 All right, good evening, everyone. Thank you for joining us for the annual George W. Gay lecture in medical ethics. My name is Bob Trug. I'm a professor at Harvard Medical School, and I'm the director of our Center for Bioethics. Ashley, you want to switch the slide over? I thought it would begin this evening by telling you a little bit about the background of the George W. Gay lecture, and then introduce this year's speaker, Professor Patricia Kane. So the George W. Gay lecture was first delivered in 1922, and it's the oldest endowed lectureship at Harvard Medical School. Each year, we select as the speaker an individual who has contributed to the public good in ways that are substantial, unique, and enduring. Past speakers have included many of the nation's most distinguished scientists, researchers, clinicians, and social advocates, including Eric Fromm, Felix Frankfurter, Margaret Mead, Eric Erickson, Elizabeth Kubler-Ross, Henry Louis Gates Jr., and Paul Farmer, to name just a few of them. This evening speaker is also someone who has clearly earned a place on the list of the most influential leaders of our time. As she described in an interview, she grew up in an all-black neighborhood in Norfolk, Virginia. With support from her family and her teachers, she received a scholarship to Wheaton College here in Massachusetts. She recounted in the interview that she had never had a social conversation with a white person before going to Wheaton. She initially struggled and actually lost her scholarship for a while, but ultimately graduated with honors. Following college, she went on to Harvard Law School where she graduated in 1969. After graduation, she turned her career towards public policy, government, and teaching. Her first job was with the Equal Employment Opportunity Commission, and then she went on to serve as deputy assistant attorney general in the Department of Justice. In 1974, she joined the faculty of law at Georgetown University, and in 1979, she became the first African-American woman law professor to receive tenure at Georgetown. As a response to the infamous US Public Health Service study of untreated syphilis at Tuskegee, congressional hearings directed by Senator Ted Kennedy led to the creation of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, commonly known as the National Commission. That was under the leadership of Dr. Ken Ryan, who some of you may remember was a longtime chair of obstetrics and gynecology here at the Brigham and Women's Hospital. Professor King was appointed to serve on this National Commission, which all bioethicists know for its authorship of the Belmont Report, our country's foundational document outlining the ethical principles for research on human subjects. Professor King went on to serve on other influential committees, including President Carter's Bioethics Commission, as well as the so-called RAC Committee, which oversaw the development of recombinant DNA technologies. More recently, she was a member of the working group of the Ethical, Legal, and Social Implications of Human Genome Research, or ELSI. The ELSI initiative is still a major source of funding for bioethics research on emerging technologies. Professor King has served on many leadership boards, most notably as the first African-American woman to be a member of the Harvard Corporation, which, as most of you know, is the governing board of Harvard University. Her incredible accomplishments have been recognized by her election to the American Law Institute and the National Academy of Medicine. And earlier this year, she was also honored with the Bioethics Founder Award from the Hastings Center. Now, in preparation for the event this evening, Professor King told me that she was going to give an old-school type of lecture without slides, something that I personally find to be a refreshing change from our PowerPoint-driven lives. But we obviously haven't totally escaped the grip of technology, as this lecture is being given over Zoom. And as such, I have to give you some technical instructions before we begin. As you know, you can enter text into the chat box or the Q&A box. The chat box should be reserved for communicating about any problems you are having with the technology. And that will be monitored by our center zone Ashley Troutman, our wonderful expert on all things Zoom. I will be monitoring the Q&A box. And at the end of Professor King's formal comments, I will relay your questions to her so that we can continue the conversation. So please do share your questions and comments in the Q&A box. So without any further delay, let me turn this over to Professor King, who tonight will be addressing the topic of racism, inclusion, and justice, interrogating Bioethics. Professor King? Ashley, I need to be able to see my talk. OK, we'll figure this out. So you're seeing yourself? I see myself. My talk is on my computer screen, which is being blocked. Can you move the Zoom window down out of the way? And will that show your? I did. That'll help. Absolutely. Thank you so much, Bob. I am really honored to be here. And I'm especially pleased that you've already let the audience know that I'm an old-fashioned kind of girl in many ways. I want to begin by saying that some years ago, Dan Callahan, the co-founder of the Hastings Center, wrote about ethics. And he said, ethics typically emerges when serious political, scientific, and cultural changes are a foot. That was exactly the case with the emergence of bioethics. Recent events suggest that worry about ethics is emerging once more, again driven by serious political, scientific, and cultural changes that