1
00:00:00,390 --> 00:00:04,290
This is bioethics bytes with me, David Edmonds and me Nigel Warburton.

2
00:00:04,560 --> 00:00:12,060
Bioethics Bytes is made in association with Oxford here Centre for Practical Ethics and made possible by a grant from the Wellcome Trust.

3
00:00:12,360 --> 00:00:17,940
For more information about bioethics bytes go to WW dot practical ethics.

4
00:00:18,060 --> 00:00:22,230
Dot Oaks Dot AC dot UK or to i-Tunes.

5
00:00:22,230 --> 00:00:30,810
You imagine the following choice. You can either finance medical treatment that was thought hearing to 50 people who'd lost hearing in just one ear.

6
00:00:31,200 --> 00:00:37,500
Or you could pay the same amount to treat an entirely deaf person so that this one person could hear perfectly.

7
00:00:37,920 --> 00:00:41,100
Which would you choose to help the 50 or the one?

8
00:00:41,550 --> 00:00:46,440
In this series, we've mainly focussed on dilemmas and debates involving individual doctors and patients.

9
00:00:47,280 --> 00:00:55,800
Jonathan Wolff is a political theorist and he believes that traditional bioethics misses a vital dimension the distribution of resources.

10
00:00:56,490 --> 00:01:00,000
Joe Wolff, welcome to Bioethics Bytes. Well, thank you for having me.

11
00:01:00,420 --> 00:01:06,510
The topic we're going to talk about is political bioethics, in a sense, as a new subject.

12
00:01:06,540 --> 00:01:11,010
Could you just say what it is and how it relates to traditional bioethics?

13
00:01:11,430 --> 00:01:22,110
Traditional bioethics has focussed on what goes on in the hospital or in the GP surgery, a whole series of doctors dilemmas as they've been called.

14
00:01:22,200 --> 00:01:25,890
What should we tell the patients? What can we release to the patient's family?

15
00:01:25,950 --> 00:01:29,580
What should we do with the patient's organs after surgery?

16
00:01:30,000 --> 00:01:33,780
What should we do at the beginning of life? Should we save the baby or not?

17
00:01:34,020 --> 00:01:37,920
What can we do at end of life? Can we legitimately engage in euthanasia?

18
00:01:38,430 --> 00:01:46,410
Those are all very good questions, but they're all about the doctor's relation with the patient or sometimes with the patient's family.

19
00:01:47,190 --> 00:01:51,360
The type of thing I'm interested in which we've called political bioethics,

20
00:01:51,360 --> 00:01:56,399
or some people call it population level bioethics, some people will even call it public health.

21
00:01:56,400 --> 00:02:07,680
Ethics wants to widen the focus to make very clear there's a lot to do with health that is not about what goes on in the hospital or at the bedside.

22
00:02:08,310 --> 00:02:12,510
And these other issues also throw up moral and political dilemmas.

23
00:02:12,960 --> 00:02:16,170
Perhaps you could give a couple of examples to show us what we're talking about here.

24
00:02:16,650 --> 00:02:21,180
Consider what drugs should be made available on the NHS.

25
00:02:21,660 --> 00:02:30,300
This is a question about health care, but it's not a question about who should give consent to an operation or what should be told to the patient.

26
00:02:30,480 --> 00:02:37,680
It's much more like traditional questions and political philosophy where we're talking about issues of justice and fairness.

27
00:02:38,100 --> 00:02:41,970
What drugs should be available? Why should they be available? Who should they be available to?

28
00:02:42,000 --> 00:02:48,000
These are questions about health, the moral questions, but they're not questions of a traditional bioethics form.

29
00:02:48,300 --> 00:02:52,020
And what about the more general issues of health that go beyond medicine?

30
00:02:52,200 --> 00:02:59,370
Do they fall within the scope of political bioethics? One thing within this literature that's very important is to make a distinction.

31
00:02:59,670 --> 00:03:05,550
You could call it a distinction between health and health care or the distinction between health and medicine.

32
00:03:05,970 --> 00:03:10,770
Most of the things about your health have got very little to do with the health care system.

33
00:03:11,430 --> 00:03:15,540
That is what makes you ill is not anything to do with your doctor.

34
00:03:15,540 --> 00:03:19,080
It's your lifestyle, your genes, bad luck and so on.

35
00:03:19,650 --> 00:03:25,050
So the things that are needed to keep you well very often have got nothing to do with the medical profession.

