2019 Public Health Ethics Forum: Ethical Dilemmas in Child and Adolescent Health – Part 1 of 6

2019 Public Health Ethics Forum: Ethical Dilemmas in Child and Adolescent Health – Part 1 of 6


>>Good morning,
everyone and welcome to our 2019 Public Health Ethics
Forum, Ethical Dilemmas in Child and Adolescent Health, which is
being co-sponsored by the Office of Minority Health and Health
Equity and the National Center for Bio-Ethics in
Research and Healthcare at Tuskegee University
in Alabama. I’m Craig Wilkins, Senior
Advisor within the Office and I’ll be serving as
your Master of Ceremonies. It’s an honor to welcome each of
our special guests, our speakers and our students from the
Tuskegee Bridge Builder’s Program, the Fox Team
Communications Program and the Latino Youth
Leadership Academy. And to each of you, for joining
us this morning and for those of you who are joining us
by live stream in IPTV. I’d also like to welcome our
participants and students from the Puerto Rico
Department of Education and from the Georgia
Department of Education. As noted on the agenda, the
purpose of today’s forum is to consider factors that affect
healthy development among children and adolescents,
particularly youth of color and how to identify and
address ethical implications for public health interventions. I had the pleasure
of being a part of a very small planning
committee — well, actually not
small, quite large — that put this forum together. My sincere appreciation and
gratitude extends to each of them for all of their
hard efforts in the planning of this year’s events. The names are on the program
and also on the screen. But I would also
like them to stand as I quickly read off their
names and to recognize them with a round of applause: Dr.
Liburd, Dr. Leandris Liburd, Dr. Rueben Warren,
Dr. David Hodge, April Bankston, Kathy
and Dr Barrett, Dr. Karen Bouye,
Dr. Denise Carty, Kayla Johnson,
Sonia Jones-Croft, Yoonjae Kang,
Dr. Melissa Merrick, Nma Ohiaeri,
Desireé Robinson, Dr. Ross,
Dr. Stokley, Dr. Michael Underwood
and Jo Valentine. Let’s give them a round
of applause please. [ Applause ] So again, on behalf of this
Committee and our office in Tuskegee University, we appreciate your
attendance and participation. I also want to welcome our two
sign language interpreters, Aaron Powell and
Christie Wilton. On today’s agenda, we
will have opening remarks and an open plenary
presentation. We will then have a youth panel that will be discussing the
social and physical determinants of adolescent health,
moderated by Dr. Warren. A poster session will
be occurring right after the panel discussion. You will note the time
for our lunch break. In the afternoon,
beginning at 1:00, we have five concurrent
break-out sessions that will be occurring
here in this auditorium and in the break-out rooms
noted on your agenda. This break-out sessions
will be repeated. After the break-out
sessions conclude, we will reconvene back
here in the auditorium for the poster recognition and
our closing plenary presentation and concluding remarks. For those of you watching
the IPTV or live stream, you could email your
questions to [email protected] or submit questions on our Twitter via
the hashtag #PHEF2019. Before we begin, a couple of
quick housekeeping issues. If you didn’t register
before you came in, please do so at the
registration table. On the agenda, you know we’ll
have two official breaks. We would appreciation you
being respectful of the time. We do have a full agenda today. So we’d like to stay on
schedule as much as possible and this will also help lessen
distractions for our presenters. On behalf of the Office, we
appreciate you completing and returning a brief
evaluation that’s designed to provide feedback
about this forum. If you registered
for the conference, you will receive a link
to an evaluation survey in your email box — email inbox
at the close of this session. For participants, doing a form
on IPTV or on the internet, we may not have your
registration information, so please go to one of
the following websites to access the evaluation,
as noted on the slide. We really appreciate — invite your feedback and
your responses will be completely anonymous. For those of you interested in
Continuing Education credits, please note on the back of your
agenda or here on the slide that where the link
would be available at. The activity and the passcode
is noted there as well. And finally, out
of common courtesy, if you haven’t already done so, please silence your
electronic devices. Throughout this morning, I’m here to answer any
questions that you might have. Now, I have the distinct honor
and privilege in introducing you to Dr. Leandris Liburd. Dr. Leandris Liburd currently
serves as the Associate Director for the Office of
Minority Health and Health Equity
here at the CDC. Dr. Liburd. [ Applause ]>>Thank you, Captain Wilkins
and good morning, everybody. It is my pleasure to welcome you to the fifth Public
Health Ethics Forum, which is an annual collaboration
between CDC’s Office of Minority Health and
Health Equity, the Division of Sexually Transmitted
Diseases, the Office of Public Health
Ethics and the National Center for Bio-Ethics in
Research and Healthcare at Tuskegee University. Since 2015, we have
worked together to examine ethical issues in our
programs that address the health of African-Americans,
Hispanics and Latinx, women and girls and
older adults. Over 1,200 persons have
participated in these forums, in person and virtually, including people
in other countries. And hundreds more have
viewed the video recording of the forums after the event, to receive Continuing
Education credits. So why have we continued
to host these forums? As the nation’s leading public
health agency, CDC is dedicated to saving lives and protecting
the health of all Americans across the life course. From preconception health,
infancy, early childhood and adolescence, adulthood
and beyond, there are threats to health and many
are preventable. We do our work through a
wide range of services, interventions, policies,
community education and data. And we use the best
available science and evidence to guide our work, that will
ultimately impact the health and safety of people
who live in communities. To be effective and to
earn the public’s trust, our public health
practice must be ethical. To do this, we must ask
ourselves questions like, “Who will receive available
public health interventions?” And, “How will we know that our
public health strategies fit within the cultural beliefs
and practices of communities at high risk for particular
illnesses and diseases?” And, “How do we overcome
historical distrust of governmental systems
of public health in order to save lives and prevent
the spread of disease?” Whether we are addressing
chronic illnesses, like high blood pressure
or disease prevention through immunizations
or health promotion through physical
activity and nutrition, there are ethical
implications to our work. Community engagement
is a cornerstone of good public health practice. But as a federal agency,
it’s challenging for us to get feedback from
communities across all states and jurisdictions
of the U.S. However, the Public Health
Ethics Forum allows us to bring together
colleagues from across CDC, academic partners, public
health practitioners from state and local governments and
community representatives, to spend their day grappling with how we can improve
the work we do to reduce health disparities
and achieve health equity in a population group that some
or all of our programs serve. The goal of the 2019 forum
is to consider factors that affect healthy development
among children and adolescents, particularly youth of
color and how to identify and address ethical implications
for public health interventions. Today, we are also privileged to have several ethicists
participating and co-leading the
break-out sessions. I want to thank Dr. Warren and
Dr. Hodge for their passion and commitment to this forum. And you will be hearing
from both of them shortly. I also want to thank Captain
Wilkins for his leadership of the Planning Committee
and I also want to thank the Planning
Committee and ask you to stand, so that we can applaud you. Where are our Planning
Committee members? [ Applause ] They have full commitments
within their own programs but they regularly and have
annually taken time to engage with us in this opportunity. We are especially honored today
by the participation of students from the Booker T. Washington
High School in Tuskegee, Alabama, who are members of
the Bridge Builders Program. [ Applause ] They were up early this
morning to travel to Atlanta. So please stand,
Bridge Builders, and let us welcome you. We want to see you. [ Applause ] I think they are more
coming in, as we are — have like small groups
that we’re getting through the security system. We also have students
