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Conscientious Objectors: Local Ethicists Lead the Way to Better Behavior

November 19, 2013 By:
Kathryn Levy Feldman, Inside Magazine Feature
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In the famous Talmudic story, Rabbi Hillel was asked by a prospective convert to Judaism to teach him the entire Torah while he stood on one leg. The learned sage summed it up this way: “That which is hateful unto you, do not do to your neighbor. This is the whole of the Torah. The rest is commentary. Go forth and study.” In citing what has come to be known as The Golden Rule, Hillel gives us an ethical basis for how we should all live our lives.

The problem is that our lives are complicated, made even more so by rapid technological and medical advances and our increasingly inter-connected society. Is doing the right thing for the right reason as cut-and-dried as it may have seemed in Hillel’s day?

Three people who deal with high-profile ethical issues on a daily basis are Dr. Ezekiel Emanuel, Amy Sepinwall and Josh Shapiro. They have made it the foundation of their careers in medicine, business law and politics, respectively.

The Book of Emanuel

Zeke Emanuel is a man of some note. So much so, in fact, that there is no way to include even half of his accomplishments within the space allotted. The brother of Rahm (current mayor of Chicago and former chief of staff for President Barack Obama) and Ari (the co-CEO of William Morris Endeavor talent agency and the inspiration for the character of Ari Gold on the HBO series and upcoming film, Entourage), knew that he was destined for a career in the medical field; he just didn’t know he would help create it.

After a lengthy medical career at Harvard Medical School, Emanuel discovered a passion for the emerging field of bioethics, located at the intersection of science and the humanities. Considered career suicide by many, bioethics appealed to Emanuel’s frustration with the culture of traditional medicine as well as his sense of social justice. “I had to accept that despite my parents’ expectations and urging, I was never going to be a doctor like my father, with thousands of grateful patients,” he has written. “But I could dive into the developing field of bioethics and begin to address the problems of structure and the thinking that got in the way of quality care.”

And dive he did, becoming one of the architects of what we have come to define as the notion of a “good death.” While writing and arguing forcefully against the legalization of euthanasia and physician-assisted suicide, Emanuel co-authored (with ex-wife Linda Wendon Emanuel) the Medical Directive, which lets patients record their preferred treatments in case they are unable to communicate. Ultimately, the concept helped make palliative and hospice care routine for terminally ill patients, but the directive was both revolutionary and controversial when it was first published in the Journal of the American Medical Association in the late 1980s.

In many ways, Emanuel has made a career out of challenging the status quo — and infusing real-world practice with thoughtful ethical considerations. Take health care reform, the recent launch of which he calls “a world historical event.” In a piece for Penn Current, he explained how political philosophy and bioethics inform his thinking on the issue, which he is such an authority on that he served as a special adviser about it to two presidents: “[Government] has a responsibility to ensure that Americans can get the health care they need, which is short of unlimited healthcare, in my view. That’s a very different thing than socialized medicine or a government takeover of health care.” And while he feels that the Affordable Care Act is not perfect, it is a “very good advance.”

For Emanuel, assuming responsibility for Americans’ health illustrates true ethical behavior. In his view, the challenge is not knowing what is right (for the record, he believes most people do know), but rather choosing that path even when — especially when — it is not expedient. “It is one thing to know what the right thing is and another to do so when it has career costs,” he told me. “The bigger the threat seems to be, the greater the conflict between advancement and doing the right thing. Just look at the whole Wall Street mess.”

At Penn, Emanuel is teaching bioethicists, and medical students in general, to identify today’s most pressing bioethical issues — which, as he sees it, include three major categories.

The first involves allotting everything from vaccines to clinical trials to organs: “Who gets what, and how do we decide?” he asks. The second is the field of neuro-ethics, which is just coming into its own with increased understanding of the brain and its functions. “Can a person consent to being changed mentally, with an implant?” he wonders. And the third is the area of global ethics, which concerns the way research is conducted in other countries. “There was a recent case in which Glaxo was found to be bribing doctors,” he explains. “How do we monitor standards on a global level?”

Emanuel calls himself an atheist, but one who “is deeply Jewish and takes the practices seriously. I have always identified as a Jew and no one who knows me would suggest that I were anything else,” he says. “And I have no time for what I call ‘bow-tie Jews,’ those who are Jewish in name only. I go to services regularly, take the holidays seriously and run two kosher kitchens (that means four sets of dishes) in my two homes.