36
00:03:25,410 --> 00:03:33,210
If you take a longer historical look, the rise in life expectancy we've had in the last hundred years is really incredible.

37
00:03:33,420 --> 00:03:37,110
People are living decades longer. Why is that?

38
00:03:37,470 --> 00:03:41,130
Now a lot of people will say it's these fantastic advances in medical care.

39
00:03:41,490 --> 00:03:46,050
We can now do heart transplants, all sorts of operations that we couldn't do 100 years ago.

40
00:03:46,500 --> 00:03:50,610
But how many people get a heart transplant? How many people have had these operations?

41
00:03:51,030 --> 00:03:59,100
The reason why life expectancy is increased, a lot of people think, is because of much more basic things like sanitation, hygiene, nutrition.

42
00:03:59,520 --> 00:04:06,450
These are now known as the social determinants of health, the factors in your life that determine your health.

43
00:04:06,720 --> 00:04:13,050
Medical care is one determinants of health, but in fact, it turns out for most people to be a very small component.

44
00:04:13,590 --> 00:04:16,650
So political bioethics tries to take the bigger picture.

45
00:04:16,800 --> 00:04:24,370
It doesn't just zoom in on doctors dilemmas or individuals dilemmas about how they should react to the available medical resources.

46
00:04:24,840 --> 00:04:31,110
He's looking at a whole range of topics that perhaps have a larger effect on your likelihood of a healthy life.

47
00:04:31,500 --> 00:04:37,350
Absolutely right. I mean, one of the most important documents really in generating this, it's quite old now,

48
00:04:37,350 --> 00:04:45,270
but it was the Black Report in 1979 looking at the progress of the National Health Service.

49
00:04:45,630 --> 00:04:51,170
National Health Service came into effect in 1948. 30 years later, what effects did it have?

50
00:04:51,180 --> 00:04:55,860
And when the NHS came in, everyone thought that it would be fantastic.

51
00:04:55,860 --> 00:04:59,630
It would equalise health or at least improve the health of the worst off.

52
00:04:59,830 --> 00:05:06,010
People who didn't have access to health care. The Black Report pointed out that health of the nation had improved,

53
00:05:06,190 --> 00:05:10,840
but most of those improvements had gone to people who were already well-off and who already had good health.

54
00:05:11,290 --> 00:05:16,629
And it argued that the social determinants of health, poverty, poor working conditions,

55
00:05:16,630 --> 00:05:21,700
poor housing hadn't really changed very much for people at the bottom end, so they were still getting ill.

56
00:05:22,120 --> 00:05:29,770
Now, one of the authors of the Black Report argue that because of this, we ought to spend less money on health and more money on poverty alleviation.

57
00:05:30,130 --> 00:05:36,100
Therefore, for reasons of health, take money out of the health system and spend more on social services.

58
00:05:36,610 --> 00:05:41,890
Naturally, that didn't go down very well with his colleagues on the committee, and they didn't make that recommendation in the end.

59
00:05:42,160 --> 00:05:44,230
But every now and again, this same point is made.

60
00:05:44,470 --> 00:05:50,470
But that's a fascinating case, because that is, it seems to me, a rigorous application of cost benefit analysis.

61
00:05:50,830 --> 00:05:58,570
If you're really concerned with the outcome that health is improved, then there might be better ways and pumping money into health service.

62
00:05:58,720 --> 00:06:06,430
That's true. And that was the argument. It was also realised that policy doesn't always follow the cost benefit analysis because that

63
00:06:06,430 --> 00:06:12,340
can be very powerful political actors who will make sure that the interests and looked after,

64
00:06:12,490 --> 00:06:16,000
even when they may not be indicated, is the best policy.

65
00:06:16,450 --> 00:06:23,890
But as philosophers, we're interested in thinking clearly about how in this case, resources might be well allocated.

66
00:06:24,130 --> 00:06:28,690
What sort of principles should we use then? Are you saying that it's wrong to do cost benefit analysis,

67
00:06:28,930 --> 00:06:35,470
or that so far people who've done cost benefit analysis have focussed too narrowly on one little bit of the picture?

68
00:06:35,830 --> 00:06:40,989
Cost benefit analysis is going to be essential when you've got a fixed level of resources,

69
00:06:40,990 --> 00:06:43,780
or at least a limited level of resources, as we already have.