participating via live stream from Puerto Rico,
as well as students from around the state
of Georgia. So let’s welcome
them, virtually. [ Applause ] The 2019 Public Health
Ethics Forum promises to be thought provoking,
educational and empowering. And we hope that you are as
excited to be here as we are. We believe that this day will be
one that you will never forget. So thank you and welcome. [ Applause ]>>To provide some opening
remarks this morning for this year’s forum,
I’m honored to present to you Dr. Anne Schuchat. Dr. Anne Schuchat
currently serves as Principal Deputy
Director here at the Center for Disease Control
and Prevention. Please join me in
welcoming Dr. Schuchat. [ Applause ]>>Good morning and welcome
to this year’s forum. Thank you so much for waking
up really, really early in the morning and coming over
from Tuskegee and all those who are participating
live stream from Puerto Rico and elsewhere. It’s just a pleasure
to be part of this. I wanted to just thank you
for the work that you do and the expertise that you bring
to this really important area and make a few comments
about the past, the present and the future. About 30 years ago in America,
the measles virus took off. Over a two year period, we
had 55,000 cases of measles and on further investigation,
they were occurring in inner city areas,
in low income children who did not have
health insurance. They were taken to the
doctors by their parents, but they were referred from
the doctors to someplace else, the Health Departments, to
get their measles vaccines. It was pretty common
to blame the parents for kids not being immunized,
but this was a system failure. The good news about the
story 30 years ago is that a remedy was made. The Vaccines for Children
Program was implemented and this provides free
vaccine to children who do not have insurance or
who are eligible for Medicaid or who are American
Indian or Alaska native. And about 50 percent
of children under two in the U.S. are now
receiving vaccines through the Vaccines
for Children Program. That led to a great increase
in immunization coverage and a prevention and
actually elimination of home grown measles in the
United States by the year 2000. But that story started
with inequity, stigma, misunderstanding and
huge disparities. Fast forward to today, last week
I believe, we were fortunate to have a tour of the South by
pediatric residents visiting from the University
of San Francisco. They were studying the current
situation of inequity, stigma, disparity and the factors
that lead to that in 2019. And as pediatric residents
who will be forging the future of the healthcare system
that they’re part of, what they could do to
understand the community context and potentially make
a difference. Fast forward to this
week, tragically, vaccinators in Pakistan and police protecting the
vaccinators were attacked and tragically some killed by
people who don’t want vaccine for that community or people
who don’t trust their government or don’t trust the program
or want to make a statement. The ethical dilemma of trying
to provide life saving care for ebola patients in the
Democratic Republic of Congo versus the many factions
that are concerned or fighting the current
context in Eastern DRC. Every single day here
in the United States and around the world, ethical
dilemmas in health are featured. We just yesterday announced
records broken for measles since the year 2000 here in
the U.S. It’s not a function of low income, inner
city youth who are — don’t have access to vaccine. It’s a question of close-knit
communities where distrust and misinformation is
probably driving the problem. The individual rights
about whether or not your child should be
immunized and the public good about protecting others
against a contagious disease that your child could
be spreading are with us every single day. Looking at the agenda
that you have for today, it’s a very challenging set
of issues and a rich set of discussions that I
hope you’ll be part of. I’m particularly pleased
that when we’re going to devote a forum to youth, to
the ethical dilemmas in children and adolescents,
that the average age of the participants is a
little lower than usual, that we actually have
teens participating in today’s efforts. I hope you’ll speak up and
be part of the proceedings. We need to hear from you. The issues that become normative
for those of us at the older end of the spectrum really
need to be questioned. So I’m really looking forward to
hearing how the discussions go and want you to know how
seriously CDC takes our responsibilities in
bio-ethics and our commitment to eliminating health
disparities here in the United States. Thank you so much to all of
you who planned the meeting and to those of you
who will make sure that it’s a day to remember. Thank you. [ Applause ]>>Thank you, Dr. Schuchat. And to provide his opening
welcome remarks, it’s a pleasure to introduce to you
Dr. Rueben Warren. Dr. Warren currently serves
as Professor and Director of the National Center
for Bio-Ethics in Research and Healthcare at
Tuskegee University, as well as the Adjunct Professor
of Public Health, Medicine and Ethics and Director
of the Institute for Faith-Health Leadership at the Interdenominational
Theological Center In Atlanta, Georgia. Please join me in
welcoming Dr. Warren. [ Applause ]>>Good morning. Just as a starter, we have
some folks from Tuskegee, students from Tuskegee that
need to be in the front. So all the young folks,
come to the front. This forum is for you. It’s not for those of us
who are not real young. So come on down. Come on down. I want you to get in the
habit of sitting in the front. So come on down and
come on down quickly. We got a lot to do. I’m going to make my
comments very short because we got a long day. And the other thing is that
you all been up since 4:00. So we want to be able to
nudge you, to keep you awake. These chairs are special
and you need to be in them. As you gather down in front, I also want to thank you
very much for getting up. This was not extra
credit for students. There’s no extra grade for
the students have come down. There’s no money that
we’re giving them. It’s a commitment that
they’re making early on in their lives
and their careers. So it’s real special. In additional to the
high school students, we have a very honored group of Tuskegee University students
called the Bio-Ethics Honors Program students and I want them
to stand and be recognized too, because they’re given the
guys — the younger folks. All the Honors Program
students, please stand as well. [ Applause ] There’s a bridge between all
of us and we need to have steps to make those bridges safe,
stepping from high school to a career sometimes it’s
too broad and you’ll trip and fall and stumble and sink. So we need some steps. So we have steps from our TIMS
Middle School, which is seventh and eighth graders to
our BTW High School, which is our high school
students to our college students to our graduate students. So we have some graduate
students here from Tuskegee too. Will you please stand
to be recognized? [ Applause ] And from our graduate students
who are professional students and our professional colleagues. So we got a bridge. Those steps are really hard to
make and sometimes you stumble and go back and fall back. But when you fall back, we got somebody behind
you to catch you. So somebody’s still catching me, because I fall back
all the time. So I get caught when I fall. A couple of important
things about this forum. First and foremost, Dr. Liburd
has been gracious and wise and thoughtful in promoting
a program in the government. And, you know, government
changes all the time but important programs
don’t change. So I want to thank her
for her continual courage and commitment to this forum. So thank you again, Dr. Liburd. In — yeah, let’s do that. [ Applause ] In 2015, we had a conversation about what I thought was health
equity and minority health. And we’ve had a cooperative
agreement with the Centers for Disease Control and
Prevention and Tuskegee for many, many years
that was the result of the 1997 Presidential Apology for the U.S. Public Health
Service Syphilis Study at Tuskegee. And we have been cooperating — it’s called a cooperative
agreement but it really — what it is, is a
cooperative agreement. We sit and talk and
we discuss, we debate and we agree upon agenda and that agenda’s been
moving forward for some years and it’s getting better
and better every year. And so I had a conversation
with the Project Officer about that cooperative
agreement, what do we cooperate
on to do better. It’s Jo Valentine. We agreed upon honoring
the 100 year legacy of Booker T. Washington
and Tuskegee decided to do something every month
honoring Booker T. Washington, a phenomenal human being. And so, in talking with Ms.
