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 and Child and Adolescent Health which is being co-sponsored by the Office of minority health and health equity and the National Center for Bioethics and 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 builders program the Fox teen 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 livestream and IPTV I would 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 a pleasure of being a part of a very small planning committee well actually not small but quite large that put this forum together my sincere appreciation and gratitude extended to each of them for all of their hard efforts in a planning of this year's events the names are on the program and also on the on the screen but I would also like for them to stand as I quickly read off their names and they recognized them with a round of applause dr. Oliver dr. Lee Andrew Berg dr. Rubin Warren dr. David Hodge April Bengston captain drew Barrett dr. Karen boo boy yay dr. Denise cardi Kayla Johnson Sonya Jones cross Youngjae King dr. Melissa Merrick boom ah Oh Harry Desiree Robinson dr. Ross dr. Stokely dr. Michael Underwood and Valentine let's give them a round of applause please so again on behalf of this committee in our office and Tuskegee University we appreciate your attendance and participation I also want to welcome our to sign language interpreters Aaron Powell and Christy Wilton on today's agenda we will have opening remarks in the open plenary presentation we would 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'll note the time for a lunch break in the afternoon beginning I want to call we have five concurrent breakout sessions that will be occurring here in this auditorium and in the breakout rooms noted on your agenda these breakout sessions will be repeated after the breakout sessions conclude we will we will reconvene back here in the auditorium for the poster recognition and our closing plenary presentation and concluding remarks for for those of you watching via IP t RP TV or livestream you can email your questions you can email your questions on – off – om h h e at cdc.gov or submit questions on our twitter via the hashtag number p HT f 2019 before he began 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 will have two official breaks we would appreciate you being respectful of the time we do have a four agenda today so we like to stay on schedule as much as possible and this will also help lessen distraction for our presenters on behalf of the office we appreciate you completing and returning a brief evaluation that's to design to provide feedback about this form if you register for the conference you will receive a link to an evaluation survey in your email box and email email INBOX at the close of this session for participants viewing the forum 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 you inviting 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 will be available at the activity and the passcode has 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. Landorus laberd Darlene Angela Berg currently serves as the Associate Director for the office of minority health and health equity here at the CDC doctor deburred 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 Bioethics and research in health care 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 Latina women and girls and older adults Oh or 1200 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 forum's 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 US 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 the 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 in co-leading the breakout 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 our planning commemorat committee members [Applause] they have full commitments within their own programs but they regularly 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 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 I think their mark coming in as we are have like small groups that we're getting through through the security system we also have students participating via livestream from Puerto Rico as well as students from around the state of Georgia so let's welcome them virtually 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 to provide some opening remarks this morning for this year's forum I'm honored to present to you dr. Ann circuit dr. Ann cyka currently serves as principal deputy director here at the Center for Disease Control and Prevention Prince told me in welcoming dr. circuit [Applause] good morning and welcome to this year's forum thank you so much for waking up we're really really early in the morning and coming over from from Tuskegee and all those who are participating livestream 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 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 department's 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% of children under 2 in the US are now receiving vaccines through the vaccines for children program that led to a great increase in immunization coverage and a prevention and near and actually elimination of homegrown 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 go 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 on 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 the current context in 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 US 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 writes 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 and children and 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 bioethics and our commitment to eliminating health disparities here in the United States thank you so much to all of you who plan the meeting and to those of you who will make sure that it's a data remember thank you thank you dr. Shepherd and to provide his opening remarks as a pleasure to introduce to you dr. Reuben Warren dr. Warren currently serves as professor and director of the National Center for Bioethics and research in healthcare at Tuskegee University as well as the Agilent 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 I just as a starter we have some folk from Tuskegee and students from Tuskegee that need to be in the front so all the young folks come to the front this this forum is for you it's not for for those of us who are not real young so come on down come on down I want you to get into head with a sitting in the front so come on down and come on down quickly we got a lot to do I'm gonna make my comments very short because we've got a long day and the other thing is that I know y'all been up since 4 o'clock so we want to be able to nudge you to keep you awake these these chairs