70
00:06:44,000 --> 00:06:53,380
In fact, raising this issue does bring us to one of the most interesting and lively areas in political bioethics, which is the role of Nice.

71
00:06:53,470 --> 00:06:57,790
There's a National Institute of Health and Clinical Excellence because they have the job

72
00:06:57,910 --> 00:07:01,960
of deciding which drugs are going to be made available on the National Health Service.

73
00:07:02,320 --> 00:07:06,390
And what will happen is that a pharmaceutical company will create a new drug.

74
00:07:06,400 --> 00:07:13,180
It will go through the normal safety and efficacy procedures to test that it actually works and doesn't kill people.

75
00:07:13,510 --> 00:07:18,220
So there is a point where it's licensed in the sense of being available, but it might be very expensive.

76
00:07:18,520 --> 00:07:24,100
There are all sorts of drugs that come forward and the drug companies want the National Health Service to take them.

77
00:07:24,370 --> 00:07:32,230
A decision has to be made and the way that's done at the moment is through not exactly cost benefit analysis, but cost effectiveness analysis.

78
00:07:32,380 --> 00:07:38,290
It's assumed that there is a certain drug budget, perhaps £10 billion a year in this country.

79
00:07:38,290 --> 00:07:45,190
And roughly speaking, the job of Nice is to work out how to get the best health benefits for that 10 billion.

80
00:07:45,460 --> 00:07:50,110
That will inevitably mean that they won't licence for refund on the NHS some drugs

81
00:07:50,110 --> 00:07:53,500
that are very expensive because they don't think they give sufficient health benefit.

82
00:07:53,800 --> 00:07:57,400
Could you just explain what the difference is between cost benefit and cost effectiveness?

83
00:07:57,730 --> 00:08:05,740
Cost benefit analysis requires you to give a valuation of the costs and evaluation of the benefits and

84
00:08:05,740 --> 00:08:11,650
then to pursue a course of action where the benefits are higher than the costs to the highest degree.

85
00:08:12,100 --> 00:08:17,080
So this requires monetisation of all values in order to do that.

86
00:08:17,620 --> 00:08:20,890
Cost effectiveness doesn't require so much information.

87
00:08:21,040 --> 00:08:25,269
Suppose you're doing your shopping and you've got a fixed amount of money in your

88
00:08:25,270 --> 00:08:29,980
pocket and you want to go out and get the most nutritious shopping you can.

89
00:08:30,160 --> 00:08:33,940
You can make decisions between different things, and you could end up with one trolley,

90
00:08:33,940 --> 00:08:38,530
and you could look at that and say, I'm sure I could have done better with this money and go back and change a few things.

91
00:08:39,070 --> 00:08:45,760
You could be sure you've made the most cost effective use of that money without having a view about the value of the benefits.

92
00:08:45,940 --> 00:08:50,769
That is, you haven't said, well, ten calories is worth five piece.

93
00:08:50,770 --> 00:08:56,170
I've got to make sure I've got that much. So you haven't really worked out whether the benefits outweigh the costs.

94
00:08:56,320 --> 00:09:02,200
All you've done is spend your money in the most effective way you can, and that is what the health system at the moment does.

95
00:09:02,650 --> 00:09:06,940
And the currency, it measures effectiveness and is quality of life.

96
00:09:07,090 --> 00:09:10,749
Yes, primarily it uses a notion known as the quality,

97
00:09:10,750 --> 00:09:16,330
which is the quality adjusted life year to people who come across it the first time, including me.

98
00:09:16,510 --> 00:09:23,350
It seems very crude and inhumane measure, but what it does is say,

99
00:09:23,620 --> 00:09:28,030
suppose you were to live for the next year in full health, no health problems at all.

100
00:09:28,240 --> 00:09:31,840
Well, that gives you a quality adjusted life. Year of one.

101
00:09:31,840 --> 00:09:37,150
You're getting a full year. So 1.0. But suppose you had some impairment.

102
00:09:37,270 --> 00:09:42,790
Suppose you had a problem for some reason with mobility and you couldn't get around very well.

103
00:09:42,970 --> 00:09:51,700
Perhaps you've got arthritis, perhaps you've had a sporting injury, so you're not in full health, so that next year will be less than 1.0.

104
00:09:52,540 --> 00:09:57,280
What would it be? Well, it might be 0.8 if you're blind.

105
00:09:57,640 --> 00:09:59,730
The current view is that gives.

