of people so mucking around with that sort of stuff without literally knowing what they're doing, because this this idea that there is a gene for X and therefore all I need to do is to change Gene, that particular gene.

And this is going to be a very surgical sort of intervention is actually a highly misleading that it's just not going to work that way. Well, if we also screen for certain genetic diseases and and don't have those babies, we're also sort of changing the human genome, right? We sure are. The first ones that people were OK to do with were sex babies, because sex is a disease that's in the Jewish population, Ashkenazi Jewish population. One thing is true that it's terribly painful disease and most babies born with it don't even live to age four.

So it's an easy kind of thing. OK, abort those babies. But I think it was because it was in the Jewish community. I'm Jewish and we just had such a strong I can identify as an atheist who, by the way, is one of them. But because of the Holocaust, we were being very careful of any kind of monkeying around with biology. So the fact that it happened within the Jewish community, it was part of the reason that it was sort of allowed that we started saying, OK, we will check for this.

And if the baby has it, we will we will terminate the most women who go in to get their babies, you know, checked with the amniocentesis and stuff. They only barely realize we're checking that for something we can fix. But whether or not we should end the pregnancy. It's a very weird thing to be doing. I'm doing a flip question. We may have to start asking not whether you should be able to enhance your child, whether it's ethical, not you enhanced your child in certain circumstances as more and more children, for example, are born through IVF.

Is it ethical to have a child with such disease who will die before biologically when you could choose not to? And then how far along that Paramatta you carry this? Do we view it as child abuse to have a child that we take? This is the other thing I'll point out is that we may or may not decide that certain enhancements are acceptable, but I think we should avoid the Naturaliste fallacy if it's OK for you to have braces and we can develop the technology to get your teeth fixed at birth, either through the germline or through your somatic cells, and then pass that down from generation to generation to the germ line, all that money we save on braces we can spend on private schools.

Well, let's go back to Massimo's. That's good. But I want to go back to Massimo's comment. Just I think we're we're kind of waiting for the first accidental monster. Something's going to go wrong. It just does all the time. When when we were in the lab, we think, oh, we'll add, we'll add, you know, something that'll make the flower white and instead the flower comes out pink and then we Basile's. Oh, right.

Adding something triggers the thing to cut out all those. And we figure it out. But when it when it happens with the first human being, when we do something wrong, that will be the time that we're really going to have to stop and ask a lot of questions and also wait till that person grows up and tells us what they think, which we don't do enough of. We really don't. With the whole way that we respond to babies, I really think we should sometimes go around and ask the people who are adult versions of what what would you choose it?

What do we do with all the people who have who are conjoined twins? The the overall the majority comment from conjoined twins is that they don't want to be separated. What do you do with that? Doesn't look right to us. What do you do with that chicken? Well, I think the question we're asking is, are these questions that can be answered either one by a majority of people or alternatively by a majority of patients or individuals that suffer from the condition?

Or is there some global answer to the question if 90 percent of conjoined twins wish not to be conjoined, but tender's do wish to begin joining, the 10 percent wish to be separated, that 10 percent get a veto power if that is closer to the norm. And what if they're babies? That's the only thing that makes it really tough. And I don't have an answer, but I think we have to ask those questions early on. I agree.

Well, absolutely. But again, there's no knock down argument, I think, either. Either way, I don't think it's possible to come up with an argument that absolutely shows that, yes, these kind of interventions are, in fact, ethical and should be done no matter what. Gordon. They never should be done right? The question is, interestingly, more complicated than that, but one of the things, again, going back to the sort of complexity of the situation is that there is only a very small number of genetic diseases.

By the way, I I know that is a common phrase. I just don't believe in genetic diseases. There's no such thing as Gene doing anything by themselves. It always is within an environmental context. And you can't just look at the gene whenever you're looking at these things. But there's a small number of human genes that don't have that very clear, almost surgical effect on the phenotype, on the on the adult traits. And those I think are obvious candidates for these kinds of things.

But the majority, you know, I just finished reviewing for Skeptical Inquirer, a book on personal genomics, for instance, where this guy got involved in this project, preliminary project at Harvard, to look at his and a few other people's genomes. And and, you know, it started out with a lot of enthusiasm about, hey, I'm going to know all about myself and all about my diseases, and I'm going to have knowledge that I'm going to correct and in terms of helping my my offspring and so on and so forth.