are special and you need Beauty to be in them as you gather down front up I also want to thank you very much for getting up this this was not extra credit for students it's no extra grade but the students have come down there's no money they'll be giving them it's a commitment that they're making early on in their and their lives and their careers so it's real special in addition to the high school students they have a very honored group of Tuskegee University students called the bioethics Honors Program students and I want them to stand to be recognized too because they're giving the guys to 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 strips to to make those those bridges safe stepping from high school to a career sometimes it's too broad and your trip and fall and stumble and sink so we need some steps so we have steps from our our Tim's middle school which is seven eighth graders to our bTW high school which is high school students to our college students to our graduate students so we have some graduate students here from Tuskegee – will you please stand to be recognized [Applause] and from our graduate students to our professional students and our professional colleagues so that abridge those steps are really 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 still catching me because I'll fall back all the time so I get caught when I fall a couple important things that about this form first and foremost doctor Lee Byrd 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 doctor the bird in let's do that [Applause] in 2015 we had a conversation about what I thought was health equity in minority health and see we've had a cooperative agreement with the Centers for Disease Control and Prevention and Tuskegee for many many years and was a result of the 1997 presidential apology for the US Public Health Service syphilis study at Tuskegee and we have been cooperating it's called a cooperative agreement but really what it is is a cooperating agreement we sit and talk and we discuss we debate and we agree upon an agenda and then agenda has been moving forward for some years and it's getting better and better every year so I had a conversation with the project officer about that cooperative agreement but if we cooperate on to do better mr. Joe 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 phenomenal human being and so in talking with mr. Valentine I said well let's 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 that's making a CDC effort and she recommended that we talk with dr. Lee Byrd about doing this as a center why engagement because it was a university-wide engagement and that that engagement has blown up in really phenomenal ways so I want to recognize and thank Miss Valentine for her energy and her thoughts now I've done all the thank-yous 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 realm 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 dilemma 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've wrestled with that the scientists validated is published it ooh it's it's spread wide and broadly and widely but the folk will need to know it the most don't believe us they don't trust us so we 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 that trust because they're paranoid or that trust founded in the history of distrust and if you go back in and read the the not only the scientific literature but the humanities literature then you will find that that trust has been violated over and over and over again over the year so the the lack of trust is legitimate it's warranted particularly and and 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 US history and it's called the African slave trade miss name me one African slave trade some say was the Middle East the Middle Passage you know some say it's the European slave trade but that was an energy and I have a Pia pin it says 400 years 1619 to 2019 the ethics the ethics of reparations and Reconciliation do better before you are forgiven do better and ironically in this country 1932 there was another unethical engagement and it's recorded as the most unethical non-therapeutic non-therapeutic me no treatment so-called study in the history of 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 went from the treat old folk period no intention not gonna treat him who was also they called him a Negro male where Macon County somehow that got distorted when it was exposed to name the Tuskegee syphilis study so that's what you've heard but just be clear that was not what happened and they also said in years later well CDC did it not true the US Public Health Service syphilis study just be clear and and that doesn't mean that we we lament over it but it does mainly acknowledge and correct and that's what the issue is about it's about a forum of ethical conversation which translates into hopefully of ethical behavior you hear the the issue of public health theory and public health practice that's a mantra that 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've done over the last several years with this forum with on public health ethics is to think about what we've done the last year and improved for the next year and I'm particularly pleased about last year because we listened to the elders it's a notion to listen to the elders they know more because they've been there done that and we listened and were somewhat surprised about the wisdom of those folks that were here when 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 so that's what we've done we've brought you here to here and the 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 ask you to come down here because this is about you this is about you and in one love is about Public Health but more broadly is about public health ethics it's about public health ethics and last year what we heard is that what is this banker ethics and what book did you read on ethics and I'm suggesting that you don't need to read a book on ethics we just look around and that's your gut level that quiet voice will say simply but this ain't right this ain't right and that's 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 you 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 got you you've come a modern 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 gonna have some fun thank you so much thank you dr. Warren for our open plenary this morning as 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 Bioethics and research in health care at Tuskegee University he also serves as a senior associate editor editor for The Journal of healthcare science and Humanities and the director of the bioethics Honors Program he has authored he's an