Ezekiel Emanuel

Oncologist, bioethicist, and health-policy scholar. Emanuel chairs the Department of Medical Ethics and Health Policy at the University of Pennsylvania, where he is also vice provost for global initiatives. He trained as an oncologist at the Dana-Farber Cancer Institute and holds both an MD and a PhD in political philosophy from Harvard. As a special adviser in the Obama White House, he was one of the principal architects of the Affordable Care Act, and he has written extensively on healthcare reform, the ethics of research, and end-of-life care.

Emanuel works at the seam between the clinic, the philosophy seminar, and Washington. His method, as he describes it, is inductive: work out the intuitively right answer to a concrete situation, then reverse-engineer the principles that produced it — a habit that repeatedly leads him to conclude that the conventional wisdom has over-weighted one value and ignored others. He is also a public contrarian: his 2014 Atlantic essay ‘Why I Hope to Die at 75’ argued that he personally would not pursue aggressive life-extension past that age, on the grounds that creativity and genuine novelty of thought decline steeply afterwards.

Core positions

Medicine overvalues IQ and undervalues emotional intelligence: the dominant problem in modern healthcare is chronic illness, and managing it is a matter of changing patients’ behaviour, not of technical brilliance. There is no real shortage of physicians — only a misallocation of their time — so training more doctors would raise costs through supply-induced demand rather than improve care. Medical education has barely changed since 1910 and should be compressed, moved partly online, and shifted out of the hospital, with more philosophy, history, and behavioural science replacing irrelevant preclinical memorisation. American bioethics has over-weighted individual autonomy at the expense of the social networks and economic externalities that individual choices carry; informed consent is a weak protection, and institutions, not lone individuals, must bear the burden of judging risk and benefit. He opposes the ‘right to try’ and deregulated supplements for the same reason: a high-trust society depends on proven-safe-and-effective drugs as its baseline.

In the wiki

• Ezekiel Emanuel on the Practice of Medicine, Policy, and Life — Conversations with Tyler, Ep. 67: emotional intelligence in doctors, the physician-shortage myth, reforming medical education, bioethics and autonomy, and the case against living past 75