are similarly a foot in our society. Today we wonder what implications these developments have for bioethics as we know it. The killing of a black man, George Floyd, by the police in Minneapolis and other police killings of black Americans that have followed, have once again focused national attention on the inequities that persist in the treatment of black people and their communities. According to the New York Times, the George Floyd killing triggered what is believed to be the largest protest in American history. In addition, the ongoing COVID-19 pandemic has shown a bright light on a health care system that has severely disadvantaged racial and ethnic minorities. The pandemic has illuminated the many ways the nation's racist past practices have built into the nation's social and economic systems, deep underlying inequities that persist and contradict our ideals of justice and equality. Let me give you one example. Consider that racial and ethnic minorities are broadly recognized as being overrepresented in jobs regarded as critical to the economy in the COVID pandemic. But often these workers have difficulty accessing, testing, and receiving the vaccine. In Washington, DC, where I live, some black residents were wary of getting the vaccine, the vaccine. They understood America's history of mistreating poor black people. On the other hand, there were black residents that were eligible to receive the vaccine but had difficulty for a few months in getting it unless they had private health care providers. Why did this happen? Well, there were obviously communication problems with the black community. Many of these residents did not see the flyers that advised they go to a website to sign up for an appointment. Even if they had seen a flyer, many would have had difficulty following through because they did not have access to computers. Those who did have access to computers, like me, encountered a website that was extremely difficult to use. There was also a call center, but many gave up on it because of long waits and failure to return calls. There's a DC map published in February 2021 that shows that 50% of eligible residents in a majority white ward 3 received their first shot, while 21% of eligible residents in majority black ward 8 received theirs. The initial rollout of the vaccine to seniors did not create health disparities. Rather, the role outtracked the prevalence of health disparities that already existed. And those planning the initial rollout of the vaccine did not account for these issues in a way that I think should have been anticipated. In the week of February 16, 2021, DC Health, the coordinating office here in DC, funneled at least one third of the initial supply of the vaccine to hospitals and health centers and private suppliers like Kaiser and One Medical, who were able to set up their own appointments. DC had to rely on a health care system concentrated in Northwest Washington, the wealthiest part of the city. Some medical facilities that generally serve underserved communities did not prioritize their own patient populations for vaccine appointments. So for those living in the poorest parts of the city, received very poor, at least initially, poor services. It wasn't until March when DC started to meet people where they were by using mobile units or churches and other community-based settings that we began to have an adequate presence in black communities. One lesson learned was that a central portal is not the best way to make sure people can access the vaccine. It is important to be in the community where people are getting private care. This confusion and delayed response to those communities illustrate the confusion that is linked with racial and ethnic disparities in health generally. I cite that example because I was so disturbed by the fact that a city that is not majority black, but mostly black, could have so many initial failures in serving its communities. In 2016, Professor John Hoberman wrote an article in the Hastings Center report entitled Why Bioethics Has a Race Problem. In that article, he observed that bioethicists have not embraced the opportunity to create a sociologically and historically informed bioethics that might be applied to the lives of black Americans and their unending health crisis. Hoberman acknowledged that bioethics, like most academic cultures, does not lend itself to being mobilized on behalf of catalyzing social or institutional transformations. But he asked an important question. Why does our emphatic imagination fail us? He was referring to bioethicists when we confront racial difference and especially why in the medical culture, which has an obligation to mitigate human suffering. I believe that bioethics as a field must respond to Hoberman's question. Racism and narratives of racial differences are deeply embedded in science and medicine, where they continue to negatively impact the lives of people of color. More importantly, if these issues are not confronted, they will be carried forward into new scientific and medical areas. We are already seeing this with the growing use of algorithms and artificial intelligence. I'm not suggesting that bioethics can resolve these issues by itself. I get that those who are involved with bioethics do not control workplaces or establish housing policies, et cetera. I do believe, however, that the field of bioethics has a unique capacity to bring ethical concerns and policy issues together. With respect to policy issues related to race and racism and narratives of racial difference, bioethics may need to revisit or go beyond our traditional principles that have