106
00:09:59,800 --> 00:10:07,450
You quality adjusted life year, your next year will be worth 0.5 qualys because there's still an awful lot you can do if you're blind.

107
00:10:07,450 --> 00:10:12,010
It seems devastating, but there's still a life to be lived with lots of satisfactions.

108
00:10:12,340 --> 00:10:16,870
If you're blind and bedridden, that might then go down to 0.2 and so on.

109
00:10:17,050 --> 00:10:21,670
And there are states that are thought to be worse than death, quite a few states worse than death.

110
00:10:21,670 --> 00:10:29,649
So they have minus quality numbers. So to put it in its crudest form, what nice does, and I'm going to modify this in a moment,

111
00:10:29,650 --> 00:10:32,650
is trying to get the most quality as it can for the health budget.

112
00:10:33,040 --> 00:10:40,660
And it charges new medicines on on the grounds of whether they're going to deliver more qualys than other things that are currently in the system.

113
00:10:41,500 --> 00:10:48,100
So that's a way of assessing what kind of drugs should be available to people who need them.

114
00:10:48,340 --> 00:10:52,930
What could be wrong with that? That seems to be quite a rational way of allocating resources.

115
00:10:53,620 --> 00:10:58,480
Well, it's true. It does seem very rational, and for many purposes it is.

116
00:10:58,630 --> 00:11:04,900
But what as a philosopher jumps out when you start to look at it, is we have a system.

117
00:11:04,990 --> 00:11:09,400
A certain amount of money is being used to maximise the number of qualities available.

118
00:11:09,700 --> 00:11:12,700
That sounds like a moral theory called utilitarianism.

119
00:11:13,240 --> 00:11:17,530
And the first thing we learn in our undergraduate classes is utilitarianism is wrong.

120
00:11:17,920 --> 00:11:21,010
Now, we might be wrong to be told that utilitarianism is wrong,

121
00:11:21,220 --> 00:11:30,190
but the standard method of decision making in health economics at the moment uses what many people believe to be a flawed moral theory.

122
00:11:30,490 --> 00:11:37,450
This is interesting in lots of ways. One way is that it allows us as moral and political philosophers to draw on

123
00:11:37,720 --> 00:11:42,430
what is now a vast literature to try to illuminate questions in health policy.

124
00:11:42,760 --> 00:11:49,090
We could go back and say what we wrong. Actually we over hasty to dismiss utilitarianism should have been utilitarian after all.

125
00:11:49,450 --> 00:11:57,190
Now to know whether that is right or wrong. In this case, what we have to do is think about the possible consequences of maximising qualities.

126
00:11:57,430 --> 00:12:04,030
One type of case that has been used in the literature is so-called discrimination against the disabled.

127
00:12:04,360 --> 00:12:10,060
Now, I mentioned before, if you're blind, your quality value for the next year is only 0.5.

128
00:12:10,180 --> 00:12:18,820
If you're not blind, potentially it could be one. Suppose we were allocating the next heart for transplants on the basis of the quality value.

129
00:12:18,970 --> 00:12:25,390
If you were going to give it to someone who's blind, the most you can get from them is 0.5 per year for however many years are going to live.

130
00:12:25,480 --> 00:12:28,750
Whereas if you're going to give it to someone who's not blind, maybe you'll get them back up to one.

131
00:12:29,020 --> 00:12:37,330
So if you were really going to use qualities in clinical judgement, people with chronic, longstanding health problems would get very little attention.

132
00:12:37,840 --> 00:12:47,500
Perhaps a rigorous utilitarian would say that's difficult to stomach, but that is actually given the scarce resources, the best thing to do.

133
00:12:47,950 --> 00:12:53,229
No doubt many utilitarians would swallow hard and say that in practice, actually,

134
00:12:53,230 --> 00:12:59,290
things are not as bad as this because quality calculations are never made in clinical judgements.

135
00:12:59,440 --> 00:13:07,840
They made it to a different level, made at the level when Nice is deciding whether a drug or treatment should be made available generally.

136
00:13:08,080 --> 00:13:13,330
So in practice there wouldn't be any of this direct discrimination against blind people or others.

137
00:13:13,330 --> 00:13:17,110
But it is true that under current situation,

138
00:13:17,110 --> 00:13:24,640
a treatment for a patient group of poor health will yield fewer qualities than a treatment that could bring people back to full health.