Valentine, I said, “Well, let’s partner and
do this forum.” And in her wisdom, she said,
“No, let’s make it bigger than my division,
bigger than my center. Let’s make it a CDC effort.” And she recommended that we talk
with Dr. Liburd about doing this as a Center-wide engagement, because it was a
University-wide engagement. And that engagement has blown
up in really phenomenal ways, so I want to recognize
and thank Ms. Valentine for her energy and her thoughts. [ Applause ] Now, I’ve done all
the thank you’s, I think at this point in time. But what I want to really pose
to you as a way of thinking — a different way of thinking —
in a wonderful, well recognized, globally recognized, scientific
enterprise called the Centers for Disease Control
and Prevention that does the best science,
I think, in the world, public health science. The dilemmas really was that
we’ve got the science down pat, but the challenge is
getting folks to understand, even not understand,
but accept the science, which is a different dynamic. How do you accept something that
we know is scientifically valid? So we wrestle with that. The science is validated. It’s published. It’s spread broadly and widely. But the folk who need to know
it the most don’t believe us. They don’t trust us. So we can bring some folk that
look like us, look like you and act like you
and talk like you, but they still don’t trust you. And is that trust because
they don’t know better? Or is that trust
because they’re paranoid? Or is that trust founded
in a history of distrust? And if you go back and read — not only the scientific
literature but the humanity’s
literature, then you will find that that trust has been
violated over and over and over again, over the years. So the lack of trust
is legitimate. It’s warranted, particularly
in 2019, particularly for people of African descent. 400 years ago, 400 years
ago, there was a ship, a boat or something that
came from the continent of Africa to North America. And that launched the
most unethical engagement in U.S. history. And it’s called the
African slave trade. Misnamed — they wasn’t
African slave trade. Some say it was the Middle
East, the Middle Passage. Some say it’s the
European slave trade. But that was an energy and I
have a pen that says 400 years. 1619 to 2019. The ethics of reparations
and reconciliation — do better before
you are forgiven. Do better. And ironically, in this country, 1932 was another
unethical engagement. And it’s recorded as the most
unethical, non-therapeutic — non-therapeutic means no
treatment so-called study in the history of
the United States. They called it the
Tuskegee Syphilis Study. That’s what they called it. But in fact, it was the Tuskegee
Study of Untreated Syphilis in the Negro Male
in Macon County. Untreated Syphilis in the
Negro Male in Macon County, which said, in fact, we won’t
intend to treat those folk. Period. No intention. Not going to treat them. Who are those folk? They call them the negro male. Where? Macon County. Somehow, that got
distorted when it was exposed to name the Tuskegee
Syphilis Study. So that’s what you heard. But just be clear, that
was not what happened. And they also said in years
later, “Well, CDC did it.” Not true. The U.S. Public
Health Service Syphilis Study. Just be clear and that doesn’t
mean that we lament over it. But it does mean we
acknowledge and correct. And that’s what the
issue is about. It’s about a forum of
ethical conversation, which translates into,
hopefully, ethical behavior. You hear the issue of
public health theory and public health practice. That’s a mantra that I learned
while I worked here, at CDC. Theory and practice. Well, I would suggest that we
go from theory to practice, which means practice
and reflection. More than just doing different, but think about what you’ve
done and then improve it. So what we have done over
the last several years with this forum on public
health ethics is to think about what we’ve
done the last year and improve it for
the next year. And I’m particularly
pleased about last year, because we listened
to the elders. There’s a notion to
listen to the elders. They know more because
they’ve been there, done that. And we listened and we’re — some were surprised
about the wisdom of those folk that were here. But what came out clear is
that they know what to do, because they’ve done it. But the question is
who needs to hear it. Who needs to hear it? And what came from that
conversation was young folk need to hear it. And that’s what we’ve done. We’ve brought you here
to hear and to talk. So this is really not
a talking session. This is a listening session. And we want the youth to
tell us what you think, tell us what you think. So don’t sit here and act like
you don’t know what you think. We’re not asking
you what you know. We’re asking you what you think. Feel comfortable. That’s why I asked
you to come down here, because this is about you. This is about you. And at one level it’s about
public health, but more broadly, it’s about public health ethics. It’s about public health ethics
and last year, what we heard is that what is this
thing called ethics and what book did
you read on ethics. And I’m suggesting
that you don’t need to read a book on ethics. You just look around. And at your gut level, that quiet voice will say
simply, “This ain’t right. This ain’t right.” And that language is okay. And sometimes, we don’t know
what the right thing is, as readily as we know
what the wrong thing is. So we don’t have to
know what’s right. But you know what’s wrong
and we need to hear that. So this session is
to listen to you. So feel free to talk. You’ve come a mighty long
way to tell us something. Don’t leave without
us hearing it. So again, welcome
and I look forward to a full and exciting day. And on top of that, we’re
going to have some fun. Thank you so much. [ Applause ]>>Thank you, Dr. Warren. For our open plenary this
morning, it’s a pleasure for me to introduce our
speaker, Dr. David Hodge. Dr. David Hodge currently
serves as the Associate Director for Education and Associate
Professor at the National Center for Bio-Ethics in
Research and Healthcare at Tuskegee University. He also serves as a Senior
Associate Editor for the Journal of Healthcare, Science and
Humanities and the Director of the Bio-Ethics
Honors Program. He has authored — he’s
an author of three books and he’s currently working
— it’s my understanding, the writing of two books,
Pragmatic Bio-Ethics, Public Health Ethics,
Bio-Ethics and Marginalization and a Physiological
Theology of Trustworthiness. Dr. Warren came to Atlanta
in 2016, where he served as part-time Professor
in Philosophy at Georgia State University
and as a guest lecturer in philosophy, theology
and ethics at the Interdenominational
Theological Center. From 2011 to 2016, he taught
Moral Theory and Bio-Ethics at Nova Southeastern
University and has taught logic, philosophy, ethics and religion
at St. Thomas University, Barry University, Miami-Dade
College and Broward College. His University of
Miami dissertation — focused on the Virtue Ethicist:
A Metaethical Anticipation of Moral Sentimentalism,
Empathy and Care — has had a significant amount
of readership worldwide. Dr. Hodges worked
with [inaudible] to intersect the role of
virtue, empathy and care in our [inaudible] concerns. For our opening plenary speaker
this morning, please join me in welcoming Dr. David Hodge. [ Applause ]>>Good morning, everyone. It is such an honor to be
here among this august group, just to have a conversation,
as Dr. Warren just put it, talking back, listening and
talking back and engaging. This is an exciting
moment for me, because I’ve never done
anything like this before. So, therefore, if I slip up,
trip up, fall over myself, then you shall be forgiving. I have the wonderful honor of
working with a group of students at Tuskegee University, the
Bio-Ethics Honors students and Dr. Warren just
asked them to stand so I would not embarrass
them any further. But they’re here today and I
want to know that I thank you and appreciate you
for being here for your presence
at this very moment. Also, I want to thank
Dr. Rueben Warren because he invited me a year
and a half ago to be his partner at the National Center
for Bio-Ethics in Research and Healthcare at
Tuskegee University. And it has been an
amazing ride so far. So I don’t want to
give another handclap, because of his presentation just
now, but just what he is doing in an effort to increase
awareness in public health and bio-ethical issues. Let’s give a handclap
for Dr. Rueben Warren. [ Applause ] You know, when we’re
walking down the hallway, we came in together and walking
in the hallway and we had to stop so many times,
because he seems to be a legend in this place. You know — matter of fact, I was just having a lunch
somewhere with my wife somewhere in Atlanta and someone asked
me, “Where do you work?” I said, “Tuskegee.” “Do you know Rueben Warren?” So he gets around. So don’t be surprised if you
see him in Madagascar somewhere, you know, he gets around. And he also have
that prophetic look that those dreadlocks
really kind of show him as a prophet and a seer. So with deep respect and
thank you, Dr. Warren. Thank you, Dr. Liburd
and, you know, Liburd, that’s a Virgin Islands name,
so they’re actually “Lie-bird,” so I try to make sure — I say “Lie-bird” because
I’m more comfortable with it as “Lie-bird,” but is Dr.