guided us so well to date. But it is not unusual to have to stop and adjust somewhat. I recently participated in the development of the National Academy of Medicine effort to develop a framework for its future use in addressing the ethical dimensions of emerging and innovative technologies. It, for example, identified eight considerations that should help in making policy for the issues and programs that the National Academy of Medicine is involved with. To the extent that bioethics engages in public policy, perhaps it should start to think or engage in similar processes. In this talk, I'm going to talk about racism and science and medicine. I use the term racism as defined by Dr. Camara Phyllis Jones. She writes that racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks, which is what we call race, that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources. I picked her definition because it has a macro perspective in which we look beyond interpersonal relations among individuals to the broader dynamics such as systemic and structural racism. I intend to make three points that I believe bioethics and its policy work must address. One, in the context of research ethics and regulation as well as health, too much attention has been directed to autonomy and informed consent. It is time to appreciate the inadequacies of using this particular principle for ongoing problems as they relate to race and racism. Two, to the extent that bioethics has considered justice, which it has in terms of distribution, we will not be able to correct inequalities. So what is needed will be new approaches in helping us dealing with matters of justice. Three, public policy bioethics should rely more on interdisciplinary approaches, especially history and its work. I'm going to begin with autonomy. Autonomy, as we all know, is an important ethical and legal principle. It affirms the interests of competent individuals to make important decisions for themselves in health care and research participation. However, reliance on consent in some areas, like dying, for example, is troubling because the concept does not ordinarily address issues raised by social stratifications, such as race, gender, class, and others. Autonomy will certainly continue to have a useful role, especially in areas where consent is not required. For example, currently in biomedical research, researchers are not required to obtain consent to use de-identified biosessments obtained from clinical practice. As our capacity to link tissues with persons increases, some recognize that the critical, ethical, and regulatory delineation between needing consent or not is rapidly becoming obsolete. Some of the limitations of relying on consent to help us in public policy bioethics were apparent to me more than 40 years ago in the deliberations of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. I briefly return to that experience because during the ongoing COVID-19 pandemic, some have argued that we should retreat from our current policies regarding research in prisons, which do not currently permit for the most part, conducting research with incarcerated prisoners. The National Commission's mandate required that it address the ethics of including prisoners in biomedical research, as many of you know. The commissioners, including myself, little or nothing about prisons and how exciting research, on how existing research was being conducted. In those days, research labs were often located on prison grounds. We decided that it was important to visit prisons and talk with inmates, and we visited two such prisons in the state of Michigan. The one I remember most was a visit to one prison that had within its walls a pharmaceutical and cosmetic research. To my surprise, when we started to meet with prisoners, many suggested pretty emphatically, as a matter of fact, that we go back to Washington. To our surprise, many of the prisoners argued that they were capable of determining for themselves whether they should participate in research or not. A few asserted that even in prison, they needed money for themselves or to send to families. And participation in research was a great way to earn it. A few others saw participation in research as a way to give back or to partially atone for past actions. After our visits, when the members of the commission returned to Washington and our deliberations, we discovered that we were deeply divided. Some members believed that prisons were capable of giving consent, but should have specific protections in view of the fact that they were incarcerated, and it was convenient for researchers to include them. Others believed that the prisoners were being taken advantage of, and that prisoners were useless in the prison environment. Our discussion went on for quite a while. I was essentially opposed to allowing the research to continue with some exceptions. At the time, I believe prisoners had the capacity to make decisions independently and for their own reasons. I thought that the prospect of pay certainly influenced their willingness to participate. I did not think they had options for earning the same level of pay in other ways while incarcerated, or could access and the range of options that would be sufficient for their circumstances. My bottom line, however, was that I thought we society was taking advantage of the prisoner's circumstances, albeit with the purpose of improving healthcare for many. I also thought that incarceration itself made it convenient for researchers to conduct their research in this environment. I have no doubt that I was influenced by my own life experiences of growing