139
00:13:24,910 --> 00:13:30,010
And this has troubled a lot of people because if you think about it in your own intuitions about cases,

140
00:13:30,010 --> 00:13:33,819
you might think people in poor health should be the highest priority for treatment,

141
00:13:33,820 --> 00:13:38,500
not the lowest, even if the benefit you can give them is not as high as you could give to someone else.

142
00:13:38,770 --> 00:13:43,360
So this is a typical objection to utilitarianism applied to the health domain.

143
00:13:43,990 --> 00:13:50,410
So how do we get out of that? The first thing to do would be to look at other philosophical theories, because after all,

144
00:13:50,410 --> 00:13:54,370
the development of moral and political philosophy didn't end with utilitarianism.

145
00:13:54,790 --> 00:13:59,980
People came up with forms of rule utilitarianism later on with John Rawls.

146
00:14:00,400 --> 00:14:06,280
Although, of course, John Rawls didn't talk about health care, his theory can be applied in this area.

147
00:14:06,670 --> 00:14:09,760
His difference principle that we should make the worst off as well off as possible

148
00:14:10,000 --> 00:14:15,100
can be interpreted in this area as a principle to give priority to the worst off.

149
00:14:15,820 --> 00:14:19,900
The trouble with doing this, and I think this is one of the reasons why Rawls didn't talk about health care,

150
00:14:20,410 --> 00:14:28,480
is that if you use the Rawls in principle giving absolute priority to the worst off, you have what has come to be known as the black hole problem.

151
00:14:28,600 --> 00:14:34,690
You may have people who are very badly off, very expensive to treat and can get very little benefit from it.

152
00:14:35,140 --> 00:14:37,930
And if you really believed an absolute priority to the worst off,

153
00:14:38,020 --> 00:14:44,250
it seems that we would have to give all our resources to those people who are very badly off, even if this gave them very little benefits.

154
00:14:44,560 --> 00:14:47,530
And this wouldn't be considered cost effective in other ways.

155
00:14:47,890 --> 00:14:56,890
So people who use Rawls in type ideas have tended to hang onto this notion of giving priority to the worst off, but not absolute priority.

156
00:14:57,340 --> 00:15:04,450
So a cynic listening to this might say. Well, these are very difficult problems, but philosophers haven't found a way to answer them.

157
00:15:04,500 --> 00:15:10,350
They just present us with further problems. They reveal to us the consequences of certain strategies for allocating resources.

158
00:15:10,350 --> 00:15:14,580
But where are the solutions? Well, I may well be one of those cynics myself.

159
00:15:14,790 --> 00:15:19,690
I think it's going to be very hard to demonstrate that one of these is the correct approach,

160
00:15:19,710 --> 00:15:24,150
is that we should be utilitarians or we should believe in equality or priority to the worst off.

161
00:15:24,810 --> 00:15:30,150
Some philosophers think if you only think hard enough, we're going to be able to get to the right single true answer.

162
00:15:30,330 --> 00:15:35,160
Others, such as Norman Daniels, have said that there are incommensurable values here,

163
00:15:35,370 --> 00:15:41,700
and what we need in the end is a procedure that everyone can sign up to rather than a set of principles.

164
00:15:42,030 --> 00:15:47,370
So Norman Daniels has what he calls the notion of accounting for reasonableness.

165
00:15:47,790 --> 00:15:52,079
And this is very interesting. It has been adopted by Nice in this country.

166
00:15:52,080 --> 00:15:57,209
So they say that they're not these crude, vulgar utilitarians.

167
00:15:57,210 --> 00:16:02,770
They're not just trying to maximise qualities. They're taking other things into account, for example, severity of illness.

168
00:16:03,030 --> 00:16:13,770
They would be much more likely to approve a drug if it cured a severe illness rather than if it gave a mild benefit to very many people cheaply.

169
00:16:13,950 --> 00:16:18,510
And you can imagine a situation where you get the same quality value by treating lots of people,

170
00:16:18,660 --> 00:16:22,350
giving them a small benefit with treating one person and giving them a big benefit.

171
00:16:22,470 --> 00:16:26,400
And Nice is prepared to take Savarese into account.

172
00:16:26,820 --> 00:16:36,120
So it's not crudely utilitarian, but what it tries to do is to have a procedure where all these values and the reasons are laid bare transparently,

173
00:16:36,510 --> 00:16:42,570
so it can explain its reasoning to other people. And if others think they've gone seriously wrong, it is subject to challenge.