Liburd, I want to thank you for how you’re being so
welcoming to me as we continue to have this collaboration
and collaboration. My wife is here and she’s a
teacher, so that means she had to take a day off to
come be with us today. That’s my wife, Teresa Paula
Hodge sitting there. [ Applause ] My son is here. Now, he didn’t get a day off. He’s playing hooky. But that’s
Jonathan David Hodge and I’ll say something
else about him later. Jonathan, raise your hand. [ Applause ] But I also have someone else
that’s extremely special to me here and that
is Dr. Marcia Riggs. She’ll be in a session
later on today. Dr. Riggs was my advisor
dissertation and Committee Chair and coverage of motivator
for my first doctor degree at Columbia Theological
Seminary. When things got tough, I
ran and hid in her office. Because, those of you who are
going to do graduate studies, find someone’s office
who you can hide with, where you can hide. Right? It’s — the
[inaudible] graduate work that they’re pledging a
fraternity or sorority. Right? So you need to find
someplace where you can hide. Dr. Marcia Riggs
represented that for me. So I want to thank you, Dr. Riggs for how
you’ve been in my life. I went to her office —
this is extremely important, especially for this moment —
I went to her office one day and she said something that
no one else had ever told me, because I was hiding it so well. She asked me, “Do you have
a learning disability?” And I was saying, “Are
you saying I’m stupid? What is this?” I’m in grad school. And she said, “No, no, no. That’s all it is.” She said, “Your mind interprets
things in a different way.” She said, “Go to
the testing center.” So I went to this — I think
Dr. Ruth something or Elizabeth. But I went to see her
and she said, “You know, it’s been so long that you
might have rewired itself to figure things out. So, you know, just keep
doing what you’re doing.” But it was in grad school, a
professor asked me the question that perhaps should have been
diagnosed many years earlier. I used to wonder
what’s wrong with me. Why can’t I understand
difficult — it’s people flying through
things, and I couldn’t get it. I thought there was
really something wrong. And it was something wrong. But the mind has a way of
correcting, of self-correcting. So I was able to
pull out of that. So when I figured
that out, I said, “I need to go do
another PhD to see if my mind has actually
figured it out.” So, amen. Thank you, Dr. Riggs. We want to have a
conversation today about ethics. And my first thought was,
given the context for today, that’s the content of our
material for today that is about how to understand
ethics and issues for children and youth. But I wanted to give
some attention to the overall broader category of what ethics is
and what it entails. Because many of us are — have a kind of pedestrian
view of ethics. You know, we kind of
roll with the punches. But it’s not easy. Trying to do the kind of work
that we do on a daily basis, trying to figure out, not just
as Dr. Warren said a moment ago, that something is
right or wrong, but why is it right
and why is it wrong. That last gate can
be extremely tedious. So I’m going to take us
through a session and I’m going to move kind of quickly,
but I’m going to try to be as explanatory as I can. Because I want all the
old people in the room — now, given last year’s
conversation about elders and Dr. Denise Carty and Dr. Warren had this
major conversation and fight between you’re old — no,
I’m not old, I’m an elder. She said, “Well, that
means you’re old.” “No, I’m not old, I’m an elder.” It was a beautiful
thing to watch. But even with that knowledge,
the old people in this room, I want you to eavesdrop
on this conversation and this presentation, really to
the young people in this room. So that’s why I named — I’m looking for kind of
what metaphor would work for young people and I
came up with theme parks, rap and moral dilemmas. Ethics and the least of these. Well, this is the way
Jonathan comes into play. Because a few years ago, I decided to take my
first rollercoaster ride. So we went to Space
Mountain in Disney World. And ladies and gentlemen, I do not know why these people
make money scaring the lights of other people. The idea about going
on a rollercoaster, paying to be scared
makes no sense to me. This was my first
rollercoaster ride and I did tell you it was also
my last rollercoaster ride. Last year, my brother and
his children took Jonathan to Six Flags and they
said, “You want to come?” “Why, to watch? I am not going on to that place,
because it makes no sense to me. When we saw Space Mountain, I actually thought it
was a haunted house. So we’re going up the
staircase and going, going, going and I’m hearing
this loud sound. It sounded a whole lot like
a tornado in the building. And I’m — I’m climbing,
“So what is that noise? That doesn’t sound like fun.” Hearing people scream
just didn’t sound healthy. But I continued to go and
go and we got to the top and while we were
at the Space — looking out where the work is,
they line you up like cattle and you have to walk into
this little space to get into something that
looks like a coffin. They buckle you and
strap you in. This should be an indication
that you should leave. And I asked my son, David,
by the way, I said, “David, you know, we are Hodges. We are proud Virgin
Islanders and petitioners. We don’t need to do this.” He said, “Daddy,
I want to do it.” I said, “We don’t have to.” He said, “Well, Daddy,
this looks like fun.” “No, it does not, son. We could walk down these
stairs the same way we came up and we will do it with
our heads held high.” He said, “No.” I said, “All right. You sit in front and I will sit
behind you and I will hold you.” So I held him. He said, “Daddy, you’re
holding me too tight.” I said, “Hush, son, just accept
Daddy’s love right here.” If you’ve ever been to
[inaudible] Space Mountain, the ride takes off in
this casket device. You know, people will talk
about near death experiences. They’ll talk about going
through a kind of corridor of light, a tunnel of light. That’s what it take you through. So there’s lights all around and
you’re going through this tunnel of light and as you’re
going through, you’re hearing this
clack, clack, clack, clack. That clack, clack, clack
noise is very ominous. The point of it is
to terrify you more. They don’t have to have it. So we’re going through
clack, clack, clack, clack, clack, clack. I’m holding him tightly
and it starts going up. Scariest thing in the world. Not because of your ascension but because you know there
will be a descension. When it got to the
top, they pause, just to terrify you even more. And then it takes off. Now, the idea is, I guess,
that you’re supposed to hold on as tightly as you
can and enjoy the ride. How can you enjoy the ride when
you’re yelling the entire time? And then it gave you a break
and then it’d do it again. Now, we got to the very end and this cute little