And at the end of it, you were so frustrated because you learned almost nothing. He said, I learned that I had a higher chance of a heart attack. I have a very large family with a history of heart attacks. So I knew that already. But all the other things were, well, you know, your present, your probability of getting this is going up by one percent. You probably are getting that is going down before but two percent.

And by the way, we don't know exactly. Depends on your environment, depends on all the things that to me really brought it clearly at home, how difficult it actually would be to make sensible interventions of that sort. That doesn't mean that we don't want to do it. But I fear that that rushing into this thing before we actually have any idea what we're doing, I'll echo that. I think we know very, very little about how these procedures will work, that how they can get it comforting that we would do would affect the human being.

But I think we need to make the ethical choices now rather than waiting for the technology to evolve and then being forced to confront the ethical choices. Once it's too late, what's the can get to the bottom right? So it's hard to it's hard to do it. That is, people will sneak around to get the things they want. But I think it's very it's very useful for people to know about these cases where someone clones their favorite cat and the cat comes out just a totally different color.

It's not the same cat. And we don't know why exactly. In some cases we do know why the way that the epigenetics, but it just plain happens. They clone the cat. Everything went right in terms of in terms of the lab. But the cat is clearly at it doesn't even look the same. And that's sort of just at least lets us in on how much we don't know what's going on and that as we keep trying these things, we'll learn things we can do.

But we're also going to learn a whole bunch of things we can't do for for you, Jacob. And then also, Jennifer, if you have any thoughts on the matter, the issue of conscience clauses for for pharmacists and doctors who have some religious or ethical objection to performing some procedure or filling some prescriptions, I, I have a hunch what your thoughts on this might be, but I'd also like to hear what the community of bioethicists and medical professionals has has to say about that.

Well, I was peripherally involved and have written about the California case of the Christian fundamentalists who ran a fertility clinic and would only provide the services to married couples and turned down a lesbian couple, and they eventually lost their case to the California Supreme Court. The upshot of which is that Christian fundamentalists really can't run fertility clinics on their own terms in California. And this is a widespread problem not just with pharmacists, with abortion, but with a whole range of procedures.

If you're a Scientologist and you want to go to medical school, can you opt out of psychiatry curriculum? If you're a Jehovah's Witness, can you not take part in surgery? And the short answer I've offered in terms of how to settle this is if your choice doesn't have a widespread impact on access to the general population, I think it's an acceptable choice. But as your choice encroaches upon access for others, then we want to quickly. Where we draw that line is a battle we're going to see in the legislatures for years to come.

Yeah, no, that's interesting. And it is it's a it's a really tricky question. It seems obvious on some issues where you think it's just offensive that somebody would say, oh, I'm not going to talk about this issue. I'm not going to prescribe plan B or whatever, where you feel like this is a it's an important and political issue. But then there are other ones where you just know that certain doctors believe in medication or believe in diet and exercise or, you know, what about a surgeon who who used to perform those kinds of of bariatric operations for people and then changes their mind and doesn't think it's the best way to go?

It would become awfully complicated to really sort out. The way that people make these influential decisions, they you know, I mean, I guess not one thing that you could say about it is in the future, I hope that there's that there's more use of the Internet to share information and to share follow up so that we could sort of look and see what different types of counseling, different types of operations, different types of choices mean to people later on in their lives.

There's not enough of that by far. But in this case, I guess I'm going to take a little more radical position than both of you, if you don't mind. Well, even if you do mind, it's OK. So what I'm going to hear about is a conscience clause is, you know, let's say the example of the pharmacist, for instance, who doesn't want to give a morning after pill or something or even or even make a simple answer.

Admittedly, perhaps simplistic is, well, you shouldn't be a pharmacist. Right. This is this is you know, nobody nobody obliges you to be to be a pharmacist. This is a public service you really ought to provide no matter what your conscience, quote unquote, and on purpose. Put that in quotes. Now, there is another solution where, you know, we have Christian bookstores, we don't have Christian pharmacies where, you know, you're not going to get condoms or, you know, you're not going to get the pill after.

But you know that when you walk in, right. You know, you don't go to a to a Christian bookstore asking for Richard Dawkins books. Right. Right. And so but you also not upset because, hey, you guys don't have Richard Dawkins books in this book. What's the matter with you? Well, you know that when you get in the issue, seems to me what happens what is critical about these situations is when you go in as a member of the public and you expect me to find whatever medical science makes available to you and you don't because somebody made an arbitrary decision based on his or her values.