author of three books and he's currently working as my understanding the writing of two books programmatic bioethics public health ethics bioethics and marginalization and for the physiological theology of trustworthiness dr. Warren um 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 more theory in bioethics at Nova Southeastern University and has called logic philosophy ethics and religion at st. Thomas University Barry University miami-dade College and Broward College his University of Miami doc dissertation focused on the virtue ethicists a meta ethical anticipation of moral sentiment ISM and empathy in care has had a significant amount of readership worldwide dr. hodgins work tends to intersect the role of virtue empathy and care in our central concerns for our opening plenary speaker this morning please join me in welcoming dr. David Hodge good morning everyone it is such an honor to be here among this August group just to have a conversation as dr. Oren 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 and fall over myself then you shall be forgiven I have the wonderful honor of working with the group of students at Tuskegee University the bioethics honors students and dr. Warren this accident Estanza would not embarrass them any further but they are here today and I want to know that I thank you and I appreciate you for being here for your presence at this very moment also I want to thank dr. Rubin Warren because he invited me a year and a half ago to be his partner at the National Center for Bioethics and research and health care Tuskegee University and it has been an amazing amazing ride so far so I don't want to give another hand clap because of his presentation it's not but just what he is doing in an effort to end Cree's awareness and public health and bioethical issues let's give her a hand Claire for dr. Reuben Wally you know when we were walking down the hallway teaming together walking down the hallway and we had to stop so many times because he seems to be a legend in this place you know every matter fact I was just having lunch somewhere with my wife somewhere in Atlanta and someone asked me what do you work I said to ski do you know Ruben Warren so he gets around so don't be surprised if you see him in in Madagascar somewhere you know he gets the one he also have that proof that prophetic look that those dreadlocks really kind of show him as a prophet and a seer so deep respect and thank you dr. Warren thank you doctor the bird and you know the bird that's a Virgin Islands name she's actually lie bird but I said so I try to make sure I say library because I'm more comfortable with it as library but it's dr. Bieber I want to thank you for how we have been so welcoming to me as I will continue to have this collaboration and collaboration my wife is here and she's a teacher so that mean 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 even get a day off he's playing hooky but that's Jonathan David Hodge and I say something that's about him later Jonathan raise your hand but I also have someone else and extremely special to me here and that is dr. Marcia rakes she'll be in a session later on today dr. Riggs was my advisor dissertation and committee chair and coverage a 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 who are going to do graduate studies find someone's office who you can hire you can hide but it's many respects graduate work as they're pledging a fraternity or sorority right so you need to find someplace where you can hide dr. Marcia Riggs presented that for me so I want to thank you dr. Riggs for how you've been in my life I went to office I'm say this is extremely important especially for this moment I went to 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'm saying well you said I'm stupid what is this I'm in grad school and she said no no no that's all as she said your mind interpret things in a different way she said go to the testing center so I went to see this doctor I think dr. root something like this a bit but I went to see her and she said you know it's being so long that you what might have rewired itself to figure things out so you know just keep doing what you're doing but here was a 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 because people flying through things and I can get it I thought it was really something wrong and it was something wrong but the mind has a way of correcting and self-correcting so I was able to pull out of that that's what I figured out I said I need to go do another PhD to see my mind has actually figured it out so amen thank you dr. Riggs we want to have a conversation today about ethics and my my first thought was given the context for today that's the content of a 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 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 that's doctor one said a moment ago that something is right or wrong but why is it right why is it wrong that landscape can be extremely tedious so I'm gonna take us through a session and I'm gonna move kind of quickly but I'm trying to be as expenditure as I can because I I want all the old people in the room now given last year's conversation about elders and dr. Denise cardi and dr. Warren had this major conversation and fight between your old no not old on my elder what she said well that means you're older I'm not old enough 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 a tenant 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 where Jonathan comes into play because a few years ago I decided to take my first roller coaster 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 life out of people the the idea about going on a roller coaster playing to be scared makes more sense to me this was my first roller coaster ride and I can't tell you it was also my last water coaster ride last year my brother and his children took Jonathan to Six Flags and I said you want to come wait to watch I am NOT going on to that claims because it makes no sense to me we win we swap spaceman I actually thought is a haunted house so we're going up going up the staircase and going going playing and I'm hearing this loud sound it sounded a whole lot like a tornado in the building that noise that doesn't sound like fun hearing people scream just in a sound healthy but I continue to go and go and we got to the top and when while we were at the space look at how they would it work it then line you up like cattle and you have to walk into this little this little this little space to get into something that looks like a coffin the buckle you are strapped you in this tell distribute in dication that you should leave and I asked my son