girl, she was so nice. She came to me, she said,
“Sir, let me help you out.” I said, “Go get some help.” She said, “No, I could do it.” I said, “Look, go
get some big people to life me out of this thing.” She said, “No,” and
I said, “Please, go get some big people.” So they went and got some
big people, lifted me up, my little feet dangling as
they took me, sat me down next to a booth, looked like
Lucy’s booth on Charlie Brown. And what they didn’t tell me — they never asked for permission
— these young people today, we got permission
to photograph you. They didn’t ask you
for permission. Honest, they had pictures of me
on over, screaming, my eyes wide and my mouth — they asked
me not for permission. A little boy sat there and
said, “Hey, look at…” and pointed and laughed. And I’m like, “What’s
he laughing about?” And that’s when I saw
he was laughing at me. Why was he laughing at me? Because this is how I looked. I looked the part of
someone who is sick. Why? Because this is what
rollercoasters do to you. This is what theme
parks do to you. So now, I stick to
what I can handle. When I go to Disney World, I go
to It’s a Small World After All. And so you got the
little Asian deck babies and you got the little
Indian babies and you — and they’re all dancing. And I love to just
go nice and slow. And here’s the thing: I’ll
ride that ride 15 times. And it never stresses me. Ladies and gentlemen,
[inaudible] theme parks all around this country and they’re
making a whole lot of money. And I think — and you
kind of pick and choose which one you want to
terrify you the most or which one you
want to utilize. And ladies and gentleman, that’s what this
conversation is all about. That’s what ethics is all about. It’s a matter of picking
and choosing which one of the various theories
you want to utilize to terrify you the most. Now, in this field,
we call ethics — ethics is a subset
of philosophy. There are six major
areas of philosophy. One is epistemology. By the way, I’m going
to be speaking — like I said, I’m
keeping it kind of fast, because I know we’re a
little bit behind time. But I want to make sure that when we start the next
session, we’re right on time. So I’m going to move
through quickly but I’ll try to be as clear as I can. So in the — of philosophy
is epistemology, which is the nature
of knowledge. Then there’s logic, which
is like one of the — that’s like doing calculus, you
know, you have some little thing that doesn’t even
look like letters, trying to figure
what things are. I didn’t do calculus, because it
had some funny looking things. I was doing algebra, and that’s
some funny looking things. I like something simple
— a, b, c and 1, 2, 3. When they start having
funny looking things, I didn’t like it. But logic is one of
those areas in philosophy that is extremely helpful
to understand how it works, because the essential part
of logic is premises must add up to a particular conclusion
for the argument to be valid. If the premises are false
or in some way undetermined to be false, then we cannot
have a valid argument. That is a lot of
what we do in ethics. Then there’s metaphysics and metaphysics asks
questions about what is real. Do I exist? Am I here now? Are you here now? How do I know I’m here? When does time end? When does time begin? Is there such a thing as time? Right? These are questions about
metaphysics and it will take us into conversations about
questions about God. You know, is there a God? You know, how can you
know that there’s a God? These are metaphysical
questions, questions that have nothing to
do with the physical reality, questions that are — move
beyond the physical reality. Then there’s esthetics and
esthetics has to do with beauty and the nature of
beauty and so on. Now, I picked some beautiful
people — now, I get a lot of — at Tuskegee University, I’m
just saying this publically because you all need to know
the kind of stress I’m under. At Tuskegee University, there
are some people in my office who say that I should
not be using that picture of me
in the middle. They say I no longer
look like that. I need for you to write letters
and say, “Dr. Hodge, yes, you still have the gift.” But that’s esthetics. What does it mean
to be beautiful? And let’s pause for a moment. But there’s another area in
philosophy, known as ethics. And that is our focus. Literally, each of those other
areas play a part somehow in the ethical conversation. And how you construct
ethical theory and ideas. And this little statement
by Dr. Martin Luther King: the time is always right
to do what is right. It’s kind of ambiguous,
with the word right. The time is always right
to do what is right, but can we always
know what right is? Sometimes, as Dr. Warren
said a little while ago, we may not always know
the right answers. So he said in those cases — and
this is why I will end later, so he was anti-climactic. He kind of stole my thunder. In the cases in which
we don’t know, he said, go with what is visceral. Go with your gut. But if you have a bad gut and
you know you have a bad gut, don’t trust your gut,
because bad gut people — I’ll talk about them
in a moment. They could cause some problems,
because ladies and gentlemen, in our world, we see
some massive tragedies. This is the Sudan
a few years ago. This little boy had just
walked several kilometers, just trying to get
food and water. The vulture or buzzard sitting
behind him is waiting for him to die so that he can be a meal. The gentleman who took this
picture, Dr. Warren, Dr. Liburd, committed suicide 30 days later. Because it seems to me
— back to the visceral, back to the gut — that anyone
who could take this kind of picture, anyone who
could be in this kind of environment is having some — or would have some
major wrestles with the fundamental questions of what does it mean
to be human. What does it mean to be
empathic, caring, altruistic? What does it mean to feel,
to have some sensibility? What does it mean to
say this is wrong? What does it mean to
have ethical judgments? Ethical theory, that is
the work that those of us, Dr. Drew Barrett, myself,
Dr. Warren, Dr. Liburd, those of us who work in this
field, who have conversations in this field, understand and must understand ethical
theory differs from the sciences because it is normative
or prescriptive. In other words, when we’re
dealing with ethical theory, the question is what
should we do. What ought we do? Given what we see, given what
we use our minds to reason and to understand,
what should we do? What is the next step? What is the next step
for the conversation? You know, when Captain Wilkins, Craig Wilkins gave the
introduction a moment ago and he was talking about, he
said there’s a large group — well, really, I mean
there’s a small group of us that get together and wrestle. He’s on the skating edge. It’s really a wrestle. It’s really a struggle. Sometimes, I remember Dr.
