 Hello, everyone. My name is Bob Trug. I'm the director of the Center for Bioethics here at Harvard Medical School. I'm here today to interview Professor Arthur Kleinman, psychiatrist, anthropologist, Professor at Harvard University and Harvard Medical School, and to talk with him about his book, What Really Matters? Living a Moral Life Amidst Uncertainty and Danger. In this book, you tell stories about people who have faced danger and uncertainty with moral courage. So I thought we might begin by asking, what prompted you to write this book, and what did you hope the people would take away from reading it? Well, thank you, Professor Trug. Actually, can we just call each other Arthur and Bob? Yeah, sure. What prompted me in writing this was that my own life I had encountered experiences that I felt were about ethics in action or values in action. And I was looking for ways of thinking about that in terms of people's real lives that reset the terminology of ethics. And the way I came to think about that was that ethics was something we aspire to and that we use the great work of ethicists to help us understand. It was a search or quest for the universal or something broader than the local. But in the local worlds we lived in, clinics, wards, in our own communities, that this was something different. It was about the enactment of values, whether we were conscious of them or not, that occurred in part of groups. And in those groups, we might concur with or usually silently disagree with what the flow of values were. And then we would have dissonance between our own sense of what was right and what we were expected to participate in. And that's what I was really interested in. And that went back to the Vietnam War, where I was secunded by the NIH to a medical research unit in Taiwan and sort of disagreed profoundly with what I saw going on there in that unit and didn't feel I had much of a space for it. It also went back to my own training, both at Yale in internal medicine and at the Mass General in psychiatry, in which I felt that there was no space at that time for ethical issues. And that's one reason why, in spite of the fact that periodically I've critiqued bioethics, I really appreciate the central role of bioethics to legitimate a space to talk about, especially the moral. So the moral for me is the enactment of our values in our work and in our lives. So the title of the book is What Really Matters? But towards the end of the book, you reframe this as a question. You ask, what should really matter? And you talk a bit about that. And if I understood you, you're suggesting that what should really matter is facing up to our existential condition. And I wondered if you might say a little bit more about that. Yeah, so what really matters is my way of talking about people's sense of what's at stake for them in their local lives. And at the end, I felt, well, I should say, kind of what's at stake for me. And it is, I think, facing up to the reality of our world. So on the one hand, in American society, we have a Disney-esque sort of a dream world that we induct children into and we slowly grow out of. That's romantic and has happy endings and the like. And then most of life has lived not in that romantic dream world, but in the gray zone of everyday life, where you're not ever quite sure whether you're meeting up with an ethical challenge or resistance, just as some idea based on emotion or personality. And you're not always sure where you stand, I think. And so here I tried to argue that really at the end, as we emerge maturely in the world as full adults, we should cultivate a sense of what really matters to us in our lives. And maybe it takes a whole life in a sense to do that. And I've discovered in my own life that what really matters is being honest about human conditions. And the human conditions, I think, are on the one hand quite uncertain. We live in a world that's increasingly uncertain. Just look at the explosion of biomedical knowledge and our inability to negotiate this, even if we have an MD degree, let alone people who don't have that privilege. But also that there are dangers that we don't like to talk about. So you and I as physicians know that if we sat down right now, we could write out a thousand ways that people could die. And in fact, the great Scottish physician, Thomas Brown, said several centuries ago, I who have seen a thousand deaths, thank my God, I can die but once. And it seems to me that without attempting to induce hysteria or fear, I just want people to be honest about how dangerous our world is. And it's dangerous at the macro level, politically, economically. But it's also dangerous at the local level. Every time I, I used to have two offices at Harvard, one here at the medical school and one in arts and sciences. And when I was younger and chairing the department of what is now global health and social medicine was then social medicine, but was also in the anthropology department, I just had a zip back and forth. And it always struck me how dangerous it was to zip back and forth in Boston. Now Boston may be notoriously dangerous in this regard because of the lack of courtesy among the Bostonians when they're on driving and when they like to scatter the pedestrians. And it seems to me that if we're honest about how dangerous the world is, then it leads to a different formulation of things. Then we get away from rosy endings. Then we get away from sentimentality. Then we say, well, okay, Disney for small kids, but let's not propagate the myth later. Let's look at how tough it is to live a life and how courageous people are. And I think I agree fully with your use of the term in characterizing my book about moral courage. I think it takes courage to face up to one's condition, to be honest about the world we live in and yet not to be afraid of it. Remember, William James famously said, yeah, read all you can, do all you can, don't be afraid of life, okay? I don't want people to read the book and be afraid of life. Quite the contrary, everything I've learned teaches me this wisdom, maybe with a small W, that if you face up to things, honestly, life becomes not only more tolerable, but more enjoyable and you feel more comfortable in life. You feel like you're not pretending, you're not denying things, but you're living in the world as a mature adult. I mean, you as an anesthesiologist probably face this every single day, just putting people under the effects of anesthesia and realizing that at any moment someone could die or you've got to, in a sense, bring them back to life. That's a, you know, a reality that 99.9% of Americans never have to deal with. And thank goodness in a way, that we have professionals who take that on. But I don't mean to make people feel paralyzed by this idea. I think that being aware of the dangers, being honest about them, and also about the uncertainty, leads to a kind of wisdom in the art of living. And that's what I want to do. I want to contribute to the art of living. And in this regard, I think ethics are enormously important because the medical ethics and ethics generally validate our quest for something beyond the local that we recognize no matter how fine an institution we're in and you and I are fortunate to be in a great institution. Nonetheless, on a constant basis, we feel frustrated and we disagree with perhaps with the flow of consensus et cetera on things. And we're privileged in our society and in our institutions to be able to step back and say, well, you know, I really disagree with this. And then I think it's a matter of being able to step forward and say, yeah, this is why I disagree. Speaking for all of us who were a part of your visit, it was so wonderful to have you for the public forum and also for the discussions that we had with the students. But I kind of wish you could have been a fly on the wall for the discussion that we had about your book before you came, because we went through each of the stories that you have and each one of them had moral lessons, you know, that we were deriving from them. So I would say to people who were out there who haven't read the book that the stories are fascinating in terms of the challenges that the protagonists face and the courage that they show in getting through them. And so we thank you for that. I also know that you have another book coming out shortly and I wonder if you might say a word or two about that. Yes, I have a book with Penguin books, which is a popular book called The Soul of Care, or at least that's the working title right now, which is about caregiving. Because when I look back across my professional life and my personal life, I see that caregiving has been a theme that's almost like a golden thread that is the spine of who I am and what I've done. And I think it's true of many people. And I feel that there is an undervaluation of the significance of caregiving. And that this is really one of the great examples of the moral glue that holds a society together and holds families together. It actually holds individuals together as we feel fragmented. One of the things that keeps us going and maybe even allows us in a small way to transcend our circumstances is the giving of care. I also realize that care is very difficult and time consuming, economically burdensome, and highly threatened today. Threatened not just in medicine, but literally in the rest of society. And so this book is about that, about the centrality of care, about the fear that we may be losing care, professionally certainly, but also in our everyday lives. And about what it would mean to revitalize care. Revitalize it in medicine, in medical education, in bioethics, making it more central to all of our themes. And I think that's something that since I'm 76 years of age and who knows how long I'll keep going on. If I have to go now, this would be the theme I'd like to go with. Oh, that's great. We're looking forward to that book. We're looking forward to reading it. And hopefully the opportunity to have you come back and talk with us about that as well. Thank you so much, Bob. Thank you so much, Arthur.