David by the way I said David you know we are Hajus we are proud virgin Islanders and conditioners we don't need to do this he said I didn't want to do it I said we don't have to he said but daddy this looks like fur no it does not son we could walk down these stairs I said when we came up and we we will do it when I had hair hi he said no I said I read you said in front and I will sit behind you and I will hold you side held him he said daddy holding me to tatters and her son just doesn't accept daddys love right here if you've ever been to Space Mountain that the ride takes off in this casket device you know people will talk about near-death experiences they talk about going through a kind of corridor flight a ton of the flight that's what it take you through so there's lights all around and going through this tunnel of light and as you're going through your hair in this pack backpack like that clock klack track noise is very ominous the point of it is to terrify you more they don't have to have it so we're going to clack clack clack clack clack clack clack and hold it in tightly and it starts going up scariest thing in the world not because of the Ascension but because you know there would be a dissension 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 tight 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 it didn't do it again now we got to the very end and this cute little girl feel so nice she came to me she said sir let me help you out I said go get some help she said no I can do it I said look go get some big people to lift me out of this thing she said no not sir please go get some big people so that when I got some big people lifted me up my little feet dangling along as it 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 are people today we got permission to photograph you didn't ask you for permission I stayed had pictures of me all over squid my eyes wide in my mouth they asked me that footage of a little boy sat there and said hey look at pointing that laughing like what's he laughing about and that's what I saw he was laughing at me why was laughing at me because this is how I looked I looked the part of someone who is sick why because this is what roller coasters do to you this is what teeth implants do to you so now I stick to what I could handle when I go to Disney World I go to it's a small world after all and see you got the little angel dead babies and you got the little Indian babies and you and they are dancing and I love to just go nice and slow and it has a thing I'll write that right 15 times and it never stresses me ladies and gentlemen but if these three 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 babies and gentlemen 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 such six major areas of philosophy one is epistemology and by the way I'm going to be speaking and a second kind of fact because no we're a little bit behind time but I want to make sure that when we start the next session we write on time so I'm going to move too quickly but I try to be as clear as I can so the in the major a the 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 things that doesn't even look like letters trying to figure what things that I didn't do calculus because it has some funny looking things I was doing algebra that's I'm funny with your things I like stuff example ABC and one two three when they start having funny things I didn't like it but logic is one of those areas and philosophy 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 for us then we cannot have a valid argument that is a lot of what we do in ethics then there's metaphysics and metaphysics ask questions about what is real do I exist am I here now are you here now how do I know here when does time and when this 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 God you know how can you know that there's a god these are metaphysical questions question they have nothing to do with the physical reality question that all be on the physical reality there there's aesthetics and aesthetics has to do with beauty and the nature of beauty and so on now I I picked some beautiful people now now now I get a lot at Tuskegee University I'm just saying this publicly because you all need to know the kind of stress I'm on there at just Giga University there are some people in my office who say 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. Holly s you still have the gift but us aesthetics 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 an 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 but the word right the time is always right to do what is right but can we always know what right is sometimes dr1 sort of know where to go we may not always know the right answers so he said in those cases and this is where I will end later so he was anticlimactic he can esteem 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 dog don't trust your not because bad that people I will talk about them in a moment difficult problems because ladies and gentlemen in our world we see some massive tragedies this is the Sudan few years ago this little boy has 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. Lee Byrd committed suicide thirty days later because it seems to me back to the vessel back to the debt that anyone who could take this kind of picture anyone who could be in this kind of environment is having some 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. Lebert those of us who work in this field who have conversation 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 we do given what we see given what we use all minds the reason command to understand what should we do what is the next step what is the next step for the conversation you know when I went up captain Wilkins Craig Wilkins gave the introduction women are going to talk and a buddy said is a large group well it really is I mean there's a small group of us to get together and wrestle he's understating it it's really a wrestle it's really a struggle sometimes I remember dr. Warren missed the meeting and when he came into the third me he said wait a minute we discuss the 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 science I see the scientist of that the scientist is descriptive describing things as they are weathers things in the natural world or society but the emphasis is prescriptive ladies and gentlemen they're saying the emphasis saying these are the kinds of things that we ought to do if we're going to function in a good and in a good environment he has to go fella by the name of Charles Darwin I'm sure you heard of mr. Darwin he's he had a thing called social Darwinism and social Darwinism says you