Warren missed a meeting and when he came back
to the third meeting, he said, “Wait a minute. Didn’t we discuss this
three meetings ago?” It’s a wrestle trying
to figure out and identify the precise
kinds of conversations we need to have, because
it’s about judgments. It’s about doing our best
to do what we ought to do, as opposed to the sciences. See, the sciences
are descriptive. They’re describing things as
they are, where there’s things in the natural world or society. But the ethicist
is prescriptive. Ladies and gentlemen,
they’re saying — the ethicist is saying,
“These are the kinds of things that we ought to do if
we’re going to function in a good environment.” Years ago, a fellow by the
name of Charles Darwin — I’m sure you’ve heard
of Mr. Darwin. He had a thing called
Social Darwinism. And Social Darwinism
says, “You know, we’re better off being kinder.” And fuse, Mr. President,
George Bush the First language, “And we in a better
world when we are kinder and gentler to one another.” As a matter of fact, you know,
Charles Darwin and evolution, we evolve better as
people who are anarchists but people who are altruistic. One of the beautiful things
of this world is if you break down on the highway, young
people, if your car break down, you could rest assured — simply wait and somebody is
going to stop to help you. It doesn’t matter how you
look, because if we go back to the picture with the, you
know, the aesthetics part, if you have a sweeter
disposition, people are going to stop sooner. Right? Because people
have other motives. But if you break down or if you’re having some
harsh experience, typically, somebody is going to help,
because the world is better off with people who help others
over against people who do not. There are areas of emphases
in our moral judgment, and I will — in each of
these areas of emphases, they actually speak to a
particular moral theory. For example, purposes
or motives. Acts, rules and maxim. Consequences, character,
caring relationships. All of these terms that we
use in our everyday language, they actually speak to a
particular kind of moral theory. Motives, acts, consequences. Motives speak to virtue ethics. Acts and rules speak to
what’s called the ontology or [inaudible]. Consequences speak to what’s
called utilitarianism. Character, back to
virtue ethics. Caring relationships,
back to care ethics. So these kinds of —
look at those words. Look at these words. These are the kinds of
words or terms that we — if these are our motivations
or inclinations, then we ought to develop them and
see where they lead us, in terms of developing
a constructive view of what ethics is. So to answer the question
about goodness and rightness and what makes for
good and what makes for right gives us several
different theme parks of ethical theories. This is the kind of stuff
that could drive you crazy. Because when you look at them,
it’s like ethical relativism. “Well, that kind
of sounds like me.” You know, I do what
I want to do. Culture activism, I’m
from the Virgin Islands. I’m very proud to be
from the Virgin Islands. Ladies and gentlemen, I eat fish
every day of the week if I can. [inaudible] do fish. Flies fish. I’m supposed to be a vegan, so
I’m working on it, Dr. Cardi. Right now, I’m going to
call myself a quasi-vegan. My son has some major
issues with that. He said, “Daddy,
you’re not a vegan.” I said, “No, I’m not. I’m a quasi-vegan.” “Well, if you’re a quasi-vegan,
you’re not a vegan.” I said, “I said that. I’m a quasi-vegan.” “Well what’s a quasi-vegan?” “I’m not a vegan.” But I’m working in the
direction, you see. But my culture put some
things on me in a certain way that helps me to make some
decisions about what I’m going to do, how I’m going to
believe, how I’m going to act, what I’m going to eat. Then there’s the
Divine Command Theory. What does God have to
say about this thing? Is something right or wrong
because God says it’s wrong, if something’s right or wrong? So some other reason? And then Utilitarianism. I mentioned that before, but it’s about the
greatest happiness for the greatest
amount of people. It’s more than that, but that’s
just a simple way of saying — the ontology, I mentioned that
before, commitment to duties, obligations, virtual ethics,
commitment to character and caring relationships. So let’s take a moment to talk
about these theme park of ideas. I went to Universal Studios. There’s a ride there called
the Incredible Hulk in a place, a thing called Island
of Adventure. Some genius sat down and said, “I’m going to make
a ride that’s going to make people very unhappy.” When you look at the faces of
these people, about two or three of them look like they’re
excited or anxious. But notice the fellow next
to the young lady in the red. He doesn’t look happy. He doesn’t look like
he wants to be there. He looks like someone
forced him to being there. They locked him in and there’s
something wrong with this. Ethical theories, ladies and
gentlemen, is like a theme park. There’s a whole lot of
them and you have to figure about which one of these
rides you want to take. You know. It’s sort
of like rap music for those of you who like rap. Listen, not all rap — you
know, see, I like Tupac. But not all of Tupac. When Tupac talking about
changes, I’m down with Tupac. When he talking about dear
momma, I’m down with Tupac. When he’s talking about some
other stuff that he said — no, Tupac, you’re
a little crazy. I’m not down with that, you see. So you have to find
conversations that will work for you ethically and morally. Because, Ladies and Gentlemen, there are two sides
to this conversation. One is ethics. Ethics is derived
from the word ethos, which is simply about character. What is my character? For example, when a doctor says,
“I am qualified to tell you that the course of treatment
will likely generate the best results,” then that doctor is
speaking from a kind of ethos. In other words, he’s saying
that I am in position — my credibility’s in position
to share something with you. My character is in position. The word ethics was — the word
ethical or ethics or ethos, these are terms that would be
fine by the ancient Greeks. As a matter of fact, excuse me. In the ancient world,
the only kind of ethics they really employed
was something we will discuss that’s called virtue ethics. Then there’s morals. Morals differ from ethics. And don’t stress
yourself with this. This is a fun talk right now. But morals differ from ethics and that ethics are more
philosophical or tends to be more philosophical. And morals tend to
be more personal. I derive from my morals and
customs and values and so on. So it tends to be more personal. But then it’s against
all corruptive when you start talking — in 1958, we started talking
about moral philosophy. Right? So now we —
we don’t really — we don’t really have to
hold on to those kind of descriptives any more. But one of the things that
we need to understand is that ethics is part of what it
means to be human, what it means to develop as a human
personality. What should I do? What is mankind? And additive theory must take into account human
nature and human behavior. In other words, ladies and
gentlemen, it doesn’t make sense to talk about ethics
if we can’t do it. You know? We are,
as human beings, we have certain constraints. There’s some things
that we cannot do. There’s some places
our mind cannot go. And then there’s places that
a mind absolutely will go. For example, I don’t
have the time to tell you about when I gave a
kidney to a student. I don’t have the time
to talk about that. A student needed a kidney. I gave a kidney. Student called me,
years later and said — every year, give me a card. It says, “Thank you, Dr. Hodge, for giving me another
opportunity at life.” Then a few years later he
sent me a card that says — with a little picture, he had a
son and he named his son David and on the back of
the picture, it says, “Thank you, Uncle David. Without you, I couldn’t
be here.” That’s called supererogatory. That’s when you go over
and above the call of duty, when you do more than is
morally expected of you. Now, if I told you I
gave a kidney to my son, Jonathan, you would say, “And?” That’s what you’re
supposed to do. Until you give a
kidney to a student. Look at you. You look all teary-eyed. You look like, “Oh my God, wow. That’s such a nice thing.” Well, here’s the problem. I really didn’t give
a kidney to a student. Right? That didn’t happen. But it’s a good story. Right? Which leads to some
of the problems in ethics, because how do we know when
something is true or false? Because when I just
told that story, it sounded true, didn’t it? As a matter of fact, as I’m
up here talking about it, I started believing it. Dr. Liburd, she was
looking at me like, “Oh, David, I love you.” And when I said it was false,
she looked away from me. She no longer my friend. She’s saying, “You are
giving a lecture on ethical and you’re unethical yourself.” Ladies and gentlemen, we’re
constrained in certain ways, such that we would say that
some things make sense to us and other things do not. It’s part of how we
develop, how we — we have embedded codes to
behave in a certain way. Part of that development
is our conscience. Because conscience
guides our moral lives. Our conscience dictates what
to do and what we shouldn’t do. And sometimes, if you
could do something bad and it doesn’t bother
you, what do people say? You have no conscience. My mother used to tell my