Yes, that sounds right to me. I think do it. I think the danger is you would find that there were large parts of the country where there are only Christian Balmaceda. I would say that is true, especially because people might then again, I'm sorry, there are also a large part of the country where you don't find Richard Dawkins books in most bookstores most pressing matter. And you could always go. OK, I grant you that. I was just going to say that a lot of people might be happy to go to the Christian pharmacies for medications that are in the safe zone that Christians approve of.

And so the other pharmacies would, you know, well, then there is a hard time supporting themselves. That is all that they could offer above and beyond the other. Well, I would boycott the other ones. So I'm going on the to the non-denominational pharmacies. So in my town, I think that it would be hard to run a Catholic pharmacy. Well, there is always a car talk solution to the problem. Can we give back the Louisiana Purchase and get a refund?

OK, next. Actually, now I want to go on this topic for a little bit, but sort of make it a little broader, which is what about in general, the involvement of religion in bioethics? So I'm sure you run into this all the time because does have its roots in religion at all, or as much as contemporary bioethics is actually a backlash to religion. The early founders of it, people like you, Fletcher had religious training.

Many of them were Episcopal priests who then turned their back not on spirituality, but on religion and probably not the code of ethics. It's interesting. In my practice, I rarely see situations where religious communities try to impose their views in medicine and form, where we see medicine overstepping its view. For example, the physician who wishes to give a blood transfusion to a Jehovah's Witness. Now, Jehovah's Witnesses believe blood transfusions lead to damnation in the afterlife. That is not something Western medicine has an opinion about one way or the other.

But I have heard physicians say, obviously, that's not true from a medical viewpoint rather than a personal viewpoint. So it's a lot of what I do is corralling doctors and reminding them what their role is and what the boundaries are. I'd like to bring this discussion back to death once more, if that's OK. I didn't want to lose that kind of person who wanted to distribute it a little bit. But I think a really interesting question is to what extent you your goal is to extend the life of your patient as much as possible, especially given the incredibly steep costs in that that end of life period and the suffering that's often involved.

So I was wondering to both of you, if you have opinions on what the priorities should be in those, you know, those last few years and what even just the last few weeks or months, which happened to be the most expensive by far. Absolutely. And a medical care. And how do you, as a practicing bioethicist, talk to people about that? The problem is hindsight is 20/20. You only know that the last few weeks because the patient died and the patient you get better because of the intervention are encapsulated in that catalyst.

But I think you raise the challenge and question for years before. Look at bioethical challenges relating to families who want to stop caring when the state wants to impose its Terri Schiavo or Nancy Cruzan. Well, we're going to see more and more of our cases like this. In Watson case, a man who cost the taxpayers millions of dollars in health care over the course of a few weeks, people who want everything possible done to the point of bankrupting the state when nothing is going to help them in the long run.

Right. I think there it is. Sometimes it's time to turn to poetry and philosophy, I guess even more poetry. I think that our culture right now is is I talk about this a lot and the happiness myth that we're really obsessed with longevity and productivity. And because of that, we will allow any drug that keeps you at your desk. You know, if it clears his head, gets you to sleep at night. Alcohol kills more people than hallucinogenics would.

But Genex lasts for, you know, 48 hours. And so it doesn't fit into a work schedule. We really are. We really think in terms of product productivity and we also think in terms of longevity in ways that don't always make sense. So that if we had a conversation that was just a little bit more about how we look, if we can extend life, good life for a long time, I'm with you. But right now it seems like it would be better to start talking about our real situation as human beings.

So, you know, it's not a play. Life isn't a play. You're not going to miss the end if you get into existence and you get to have some some good years with where is this huge difference about these issues of longevity to the point that we use so much of our science attention and money towards that nobody's ever lived as long as we do. And we just talk about wanting more. And so many of us are doing so because we're not living the way we want to now.

We're exchanging the time of our lives now for money every day so much. And then you realize you want more at the end. It really seems like it's time to step back and ask, what do I want from my life now? So that at the end of the day, I feel like this day really happened. I was awake for it. If we have a little bit more of a conversation about that and a little bit more of a conversation about how, you know, the entire eastern world, the whole religion, was that you're always being born back into existence and they're trying to get out.

Nirvana is you finally get enough knowledge to get out to be done. I don't want to be morbid, but I really think that the great philosophers and poets and most poets of history, the great ones, have been screaming atheists. I mean, we really have to look at them again, try to get our our skeptical culture to realize that the humanities are on our side in some really big ways. But but really to also just start to look at what life means.