know we're better off being kinder and used mr. president George Bush the first language we're 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 we evolved better as people who are not on arcus 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 assure simply wait and somebody is going to stop to help you down doesn't matter how you look because if we go back to the picture with the the the you know the aesthetics part if you haven't we tat disposition people don't stop sooner right because they have other motives but 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 emphasis on our moral judgment and I will in each of these areas of emphasis they actually speak to a particular moral theory for example purposes or motives acts rules are 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 feeling motives that consequences motors speak to virtue ethics acts and rules speak to what's called the ontology or Contin ISM constant question speak to what's called utilitarianism character back to virtue ethics caring relationships back to care Essex so these kinds of look at those words look at these work these are the kinds of work on 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 the asset the quantity to answer the question about goodness and rightness and what makes for good and what makes a 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 is a it's a competitive and what that kind of sounds like me you know I do what I want to do go to 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 bounce to fish fried fish I'm supposed to be a vegan so I'm working on it dr. Cardy right now I will call myself a quasi vegan my son has some major issues with that he's a daddy you're not a vegan I said no I'm not I'm a quasi vegan what if you're quasi thinking you're not a big I said that I'm a quasi but what's the quasi vegan or not a vegan but I'm working in the direction you see but my culture puts some things on me in a certain way that helps me to make some decisions about what I'm gonna do how I'm gonna believe I'm gonna act what I'm gonna eat then there's the divine command Theory what does God have to say about this thing if something right or wrong because God says it long is something right or wrong for some other reason and then utilitarianism I mentioned that before but it's about the greatest happiness for the greatest amount of people is more than that but that's just a simple way of saying it deontology I mentioned that before commitment to duties obligations virtue 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 embrace the thing called I love adventure some genius sat down and said I'm gonna make a ride that's gonna 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 days and Jim was like a theme park there's a whole lot of them and you have to figure out which one of these guys you want to take you know it's sort of like it's not like rap music for those of you who like rap listen not all rap you know I see I like I like Tupac but not on a two-pot when Tupac talking about changes I'm done with Tupac we talking about their mama I'm down with to park when he talked about some other stuff that he's an iron that do Paki 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 would likely generate the best results then that doctor is speaking from a kind of ethos in other words he is 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 work the work ethic our ethics our ethos these are terms that was defined by the ancient Greeks as a matter of fact you can in the ancient world the only kind of ethics they really employed was something we would discuss is called virtue ethics then there's morals more is different from ethics and and don't stress yourself with this this is just fun talk right now because but more different from ethics and that ethics is more philosophical but tends to be more philosophical and morals tend to be more personal up for derived for my more ease and customs and values and so on so it tends to be more personal but then as I guess all corruptible we start talking in 1958 we start talking about moral philosophy right so now we we don't really tapped it we don't really have to hold to those kind of descriptors anymore 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 out of the theory was taken to 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 you know that we are as human beings we have certain constraints there's certain things that we cannot do that some places online cannot go and then the places that I mind absolutely will go for example I don't have the time to tell you about that about when I gave a kidney to a student I don't have the time to talk about that student needed a kidney I gave a kidney student called me yes later and said every year give me a card says thank you dr. hodgins forgive me another opportunity life then few days later he sent me a card that says good enough pitcher he had a son and he named his son David and on the back of the picture says it says thank you uncle David without you I couldn't be here that's called superior auditory that's when you go over and above the call of duty will you do more than as more than expected if 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 well you never kid it just thought it look at you you look all teary-eyed you look like oh my god wow that's such a nice thing well here's a problem I really didn't give a kidney to a student that didn't happen but is a good story right which leads to some of the problems and 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 I'm not affect as I might talk to him but I started believing it dr. blabbered she was looking I mean I love it I love you and right when I said it false she looked away from me she's no longer my son she said you are giving a lecture unethical in your own ethical yourself ladies and gentlemen there we are constrained in certain ways such that we would say that some things make sense to us and other things do not it's a part as part of how we develop how we be how we are how we we have embedded codes to behave in a certain way part of that development is a conscience because a conscience guide our more 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 not me and mama if you're watching now not me she's at my brother but he eat too much food or we eat more than a bar you know got a conscience you know yeah you know that no 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 check 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 so I'm not gonna go through this long this the Miss long dissertation but just as this is so forth suffice to say that cut that our conscience governs that were critical