up in a totally segregated environment in a southern city, as well as working on civil rights issues in two federal agencies. But the prisoners that I met with reminded me of the environment in which the Tuskegee study had taken place. The participants of the Tuskegee study were despised, they were limited in their access to healthcare, they were limited in their education and lived in social and low-income circumstances. I think that those considerations made them vulnerable to be used by others for their own purposes. Now, I realized that the participants in the Tuskegee study did not give consent. And some of you may think that that is a significant difference. I would have continued to argue that in both the case of prison research as well as Tuskegee that what should have taken place is some discussion of whether it was appropriate to conduct the study given the environmental circumstances in which the participants found themselves. I will note that I noticed at the time that unlike the Tuskegee participants, some of the prisoners were white. But I felt that they as prisoners who were incarcerated, if you understand today's prisons could be similarly impacted. My life experiences made me appreciate the truth of what Madison Powers and Ruth Faden, a philosopher and a ethicist public health person later wrote in their book, Structural Injustice. The expansion of choice worthy options is a nominatively incomplete public policy response. To some structural impediments to a decent life. Today, the value of the social structural literature is that it provides a more accurate assessment of real world injustice that encourages a focus on political, economic and social structures. As opposed to previous justice theory that was idealized and abstract. Powers and Faden put it this way in their book. Structural theories of justice require one overarching assumption. It is the assumption that social arrangements including certain institutions and social practices have highly consequential, differential and sometimes unjust effects on individuals because they are members of identifiable groups. I believe if we maintain a focus on social societal structure theory, we have an opportunity to excavate and eliminate centuries long practices of using race as a variable in science and healthcare. I was planning at this point to applaud the efforts of the National Kidney Foundation and the American Society of Nephrology to explore how race is used in their diagnostic tests for kidney disease and determining access to care and treatment. Their activities constitute for me the direction that medicine should be moving towards. These two organizations focused on kidney treatment had previously used and relied on levels of, and I hope I pronounced this correctly, creatinine along with considerations of race, age and gender of their patients. When this crediton was used in connection with race, it would appear, did appear, that the kidney function of the person who had been tested was better. And that patient would be listed lower in the waiting lists for a kidney transplant. These agencies, these organizations in September, 2021 adopted a new rule, a race free rule that would, in their view, better predict where patients that had been tested should be located in the list or the wait list for kidney transplant. You cannot believe how excited I was when I got up early this morning and received a text from a friend who pointed out to me that the health systems in Maryland and adjacent jurisdiction decided yesterday that they were going to stop using race in their procedures for determinations of who should go on kidney lists, waiting for a kidney and in what particular order or place. My hope is that we will see efforts in the future by other organizations that focus on the reliability of race in their own use of clinical practices and work towards eliminating them. As some people know, I have had a problem with my computer today and it is definitely showing up again. But I believe that I have covered everything that I wanted to say and I will attempt a small recapitulation. And that is that with respect to my second point, we should seriously focus on structural theories of justice and that we should work to eliminate some of the embedded pieces of race in the ways that we conduct our business. Now, why history? Why would I recommend the greater use of interdisciplinary groups to bioethicists? So let me begin. I think bioethics needs a more historically informed conception of justice. Perhaps more importantly, we collectively need to know our history and we need to know how we have gotten to the present. As one scholar put it, we must begin thinking about race as a social construct with different meanings changing over time and as a relationship rather than a variable. Lots of writers have noted the importance of understanding history for our society. I think my favorite is the Southerner William Faulkner who famously wrote, the past is never dead, it is not even past. All of us labor in webs spun long before we were born, webs of heredity and environment of desire and consequence of history and eternity. Moreover, I would argue that history is a wonderful tool for problem solving. With the use of history, we can develop information with the basis of observation, experiment or experience. Studying history involves notions of human agency, change, the role of material circumstances in human affairs and the alleged meaning of historical events. History offers a pathway to discover and perhaps appreciate patterns of domination, subordination and inequality and how racial hierarchy came