I want to get something out of it and to sometimes realize that the longevity question is not where we should be obsessed, and especially if you hate the treadmill, the treadmill, the actual metaphor for effort going nowhere in a world that's having energy crisis, we take every able bodied man, woman and child and tell them to go run. We have escalators and Stairmasters folks, there is something wrong with a culture that has escalators and Stairmasters. And what has wrong with it is that we like ourselves when we're not laborers.

We want if we think well of ourselves, if we go home and clothes that are not sweaty at the end of the day. So we have a special duffel bag full of the sweaty clothes. That is a culture that is too aware of class differences. That's too hyper about some of these classic things. You can't find a culture with a cult of the body beautiful other than ancient Sparta and the fascists, no one comes anywhere near us other than that.

And those are those are not particularly good examples. No, it's not the company, folks. There is a mind also right above that, the little fleshy part that we spend all the time thinking about. It's worth considering. OK, shall we move on to questions from the audience? We have plenty of food for thought that has been provided in the last forty five minutes or so. So we can take the first question. Hi, we or you discussed the example of a pair of conjoined twins.

When you ask where when you ask them as adults, do you want to be separated, they all say no. I kind of it raises a question to me of does it really matter? Now, I want to give another example of something where it is what doesn't really matter whether you separate them as children or not. And I want to give another example of something where we make this kind of decision for babies every single day, and that's of circumcision.

If you go to an adult man and you ask him, hey, do you want me to cut off the end of your penis? Hell no. That I mean, unless they're in a and there are situations where the advantages of that actually outweigh the costs and they'll say yes, but the vast majority say no. If you go to a circumcised man and say, hey, how do you feel about that? I'm going to be like. It doesn't stop.

You know, I'm okay with it. It really doesn't bother me. And I think that most of what you do to a child before they've reached the point of self awareness kind of washes out in the end. And they don't it really doesn't affect. So it doesn't wash out. Well, I will say that you're certainly right until I mean, until Paul, you had to be Jewish before you could be Christian, and that meant adult circumcision. And guess what?

It just really didn't take off. It was one of these situations where that was really like all the Jewish laws and prohibitions. It was the circumcision that was. But, yeah, I take your question, and I think you're right, that the idea of changing a little baby's body before it gets to the point where it can weigh in is problematic. I mean, I'm Jewish and I'm from a Jewish tradition that does that. And it doesn't seem like a huge issue because because we don't have a lot of adults talking about it, having been the wrong choice.

We have some. But it is an issue. It's an issue. I think the key key part of your question, your statement is most most of the time this may be neutral, based in how people turn out. Some of the time it's not figuring out a priori which you're going to be. The case is where it is really the challenge for us. I would just add two quick comments. First, even if the adult doesn't remember the pain of whatever, because you say circumcision was was performed on him as a baby.

It doesn't mean that it wasn't painful for the baby. So that is a cost that we should keep in our balance sheet. And second, it sounds like the real problem I think you highlighted this nicely is that the adult doesn't have anything to compare his his situation to. You know, the separated conjoined twins doesn't know what it would have been like to not be separated and circumcised. I doesn't know what it would have been like to not be circumcised.

So it's really hard to judge whether we did the right thing by asking adults how happy is next. This was the first question and second brief comment. First question is, I read that those loans, sheep, sheep were had some somewhat weak immune system. I want to to confirm whether it's true or not. If it's so, then it has no sense to clone people like sheep. OK, just just like, oh, OK. Second comment is in the UK, they already introduced a law that says that you can be switched off of the patient terminally ill because that's just the government cannot afford those moneys.

This government still can go independent and introduces by law. Maybe the United States moves in the same direction, some unfinished. I can address the problem, not the larger question, you suggest the difference in how Europe handles many of these questions and how we do it in much of Western Europe. Each nation has a board that governs a subset of all the bioethical questions in Britain is a board that governs fertility, the support they make decisions about cloning. We don't do it that way.

No matter what we do. They're always going to do these things someplace at the lowest common denominator, whether that's Singapore, whether that's Thailand. And that's something we can take into account when making our own policies. I think as to the specifics of Dolly, Dolly in the specifics didn't turn out that well. She'll be the first shot. Hopefully we will get better before we try on people. Yeah. Although the only thing not better, it's perhaps even it's sort of an understatement.