174
00:16:43,020 --> 00:16:50,160
So is that a kind of cancer history where you debates the particular case rather than impose a principle that fits every case?

175
00:16:50,810 --> 00:16:56,970
There's a type of ideal of reason where we should have a principle that we can apply to every case.

176
00:16:57,330 --> 00:17:00,420
This is the holy grail of philosophy.

177
00:17:00,450 --> 00:17:07,140
Ideally, we want a principle that is as small as possible, maybe two variables in one relationship and universal coverage.

178
00:17:07,830 --> 00:17:14,550
But we all know really that we're not going to get anything like that. It would have to be much longer, many more variables, exceptions and so on.

179
00:17:14,850 --> 00:17:19,560
So in the end, you find that the principle has so many exceptions, it's no longer principle.

180
00:17:19,980 --> 00:17:27,750
And what we're doing really is appealing to a whole range of values and seeing how weighty they appeal to us.

181
00:17:28,050 --> 00:17:34,140
And quite often all you can do is hope other people share the same view about how weighty the different values are.

182
00:17:34,590 --> 00:17:41,650
It's a form of case by case analysis. There is room for principles, but nothing is going to be determined fully by principles.

183
00:17:41,670 --> 00:17:48,660
You can appeal to all sorts of different types of considerations. But I think it has something in common with legal reasoning.

184
00:17:49,140 --> 00:17:56,730
So if you think about a court case, very often a case is decided because there's some very clear principle of law and it's all cut and dried.

185
00:17:57,120 --> 00:18:02,820
But most of the time, cases go to court precisely because there isn't a clear principle of law.

186
00:18:03,180 --> 00:18:09,180
Both sides think they've got an arguable case, and very often you can't really predict which way the judge is going to go beforehand,

187
00:18:09,630 --> 00:18:15,060
although the judge has to make it look like this was the only possible decision he or she could come up with afterwards.

188
00:18:15,330 --> 00:18:23,880
So they provide a set of reasoning. They employ new distinctions that no one had ever thought of before, and they find a way of getting to an answer,

189
00:18:23,970 --> 00:18:30,450
which is, in a sense, objective, and it creates a precedent for future cases as well.

190
00:18:30,660 --> 00:18:36,780
It's rational and it's transparent, but it's not applying a single principle in order to determine an answer.

191
00:18:37,020 --> 00:18:42,760
And I think a lot of reasoning in life is much more like the legal model than the principle model and decision making.

192
00:18:42,790 --> 00:18:45,240
Health care allocation, I think is like that, too.

193
00:18:45,780 --> 00:18:52,030
Well, is there a role for a philosopher in that world, then, where you're just presenting evidence, presenting arguments on either side?

194
00:18:52,050 --> 00:18:56,610
What can we do as philosophers? There's a lot we can do. Maybe not what we thought we could do.

195
00:18:56,820 --> 00:19:00,390
We probably thought we could solve the problems by coming up with the best theory.

196
00:19:00,660 --> 00:19:04,140
I no longer have any confidence that this is what we're going to be able to do.

197
00:19:04,470 --> 00:19:08,760
But we can clarify patterns of reasoning.

198
00:19:09,150 --> 00:19:16,200
We can make clear what values are involved. We can show what logical relations, different values may have to each other,

199
00:19:16,200 --> 00:19:19,260
that if you believe in one thing, then you shouldn't believe in something else.

200
00:19:19,620 --> 00:19:23,699
Now, I wouldn't want to say that only philosophers can do this because other academics,

201
00:19:23,700 --> 00:19:27,540
intelligent people, can do it to some degree, and they already do to it.

202
00:19:27,960 --> 00:19:31,770
But we have the advantage that this is, in a way, all we do and in this area,

203
00:19:31,770 --> 00:19:36,450
like many other areas of philosophical training, is going to be very helpful.

204
00:19:36,480 --> 00:19:40,110
But I've said this many times, I'll say it again, I'm sure.

205
00:19:40,110 --> 00:19:48,000
But in this area of public life, what we need are people with philosophical skills, not philosophical theories.

206
00:19:49,170 --> 00:19:59,130
Jonathan Wolf, thank you very much. My pleasure. For more information about bioethics bytes, go to WW dot practical ethics dot oecs dot ac dot you.

207
00:19:59,820 --> 00:20:00,900
Or iTunes you.