to be. Moreover, the study of history will help us appreciate a straight line that runs from slavery and segregation to the lives and circumstances of black Americans today and the lack of trust that black Americans bring to the nation's systems and structures, especially in their encounters with science and medicine. Lastly, with historical knowledge, we may be even more motivated to dismantle, modify or correct the ingrained structural implements such as strategies of racial differences that people of color face in assessing healthcare and approving their overall health status. Thank you very much for your patience. All right, Professor King, thank you very much. We have some questions in the chat box, but I thought I might begin our discussion with a personal reflection about why I became interested in bioethics 30 or more years ago. And it intersects very much with your talk in that what drew me towards philosophy was the ethical challenges that I saw in my case in my work in an intensive care unit and wanting to have like a structured approach for how to address them. And I went to Georgetown and did their seminar series and learned the four principles that they talked about. And I found these to be just so helpful, these kind of abstract principles that I could apply to problems and that seemed to give an answer. And indeed those very principles came from the Belmont Report and the National Commission that you were a part of. And it seems like that approach is somewhat falling apart and you point out that as we came into the pandemic and we saw that so many of the discrepancies and outcomes were based on systemic factors that really had nothing to do with those principles. It made those of us who I think were traditional bioethicists really doubt whether we had a handle on things at all. And I think that that was somewhat the theme of your talk today. But on the other hand, like where do we turn? And you mentioned history and things like that, but I somehow feel like the rug's been pulled out from under us in terms of many of the principles and guidelines that we've been trained to rely on. Maybe before I ask before you respond, let me read from one of the comments in the Q&A that I think captured this very well from James Shirley. He wrote, many bioethicists do not necessarily incorporate moral principles in their work, nor do they need to for meeting the academic definition for bioethics, which in concept incorporates moral principles as only one basis, only one basis for ethical behavior by an assenting group. However, the common public impression is that all bioethics is based on moral principles when in fact they are not. A predominant ethic in bioethics is the preeminence of the advance of human knowledge, especially in how many bioethicists justify human research that is objectionable to some on the basis of moral principles. And so he sort of asked the question that I'm asking as well, what role should moral principles play in bioethics? And when it comes to reducing racist practices in biomedical research and medicine, is greater emphasis on the moral basis of bioethics important, needed, or in fact, even necessary? So maybe to put all of this into just a sentence, how do we reconcile the heavy reliance of bioethics on moral principles with sort of the really counter examples that we have seen in the last couple of years related to race and class? Well, I can certainly say that you and the other person know how to ask hard questions, but I think questions that actually face the field. So I'll go back to the National Commission and I would say that some things we should remember. At the time we met between 1974 and 1978, for the most part, women were not, and remember that the National Commission was really focused on a lot of things, but especially how to conduct research with people who, for the most part, had no capacity to give consent that would have been children, for example, and mentally ill. And we were working at a time when research, in research, there were no women to speak of, there were no blacks or minorities on the professional side, and certainly in terms of research participants, they were not included. So my first point about the National Commission's work is that it was long time ago and was created in specific kinds of circumstances and had to deal with issues that Congress thought was important at the time when they handed us this incredible mandate, which also included trying to describe the principles that should govern research. So in that sense, I think times have changed and the National Commission, some of its work is outmoded. I have always had a problem with thinking about these as principles, in part because the principles clearly didn't relate to people who were not fully autonomous or people who were in, really difficult social and political and economic circumstances. So I had trouble with them myself, but my biggest problem as over the years with the development of genomics, with the entry of women into the field, I am my own problems with the fact that the principles and our discussions did not seem to me to sort of be focused in any way on inequality and that could have been at the time for on the grounds of race and on the grounds of gender. And the second point I would make is that the one that was made and so we never really tried to reconcile it and that is the focus on the value of better information and knowledge about treatment and care and science and how that worked with those three principles. I think that's what I was hearing from you both. My own resolution of this is that because I'm talking public