I mean, it was quite there were hundreds and hundreds of trials before we got anything that was even close to working, which was goes back to Jennifer's point about, you know, some one of these days some big problem is going to come out. And then we had to face it, because at that point, it's human being. It's not a sheep anymore. It's not a cat or whatever it is. And yet there were hundreds of trials before the first test tube baby.

And Mrs Brown turned out just fine and is thrilled to be here. I'm still not on board with that stuff either. But anyway, next question is a question for Jennifer. You've said that people who wanted to enhance their babies would be bad parents. Do you have any evidence of that? Seem to have any evidence of that? Do you have any evidence of that right now? I guess I was being a little cheeky, but I think I was also trying to say that the the the ways in which we see people try to give advantages to their children very often backfire because.

Well, I guess for me, I have my kids are five and six. And what they need is attention and love and sort of support. I mean, they hardly want you to play their game. They just want you to look and like it, you know? And it just seems like if you're being interventionist, it's it's almost always a little problematic. So when I imagine somebody being that interventionist, that interested in the end point, it looks to me to be just a bad recipe for parenting in some sort of general terms.

This does remind me of this recent case in New York of a woman suing a kindergarten, I believe, because she thought that the way her daughter was treated would preclude her daughter from getting into Harvard. Yeah, and I guess this happened in New York that this happened in New York, in the Upper East Side. And, you know, I think that is the kind of thing we're looking at. If it can be done today with just simple education, can you imagine when we start messing around with the human genome?

So but yeah. Next question. Yes. I was glad to see that the humanities were brought up. That's kind of my my thing. What do skepticism and the humanities have to offer one another? Well, like I said, it's a great question. And like I said, the look, science has had a really good century, right? I mean, right from start with Pasteur and and and go up until until like the 1960s or 70s.

And you really do see some tremendous, you know, curing polio and getting to the moon. Very impressive stuff. And it's true. It's pretty cool to see that people throughout history have been able to say things like Voltaire said, it's crazy to believe in God, but crazy or not true because how did we get here? And, you know, we didn't have Darwin. The thing is that throughout most of history, people don't stop with what they've figured out.

They look around and see the natural world working. They hear these crazy, different, varied religious versions and they're able to think it through and say, I don't know how it happened, but I don't think it happened like that. There have been atheists. The earliest clear, explicit atheists I found were 600 B.C. in ancient India. You know, the Kavakeb saying if the soul could exist without the body, Mango's would hang in the air without trace, but they don't.

So people have been doing this. And why do you become a poet? There's never been any money in it. If you wanted to say beautiful things about the universe, go do it in the church. But if you have real existential problems and you want to think about them and think about them in a wide and wild way, you become a poet. Shelley got kicked out of Oxford and like 1811 for handing out a pamphlet called The Necessity of Atheism.

Keats writes about the meaning of life. He saw his brother die. He's spitting blood into a handkerchief already never mentions Jesus, never mentions God mentions going down to the beach and watching the ocean come in till fame and love, till nothingness to sink. He is a manager, Emily Dickinson. She's not sure in some ways, but before she stopped going anywhere, she stopped going to church. The first place she stopped going was to church. And she's got great.

I mean, faith is a fine invention when gentlemen can see microscopes are present in an emergency. There's a lot of good stuff out there. And also, as a former scientist and philosopher recently, I have a couple of different answers to the specific question, which is about what is it? Skepticism and humanism also can get out of things like philosophy, for instance. Well, let's remember that we're talking if we're talking about a skeptical inquiry, we're talking about critical thinking.

We're talking about epistemology. That's philosophy. And if we're talking about values we talked about earlier, what else do we get our values, if not from religion? Well, there's two thousand four hundred twenty five hundred years of history of philosophy and think people thinking about values. So I think that the humanities in general and philosophy in particular have quite a bit to contribute. That is not to the detriment of science. That's to the enhancement of science. Or I would add my perspectives a little bit more skewed is that the humanities step in where science and rationality and skepticism self-destruct, providing answers and the magic of literature or poetry is didn't matter how much we study the human brain, there are some questions we in no foreseeable future, maybe ever will be able to answer definitively.

And that is the role for the humanities. In the skeptic world. You we have five more minutes of the issue of the naturalistic fallacy was raised momentarily. I'm not sure what follows from that. I didn't I didn't follow it. It's a fallacy. But but I wonder if we neglect to consider that that medicine may be prone to the naturalistic fallacy in terms of looking at a population and deciding that that that that's the norm. And then when the mutation of the six six fingered baby comes along, we say, well, that's not the norm.