brother — not me, my brother — and mom, if you’re
watching now, not me. She used to tell my brother,
when he eat too much food or he ate more than
his share, “Boy, you’re not going to
conscience it up.” You don’t have any conscience. In other words, you
don’t know when to stop. Dr. Warren’s word, it’s
a kind of gut thing. We all should have a conscience. And such that a person doesn’t
have a conscience, then we have to raise questions about whether
or not they can be moral, whether or not they
can be ethical. So I’m not going to go
through this long dissertation, but suffice to say that
our conscience governs our critical thinking. It governs our rational
capacity. It gives — it puts
parameters on our emotions and how we should feel
about certain things. Immanuel Kant, the
great philosopher, says, “The good will is
good in itself.” And he went on to say that, “We should be governed
by this good will.” He said, “Two things excite me. The starry skies above
and the moral law within.” Because it seems to be something
that we could always look — when we see something that is
universally wrong, we admit it. We say, hey, it’s universally
wrong to harm children. It’s really universally
wrong to hurt anybody, but for some reason, it
seems like even more wrong. We were driving in today and
we heard about some athlete, a football player I think, and
they recorded how he talked about punching his
three year old. That thing just shut me down. Because it’s wrong —
the moral law would end. It governs us. It governs us rationally,
even if you’re an atheist or have no God concern, you’re
still governed by rationality or sentimentalism,
emotions, you see. So no one is without excuse. In our modern world, ethics is about the philosophy
of right or wrong. Moral is about my personal views
of right and wrong and ethics, like I said, is more
philosophical. So back to the themes
that we said, this culture of relativism. I’m going to flash through them
very quickly, very quickly, so catch up — keep up. Here we go. Ethical relativism —
people can never be mistaken about what is morally
right or wrong because there’s no objective or universal moral
statements of truth. Instead, they’re only opinions. In other words, you
know, there is — it would have been so easy — if there was like in
the clouds written, “These things are wrong,”
so anytime there’s an issue, we just look to the clouds
and say, “Hey, that’s wrong.” But we don’t have that. That kind of objective,
universal thing. But somehow, on the inside, we feel like we do have
something of that sort. Ethical subjective
will say, “No. I do want to do. What is right is
what I say is right.” Opinions express what
a person believe. It doesn’t have to be backed
up by reason or facts. An ethical subjectivism is
I do whatever I want to do. I interpret the life through
I want to interpret it, because you only get
just a piece of elephant. You don’t get the whole thing. And you interpret the
part that you have as what’s exceptional for you. But the danger is, is
that the only requirement for ethical subjectivists is that they do what they
believe is right to do. So if you believe
that giving money to the poor is right,
then that’s right. But also, if you believe
discriminatory practices is right, it is right. If you believe the right to
discriminate against Jews, black, women, gays, lesbians
or whomever, then it’s right. So ethical subjectivism
has its fun parts, but also has its danger. Cultural relativism, it,
too has its fun point, because cultural —
I love this cartoon. On one side, she says —
everything covered but her eyes, “What a cool, male
dominated culture.” On the other side, nothing
covered but her eyes, “What a cool, male
dominated culture.” You change — the only thing
you do is change the universal affirmation to universal
negation and the whole thing changes and that’s what cultural
relativism is. You know, based upon
your culture, you define what is right for
you and what is wrong for you. And then back to
the thing about God. What if you don’t
believe in God? Or if you believe in
God, uh oh — which one? Are we talking about Jehovah,
Allah or are we talking to something more
eastern, like Buddhism or [inaudible] or Sectism? How are we supposed
to understand it? But maybe we should just make
ethics be a part of our ego. I’m not going to ask
— the ego done says that I do what’s in
my best interest. I’m not going to go
through with that, because it’s just
too much fun stuff. But the major part that I
wanted to start closing it down on is three things. Number one, the ontology. The reason I want
these three things — and I want to slow down, so I
can say them just about right. So in the work that we do
primarily, ladies and gentlemen, bio-ethics is characterized or
is best — let me start again. I’m sorry. Where there’s bio-ethics
or public health ethics, there has to be a theory
that undergirds that system. Once you have a buy-in
on the theory, then you can have
conversation with partners. Are you with me? Are we on the same page? Let me say that again. I’m going to keep saying
it until you say, “Yes, sir, we on the same page.” If we’re going to talk about,
say, bio-ethics, then we have to have a theory — one of
those many theories I talked about — that undergirds it. And once you develop the
principles or understand how that undergirding theory works, then you will know how it will
function in the operating theory that you want to use, sort of
like software and hardware. If you have the correct
software, it can run — do some major work on a particular hardware,
computer system. But if you have a software
that’s not going to fit, it may not fit accurately. It may not take you to
where you want to go. So undergirding bio-ethics is
typically what we mentioned earlier, this thing
called the ontology, this notion that
rules govern behavior. Obligations, duty governs. And that means bio-ethics
has a tremendous regard for respectful persons, for
benevolence, for justice. On the other hand, the other
argument, Utilitarianism, which argues that what is right or wrong is based upon
what the consequences are. In other words, imagine
this situation. What if you’re in a
scenario where you have to kill one person
to save 50 lives? What do you do? What do you do? Utilitarianism, the greatest
good for the greatest — the most happiness
for the most people, what that which would bring
about the best consequences? Publical ethics typically is
grounded in Utilitarianism, because what is public
health about? It’s about population. It’s about social
ethics and social regard. We have situations, right,
where we have scarce resources. But we have to do the best
with the resources we have, to reach the most people we can. So Utilitarianism governs. I stole those words
from Dr. Drew Barrett — that’s your words. I stole them on the
right hand side from you. This is what public health
ethics is, is identifying and clarifying ethical dilemmas. That’s what these
sessions are about. That’s why you have to talk
— especially on people — that’s why, when
you present shortly, that’s why you have
to give your best. We don’t know — I
have to go to my son, Jonathan, to figure stuff out. And he will let me know
if we still say word up. Oh, that’s down, yo. You know, he lets
me know what kind of language I should be using in this particular
part of the century. Right? So he lets me know
which kind of dances I can do. He said, “Daddy, don’t do
that dance publically.” And that’s what you have to do. You have to let us know what
kind of dancing we can do, because, see, we’re not
coming to your theme park. We’re scared. I guarantee you, Dr. Warren. I don’t know — I
never asked him but he doesn’t get
on a rollercoaster. They’re scary. So you have to tell us
because if we’re going to get to identify what the
dilemmas are, what we propose to do is the stuff that
we thought would be best, given our training and
education and so on. But you have to now, shortly,
get up and say, “You’re right.” “You’re wrong.” “Here’s what’s really happening. ” We had a young man come to — one of my former
students, actually. He lectured last week at the Public Health Ethics
Intensive we had at Tuskegee for the [inaudible] ETN
and what I want to know about young people, I go to him. Because I had no idea,
a couple years ago, that there was a drug
problem in the inner city — and I mean in the suburbs. Before I heard about opioids
and [inaudible], he was the one who told me, “Dr. Hodges, “it’s coming and its coming fast.” Finally, in closing, how do I
ground public health ethics? How do I ground bio-ethics? I ground them in
virtue and care ethics. And I have a reason for doing
that, as Captain Wilkins read. The last sentence of my dossier,
he said, my dissertation was on Jesus and Virtue Ethics. Jesus gave us something
in virtual ethics that Aristotle didn’t give
and that was a notion of love, the notion of compassion. Those kind of conversations late in the 18th century became
very prominent with the words like empathy and in the 20th
century, words like care. So I tend to ground
the work that I do in public health ethics,
not in Utilitarianism, not in the ontology and those
kind of things, but I ground it, and as Dr. Warren was said,
what is closest to my stomach and what is closest to
my stomach is my faith. And so regardless of
your faith, right, what cause of your
belief, your tradition, there are some principles
in your tradition that are very similar