policy bioethics, I want to remind everybody is that we need to recognize some of the deficiencies of those principles as stated in 1978. And in the best possible circumstances work to try to change them or perhaps in other circumstances, just ignore them and continue to debate as I think often the National Academy of Medicine does, have big debates about how to proceed drawing on moral principles to some extent and go ahead and try to make policy. I hope that answers your question but I'm not sure that you'd agree. No, I think this is all part of that conversation. Let me turn to some other comments here. Ruth Mickelson asked, the 1619 project challenges Americans to relearn history placing slavery much more in the center of our historical narrative. Can you speak to how philosophy and applied ethical frameworks would change if this more accurate history was widely acknowledged as part of American and European philosophy and applied ethics? Well, my first thought is I love the 1619 project. I think you would expect that. And I am so grateful that it was produced. I think that it has helped to change at least my focus as somebody who participated in bioethics to the idea that I could actually move away from these principles that were stated in the Belmont report. I feel comfortable moving towards structural issues. And the use of history for me in focusing on structural issues is it tells me where to go if I'm really interested in rather than just surface of widely apparent deficiencies in the past that by reading history, we get to appreciate where to find the bodies that have been buried so that we can excavate them and move on. I think this is really important because we continue to use black and white race in so many of our fields, but especially in medicine and science and that those terms which continually focus on the distinctions among humans can be eliminated or pushed to one side. So I am practical, I think, in the way I read what she is saying and wanna immediately run to trying to do some digging or to get some concepts out of the way. But I think what's more important about what she, than my concerns about what she has done is that she is asking us to relearn, re-understand American history. And I agree that that needs to be done. But my experience is that most Americans think they already know American history, so which they don't. So what we must be prepared to do is to grapple with what focusing on her project is likely to bring. I think we already see it. I can't get over in the adjacent jurisdiction here about the public outcry about what is taught in schools, but I expect that to continue. And I hope I've been clear about this, both the bioethics, for me it means it's time to look at history because there we will find some of the structures that should be dug out and gotten rid of and hope that many of us appreciate that this may, that process might have national impacts that go way beyond bioethics and feed into views of white supremacy and views of we do not want to have our children labeled racist, which I don't think any of this does, but I'll leave it there at that. Well, before, I mean, there's another question here, but let me just maybe ask a little bit more there. What do you think about the debate that's going on around critical race theory and this issue of how we teach the history of our country and what are the lessons to learn from it and the way it's been politicized and et cetera? Do you have more to say about that or? Well, I have a couple of things to say. First of all, I really think that people should stop using terms and like critical race theory and say what they mean that the use of terms where there are wide differences about what that term might mean, there's a value when talking about them when saying what you think, saying what you would like to convey rather than give a quick references to terms. My second thought about this is I think this period is a reckoning in my view for bioethics, but I think it's a reckoning for the nation. And that is that we have not gotten over the civil war and we for a long time did not have to get over it other than the few years of reconstruction and the post-1964 period. So that what we were seeing is a re-fighting, not on the battlefield like the civil war, but some of the issues that the civil... Whoops, we've had you freeze here, I think, or I'm freezing. Hello? Yeah, you froze for me. I don't know if you froze for everyone else. Are you? And I can't see anybody else, so I don't know. How do we... Ashley, are we still connected? We are connected and good to go, just froze momentarily. Okay, all righty, good. You wanna finish your thought there? I did, but I don't know how much people heard. That's my problem. I had finished. I basically was saying that I think what's going on in America is that we're re-fighting the civil war. That we're not on a military battlefield, but I think we are fighting again about quite supremacy and we are fighting again about the emerging role of black people in the population and we're fighting again, let us have control of the states versus be governed by a federal government. Beverly Wilson has a few things to say here. First of all, I think we all echo her in saying thank you ever so much for your service scholarship and contributions to bioethics. And she also says, what do you think about the participation of African-Americans who are doing bioethics in the United States and the present scholarship of bioethics? And she brings up three areas where there are very troubling disparities. The first is pain management and obstetrics and childbirth, the