thinking it governs our rational capacity it gives it puts parameters on our emotions and how we should feel about certain things in mind York on the great philosopher says the good will is good in itself and he will hard to say that we should be governed by this good will he said two things excite me the starry skies above and the morn or within because it seems to be something that we could always said when we see something that is universally wrong we admit it we say hey is universally wrong to harm children is really universal on to her to be body but for some reason it's even seem like even more wrong we were driving it today and we heard about some athlete a football player thing and they recorded of how he talked about punching his three-year-old that thing just shut me down because it's wrong the moral law again it governs us it governs us rationally even if you aren't atheists or have no God concern you still you're still governed by rationality or sentimentalism emotions you see so so so no one is without excuse you know a modern world ethics is about the philosophy of right and wrong moral is about my personal views of right and wrong and ethics like I said he is more philosophical but back to their themes that we said this ethical relative of a coach of relativism I'm gonna 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 in other words you know there 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 subjectivism say no I do what I want to do what is right is what I say is right opions Express what a person believed it doesn't have to be backed up by reason of facts in ethical subjectivism is I do whatever I want to do I interpret their life do I would interpret it because you only get just a piece of the elephant you don't get the whole thing and you interpret the part that you have that's what's exceptional for you but the danger is is that the only equal I'm for ethical subjectivist 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 this criminal attorney practices is right it is right if you believe is right to discriminate against Jews black women against that's better whomever then it's right so ethical subjectivism has its fun partner has his danger cultural cultural relativism it too has this fun point because cultural Elizabeth I love this cartoon on one side she says everything covered by her eyes what a cool man dominated culture on the other side nothing covered by the eyes what a gloomier dominated culture you changed only thing you did was change the universal affirmation to universal negation and the whole thing changes and that's what cultural relativism is we 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 Oh which one are we talking about Jehovah Allah are we talking to something more Eastern like Buddhism Jainism or 2nd Sikhism how are we supposed to understand it but maybe we should just make ethics be a part of our ego I'm not gonna essica egoism says that I do what's in my best interest I'm not gonna go through with that because it's just too much fun stuff but the major part that I want to start closing down on is three things number one deontology the reason I want these three things and I want to slow down so I could say them just about right so in the work that we do primarily ladies and gentlemen bioethics is characterized as best let me start again I'm sorry weathers bioethics 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 could have conversation with partners are you with me I'll wear the same page let me say that again I'm gonna keep saying it until you say yes there are we in the same day if we're going to talk about say bioethics then we have to have a theory one of those many theories I talked about that on the Gerdes it and once you develop the principles I 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 arm software and hardware if you have the correct software it could run some do some major work in a particular hardware computer system but if you have a software that's not gonna fit it may not fit accurately I may not take you to where you want to go so so undergirding bioethics is typically what we mentioned earlier this thing called the ontology this make this notion that rules govern behavior obligations Duty governs and that means bioethics 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 the situation what if you miss an area where you have to kill one person to save 50 lives what do you do what do you do utilitarian is the greatest good for the greatest among the most happiness for the most people what that would you bring about the best consequences public health ethics typically is grounded in utilitarianism because what is public health about it's about population it's about social ethics and socially regard you we have situations right where we have scarce resources but we have to do the best with the resources we have to eat the most people we can so so utilitarianism governs I stole those words from dr. dr. dr. drew Barret that's your word I stole them on the right hand side for me this is what public health ethics is is identifying and clarifying ethical dilemmas that's what these sessions about that's why you have to talk especially young people that's why when you present shortly that's why you have to give your best you we don't know I have to dive to go to my son Jonathan to figure stuff out and he will let me know if we still say wear it up oh that's down yo you know he lets me know what kind of language I should be using this in this particular part of the century right so he he lets me know which kind of dances I can do he said that he don't do that dance publicly you know you got and that's what you have to do you have to let us know what kind of dances we can do because she we're not coming to your theme park we're scared I'll guarantee you doctor one I don't know I'd have asked him he doesn't get on a go to coaster it scary so you have to tell us because this if we're gonna get to to to identify what the dilemmas are what we proposed 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 um last week at the public health ethics intensive we had it Tuskegee brother Sonny TN and I would I want to know about young people I go to him because I had no idea a couple years ago that there's a drug problem and inner-city and I'm in in the in the in the in the in the suburbs he that he before I heard about opioids and so on he was the one who told me um that Todd is coming on it's coming fast finally closing how do i ground public her ethics and how do i ground bioethics i ground him and birth virtue and KFX another reason for doing that as dr. 