to what you see here. Benevolence, being kind. But benevolence — doing good. Don’t just be kind, but do good. See, empathy is to feel
what you’re feeling, but compassion is going beyond
that and demonstrating it. Thank you very much
for indulging me for the last 40 minutes. And young people,
this day is yours. Take this opportunity to say the
things that you always wanted to say and felt you couldn’t. Let it go. And if it’s deeply personal,
there’s enough adults around here who you
can find trustworthy. You can trust those
who are trustworthy. Thank you very much. Allow me to give you these
words, rest them upon you. Take care. [ Applause ]>>Thank you, Dr. Hodge. We’re just a few minutes
behind schedule, but I do want to save a minute or
two for any questions that we have for Dr. Hodge. We have two standing
mics in the back. Or you can also ask a question on your table there
in front of you. Or you can send a
question to our mailbox and through Twitter feed. So, any questions for Dr. Hodge?>>Yes.>>I can actually
just talk loud, right? Oh, got it. Okay. Thank you. I was interested in
what you were saying about the greatest happiness for the most people
and that concept. I work for Feeding America
and the food banking world and programs that are intended
to help people get enough food. And I find that a
conundrum that we think about frequently is
this concept of sort of scale versus specificity. So is it quantity,
serving a lot of people and doing the best we can
there versus knowing that, as we have these deeper
programs or interventions, we can actually probably
make a bigger difference, but it’s to a smaller
number of people. So I was just wondering if you had any sort
of thoughts on that?>>Thank you and I
appreciate the question. There you go. Thank you very much. I appreciate the question. The dilemma that that question
motivates is precisely why I am not a Utilitarian, though
there’s some good work to be done in Utilitarianism, stuff like xenotransplantation
are usually an Utilitarianism argument to demonstrate
why we should have respect for animal lives and
so on and so forth. But what — the constraints
that you just put forth, the dilemma that you’re offering
is why I go with virtue ethics and care ethics, because
Aristotle said it this way. He said, “Find the virtuous
person and follow them. And then habituate virtues.” In other words, we can’t be
wrong when we’re operating out of good motives
and gracious character. So your safeguard is that
you know you’ve actually done your best. So where there’s quality or
quantity, you know in the end, you can sleep well at night, because I did do my
best in this situation. But if we put it to a purely
Utilitarian situation, then we fall into
some other kinds of discriminatory behaviors. For example if, when we start
talking about Utilitarianism and start balancing the
many versus the minority, then we’d have a problem, who would the minority typically
tends to be — the minorities. And so, that’s why we have
to have some kind of caution. But if you’re operating out
of a sense of character, then you’re not constrained
to operating by numbers, but by what is the
right thing to do. So I would say, that’s why
I ground my ethical theory in virtual ethics over
against the opposite.>>Thank you, Dr.
Hodge, for your talk. It was — I think it was very — your use of narrative and story
really brought these concepts to life. And as you know, we’re
trying to look more at how we can use
narrative ethics approaches, to better have people
learn about ethical. And I think scientists
often have a hard time with that, there. They just want to
express the facts. They don’t — it’s more
difficult, I think, to sort of understand
their approaches. So I’m wondering if
you could talk some about like what you see — you
know, you’re obviously an expert in telling, you know,
bringing the stories to life and presenting a narrative. And I wonder if you have
any tips for scientists and how they can do a
better job in that area.>>That’s a good question,
tips for scientists. I, of course, I don’t
mess with you people. Part of the work that we do
often is to critique the work of the scientists to kind of
hold them up to a standard and a level because for example, back to the statement I just
read was xenotransplantation, scientists give an opportunity,
they’re running very fast into taking animal organs and
putting them into human beings. And just to speak slowly
here, we need to ensure that we involve — and this is where relational
ethics come into play. Right? Now, relational ethics and virtue ethics
are not the same. Relational ethics came out
of the feminist conversation, not the radical feminists, but
the more relational feminists. And their conversation is
about getting to know people, being in conversation with
people, to use your word, Dr. Barrett, to understand
their narratives. The work that Dr. Warren and
I do, in terms of the research in clinical trials, has to do
with going into the community, getting to know the people. Because the good part,
the good part of, say, xenotransplantation against
translating animal organs with a human, the good class — the good part is that there’s
a whole lot of benefits. You know, if there’s a
110,000 people each year on the waiting list for a kidney
or heart or some kind of organ, but only 30,000 surgeries
can be done. So what if you can give
someone a pig kidney that could give them five
more years of sustained life until a kidney become available? So there are some —
there’s some good there. However, you can’t just
walk into a Muslim community and give somebody a pig kidney. You know? There has to be
some conversation and that is where the narrative, the
relationships come in. Now, part of what the — the scientist is on a very
purposeful trajectory. We have to get it done
by a certain time. Right? They have
these constraints. But the human beings
that we’re dealing with, they kind of move very slowly. Dr. Warren pointed
out the notion — the contract between trust and trustworthiness
in the larger scheme. And we don’t have to go
into those conversations, but we know what they are. And so there are
communities that do not trust. So therefore, it takes
more and more time. My endocrinologist goes
into the Seminole county, into the Seminole community
to offer free clinics. And that’s from a Seminole
community in South Florida where the Hard Rock Cafe
is and the other casinos. So it’s an extremely
wealthy community. And he tried to go in
and have a conversation, but the problem is, they’re
saying, “Wait a minute. We don’t trust you.” Now, the [inaudible], who
has a few several years ago. “We still don’t trust you.” So relational ethics,
Dr. Barrett, will be extremely helpful in building conversation
and community. So one of the things I foster, in terms of the public
health conversation, how do we define public
can be quite misleading or misunderstood. Because public could
be numerical. Public could be political. But public can also
be community. So that is where I think public
health ethics need to try to do mostly — that
is, to understand that the people we’re dealing
with, regardless of the science, and though the scientists
be starting to understand, that the people we’re
dealing with are real people with real stories
and real tragedies. And there must be
a conversation, not a kind of patriarchal
pushing on oneself into a person’s community.>>Dr. Hodge, thank you
so much for your talk. I have a question. This is something
that we’re grappling with right now, in the Office. So we have a series
of definitions that define our work — health
disparities, health equity, health inequity, social
determinates of health. There and others. And we’re finding that the
more we engage in this work, the more nuanced our
understanding of it is, particularly from a standpoint
of wanting to take action. And so in our definition
of health equity, we talk about things that
have three characteristics. They’re avoidable, they’re
systematic and they’re unfair. And some I’m interested in how
you think about what is fair, particularly in a cultural
context of the U.S., of what I’m going
to just describe as rugged individualism.>>Thank you, Dr. Liburd. You love me again? Thank you very much
for that question. Back in 1972, one of our
great academics, John Rawls, wrote a book called Justice
as — a Theory of Justice. And in there, the major
argument was one called justice as fairness. So there is no fairness that
is dissociated from justice. And one of the —
part of the problem, going into these conversations, that the word justice
seems so abstract. As a matter of fact, relational
ethicists have struggled for a minute about how to
understand the word justice because they’re relational. They’re not abstract. They’re not talking about
something in the sky somewhere. They’re talking about
what’s right in front of us. So John Rawls’ conception of
justice as fairness is one that would do, as the other
part of my definition is, it’s kind of reach out
to the least, the lost and the left out,
to prioritize those who simply do not have access. The other people
can hold their own. If we are not doing
for the least, the lost and the left out, then
we’re not being fair. And if we are purposefully
blinding ourselves to the least, the lost and the left out, then there’s something
extremely egregious about what we call our
ethical philosophy.

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