second being inpatient psychiatric commissions and the administration of the most potent anti-psychotic medications. And third, infant morbidity and mortality. And are these, well, she doesn't say this, but I'm wondering, are these bioethics issues that have perhaps not received the attention that they should have given the racial disparities that exist in these areas? I'm, this is our opinion, I'm almost, I don't want to attack this because I know so little about the three areas that she recommended, but she suggested it. But yes, I think, how can I not think that they shouldn't get attention? I'm not quite sure because I don't know the fields about whether there's room for bioethics, a bioethics approach other than they may not be receiving the services that they should be receiving. Maybe the person could help clarify a little bit the first part of her question for me, because- Well, she sends a clarification in here. Let me, please comment upon involuntary inpatient psychiatric hospitalizations versus voluntary inpatient psychiatric hospitalizations and the administration of the most potent anti-psychotic medications to manage inpatient psychiatric patients where psychosis is- I lost you. Oh, are you, you've lost my eye? I got most, I got most of what you said, but I lost you. And what I'd like to say is I really apologize, but I know next to nothing about psychiatry or psychology for that matter. So I don't have a background in the, with respect to the drugs and the circumstances in which they were used to comment. I would say this, that I cannot imagine any area of medicine that we would not, where it would not be appropriate to bring moral values to a discussion of their utility and their actual use. And I think that if they are used in difficult ways with respect to African-American patients, I would feel even stronger strongly about that. Let me end there. I'm sure I haven't helped, but I do see her area as a part of what I have termed as medicine. Great, but we'll just, we'll do a couple of more questions here. Katie Peeler raises, I think a issue that I've often heard, which is she doesn't mention this, but in the United States, we've been guided by the idea of principles stemming from the Belmont report, et cetera. Whereas the guidelines in Europe tend to be more based on human rights. And so she says here, related to the question of moral principles, how do you feel the field of human rights should apply to bioethics? These two fields are fundamentally related, but often bioethics scholars feel that applying human rights frameworks is inappropriate. It's less neutral. And would a remedy to some of the problems that we've seen with bioethics in the United States be better fixed by focusing on issues of human rights? I think yes, that I would like to see a better understanding of the United States. Some of the theories that have arisen that we call human rights theory. I am not put off, and you can imagine why, I am not put off by a little bit of leaning in the direction of that she described with respect to human rights theory. And I know that one of the reasons I cite the Powers and Faden book is, in their discussion of structural theories, they apply it both to the United States and to human rights work around the world. In other words, if you take a look at their book, because it's structure, it's that they're primarily focused on trying to address in the hopes of bringing well-being to individuals and populations. It has this universal theme that's absent in a lot of other bioethics theorizing. And what I see I try to do too subtly is that I really like that approach, which doesn't come necessarily from philosophy, comes from, I blanked, it'll come to me while I'm talking. It political theorizing, but I am very drawn to it and I think that bioethics will be too, if over the coming years those theories that are involving will enter what we now call bioethics as well. All right, we're a little bit past six. Let me ask you one last question. You served on President Carter's bioethics commission. And one of our questions makes the point that President Biden has not yet formed a bioethics commission. Given what's going on right now, do you think that that would be a plus? Do you think that that could make a positive contribution to some of the issues that we're facing right now based on maybe your own experience of having been on a president's commission? I am smiling because I couldn't agree with that person more. I really hope that if the president should decide to create a bioethics commission that he will focus on these issues so that we can get some revision from the National Commission. And I hope that it will be done because I think that it is time to try to set guidelines and rules at this stage of our science and medicine development for how we use race in science and medicine. And I say this particularly with respect to genomics because what we know in that field is continuing to expand. And many of us are very troubled by the continued use of race, particularly in that field. Well, I always think of the George W. Gay lecture as a way really to celebrate the lives of people who have made just enormous contributions over their careers. And you certainly are that all the places you've been, all of the things you've said and done we're incredibly grateful for those and really wanna thank you for that. And thank you very much for being our speaker this year. So... Thank you so much for inviting me. I really enjoyed this. Thank you. All right. And thanks everyone for participating and good night and enjoy the rest of your evening. Bye-bye now. Bye.