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 virtue 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 of words like empathy and in the 20th century was like here so I tend to ground the work that I do in public health ethics not in utilitarianism not in not in the ontology and those kind of things but I ground it in as dr. Warren was 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 beneficent doing God don't just be kind but do God 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 could find trust worthy you can trust those who are trustworthy thank you very much for allowing me to give you these words based on the pond you take care [Applause] Thank You dr. Hodge which is a few minutes behind schedule but I do want to save up a minute or two for any questions that we have for dr. Hodge we have a we have two standing mics in the back or you can also ask the question on your on your table there in front of you or you can send a question to our mailbox or an to Twitter feed so any of any questions for dr. Hodge yes okay thank you I was interested in what you were saying about the greatest happiness for the most people and that concept I worked for feeding America and in 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 if 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 it's just wondering if you had any sort of thoughts on that there you look 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 I use utilitarianism argument to demonstrate why we should have respect for animal lives and so on and so forth but but what the constraints 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 a 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 you your safeguard is that you know you have actually done your best so whether it'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 kind of 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 have a problem who would 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 virtue ethics over against the others thank you dr. Hodge for your talk it was um 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 the better have people learn about at the code and I think scientists often have a hard time with that they're they're like you know they just want to express the facts they don't it's more difficult I think to sort of understand narrative approaches so I'm wondering if you could talk some about like what you see you know you're obviously expert in telly you know bringing the stories to life and I'm presenting in there there's I wonder if you have any tips for scientists on how they can do a better job in that area that's a good questions tips for scientists I first of all mess with you people yes what part of 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 in the level because for example back to the statement I just raised about xenotransplantation or I'm scientist given opportunity they're running very fast into taking animal organs and putting them into human beings and just speak slowly here we need to ensure that we involved and this aware relation null 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 feminist but the more relational feminist and their conversation is about getting to be to know people being in conversation with people to use their word dr. Barrett to understand their narratives the work that dr. Warren and I do in terms of the research and 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 at the human the good class to the good good part is that there's a whole lot of benefits you know if there's there's a 110 thousand people each year on the waiting list for a kidney or heart or some kind of organ but only 30 thousands of surgeries can be done so what if you could give someone a pig kidney that could like it give them five more years of sustained life until a kidney become available so 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 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. important about the notion that the contract between trust and trustworthiness in the larger scheme and we don't have to go into those conversation but we know what they are and so there are communities that do not trust so therefore takes more and more time my endocrinologist goes into the Seminole County into the Samoan Seminole community to offer free clinics and after all my Seminole community in South Florida where the Hard Rock Cafe is and the other casinos so the X is extremely wealthy community and he tried to go in and have a conversation but the problem is they say wait a minute we don't trust you now the Trail of Tears whereas a few several years ago we still don't trust you so relational ethics dr. bag will be extremely helpful in building conversation and community so one of the things i forester in terms of in terms of the public health conversation do how we define public can be quite misleading or misunderstood because public could be numeric 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 to understand that the people with being with regardless of the science and what the scientist needs to understand that the people were dealing with are real people with real stories and real tragedies and there must be a conversation not a kind of patriarchal pushing of oneself into a person's community okay dr. Hodge thank you so much for 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 inequities social determinants of health there are others and we're you know finding that the more we engage in this work the more nuanced our understanding of it is particularly from the standpoint of wanting to take action and so in our definition of health equity we talk about things that have three characteristics they are avoidable they're systemic and they're unfair and so I'm interested in how you think about what is fair particularly in a cultural context of the us of what I'm gonna just describe as rugged individualism thank you dr. Lippert you love me again thank you very much for that question back in 1972 one of our great academics John Ross wrote a book called justice as 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 form justice and one of the part of the problem going into these conversations that the word justice seems so abstract as my 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 you're talking about what's right in front of us so I'm John what John was conception of justice as fairness is one that would do as the other part of my of my definition is it's kind of we reach out to the least the lost and I 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 of the lost and the left out then it's something extremely egregious about what we call our ethical philosophy

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