Maybe that's that's not healthy. But then are we missing out on the evolution of piano players? But we have a special advantage or for something else. And there may be maladaptation to say, well, it's got an extra toe in the in world with shoes. That's more problematical than it's to figure this in a world that really values fingers for all the things we do with them. That is an excellent point. I wish you would come and teach that to the medical students.

Well, I'd also like to add that we're talking about things like the naturalistic fallacy. Those fall under the general rubric of informal fallacies that it doesn't actually not logical, formal, logical fallacies. Those are just bad habits of thought. It doesn't mean that it's always wrong, however. So. Naturalistic fantasies of fantasy. If you say that, you know, everything that is natural is automatically good, then it would become a fantasy. That does not imply that a lot of natural things aren't that good.

And so we need to discuss about the specifics of each case. There is an important distinction between a form of logical fallacy where you're always wrong if you ingrowing that fallacy in an informal one where in fact it's up for discussion. It depends. The answer is it depends. Next question. Yes, my comment is directed to Dr. Appel with regard to conscience exceptions that prohibit access, that don't prohibit access to others. Anti vaccination has embraced this very option, but their choice directly jeopardizes the health of the collective by changing the threshold of herd immunity, as you know.

So it seems to me that the qualification of not prohibiting access is insufficient to guide us, and a normative conception of health is necessarily prevails in this instance and in fact justifies coercion. Well, I would agree with that. When I speak of limited access, I'm talking specifically about providers choices rather than the procedures provided in a more general scope. I think you have a right to make any medical choice until you start threatening the public commonweal. And we've now reached the point with anti vaccination in Arkansas, in Missouri, where people have dropped this below herd immunity and are threatening the commonweal.

And it's concerning. But I think we can also ask ourselves questions and I don't know where to go with this, but why are so many people having such a good time being mad at science, saying no to scientists? And that starts to look at maybe we should think about some of the ways that I'm not sure it's even the scientists doing it, but the press reporting on science. But there's a certain kind of scolding about health that goes on a lot and that, I think gets some people sort of ready to find some way to to mock science.

But some of that is we have to think a little bit about how the culture is, especially with the news. They have to report on new things and they don't have any scruples anymore. It used to be waited until there were three replicated events before you even reported on it. Now, the first thing that and we know that most tests are going to be random the first time it could all sorts of outliers thing. And then we go back and say, oh, didn't look like it panned out.

So whether or not we should start to maybe really try to weigh on the press, look, if you just keep making science look like it changes its mind every 20 seconds, people are going to feel a little bit more strong about what I think the question has something to do with that. Why are they all so delighted to be to be mocking the science and not from a religious standpoint, but just from a I'm going to make my own decision?

I think we could squeeze in one more question. What about socio economic mobility? If the people born, it's money and privilege, but also the most beautiful and the most intelligent one spoke to the rest of us. What can I just say? I'm just so sure that the humanity means it won't work out that way. It just won't. I'm sure of it. It just it just we don't intelligent either. Not a lot of families of geniuses.

When people try to find it's just a lot of different things go into making smart or beautiful. And it's very difficult to even imagine there's no one gene for smart or beautiful. There are a whole bunch of different things that pan out differently for different people. And then you add in the environment, it just won't work. I have a lot of faith in science to anything, but if we can do it is not a world you want to live in, if you can do it.

Well, the optimist reaction to that, and I'm really an optimist, but the optimist reaction to that is going back to Jennifer's idea of monsters. Those are the people that might actually experience the first monsters. And then the rest of us is going to laugh. I question and you're right, if it were possible, it would be profoundly problematic. But I don't really think it is up, though. Your optimism looks a lot like setting aside it to me.

What can I say? I guess we're we're just out of time. So I think we're going to have to close here. I'm sorry, but. But you've been a wonderful audience. Made our first live next episode of Russian Speaking. Very special. Thank you so much. And this concludes another episode of Russian speaking. Join us next time for more explorations on the borderlands between reason and nonsense. The rationally speaking podcast is presented by New York City skeptics for program notes, links, and to get involved in an online conversation about this and other episodes, please visit rationally speaking podcast Dog.

This podcast is produced by Benny Pollack and recorded in the heart of Greenwich Village, New York. Our theme, Truth by Todd Rundgren, is used by permission. Thank you for listening.