“It turns out that not believing was no excuse for not doing,” Emanuel elaborates. “This is the part of the Jewish tradition that seemed to have animated my grandfather as well as my mother and father. None of them were believers as far as I could tell; none had a spiritual bone in their bodies; but all seemed impelled to do mitzvot, which they demonstrated in their public and personal activism. Later in life, Rahm, Ari and I would all fight for public policies and ideas that we believed would benefit all.

“When we fought to be leaders in academics, politics and business, some would see ego and little else,” Emanuel continues. “But anyone who knew how we were raised, in our family and our religious faith, would know there was more to it. We didn’t fight so hard — and take so many criticisms — just for ego satisfaction. Somehow, we all feel obligated to do good. Trying to make the world better doesn’t arise from an explicit decision; it is just what I — we — have to do. It is, in the old language, a calling.”

Teaching ethics to MBAs

Growing up in Jewish schools in Montreal, Amy Sepinwall felt certain that she was destined for a career in medicine. That viewpoint changed between her junior and senior years at McGill University when she shadowed a physician. When he removed a child’s stitches, she almost passed out. “I learned I was pretty squeamish and that a career in medicine might not be such a good idea,” she laughs.

Instead, she pursued a master’s degree in bioethics and went on to the doctoral program at Georgetown. (As an aside, Sepinwall partially credits Zeke Emanuel with her marriage to Andrew Siegel, a research scholar at the Johns Hopkins Berman Institute for Bioethics, since they met at a seminar series that was co-sponsored by Emanuel’s bioethics group at NIH.) Realizing that it was difficult for even one bioethicist to find employment, Siegel asked Sepinwall if she would consider going to law school. “It turned out to be a fabulous decision,” she says. She earned her J. D. from Yale Law School in 2004 and finished up her Ph.D. at Georgetown in 2011.

At Wharton, Sepinwall teaches corporate responsibility and ethics. As a legal philosopher, she might be considered a “bit of an outsider” at a business school, but she points out that Wharton has had a commitment to teaching students law as it relates to business since its inception. However, as Supreme Court Justice Anthony Kennedy recently told a group of Penn Law students, the practice of that law has changed. “I’ve had CEOs tell me that their lawyers used to be the ‘no’ person,” Kennedy said. “Now lawyers who want to get business say, ‘You can do this and that.’ ”

Sepinwall agrees with that assessment (“The law is seen more as a strategy than an impediment,” she concurs), which is why she says it is even more important to recognize the legal and ethical boundaries. “At the same time, we can’t be teaching right and wrong at this stage of the game,” she notes. “What we can do is get [our students] to think seriously about what kind of people they want to be and what kind of examples they want to set by exposing them to sticky situations.”

Some of the questions that her course examines include the scope of the market (“Is it right to pay for babies as in adoption?”), compensation (“How might we justify high executive salaries if at all?”), corporate responsibility (“What is the purpose of a corporation?”) and social responsibility (“How do we ensure equal treatment of women and minorities in the work place?”).

According to Sepinwall, the jury’s still out on whether or not there are more acts of corporate greed today than ever before. One thing she is certain of, however, is that “there are more opportunities to exercise it.” “And then the problem becomes, ‘If everyone else is doing it, why shouldn’t I?’ The moral significance of an act becomes less recognizable when it is widespread.”

Sepinwall’s intent is to give her students the tools to go in the other direction, such as parameters for whistle blowing. “My own view is that if you have taken steps to address something troubling of a legal and ethical nature within the organization and find yourself being stonewalled, then it’s time to go outside,” she says.

Much of Sepinwall’s research focuses on the role that the individual plays in institutional culpability. Should all Americans share some blame for war crimes in Iraq by virtue of their citizenship? Should all investors share some responsibility for the collapse of Wall Street by virtue of being “risk takers”? Should corporate executives be punished for crimes committed by a few underlings, simply because of their role within the corporation? And should innocent winners in a Ponzi scheme, such as the one Bernie Madoff ran, be forced to return their earnings?

In all but the latter, Sepinwall argues in the affirmative. In stating her position on the hundreds of clawback suits filed by Irving Picard, the trustee charged with liquidating proceedings to distribute billions of dollars to victims of Madoff’s scheme. Sepinwall argues that the “innocent winnings of investors should [not] be made to help defray the losses of the losing investors.” Not surprisingly, she notes her position was “warmly received by the Madoff winners,” and was cited in the appeals brief from the Second Circuit to the Supreme Court, which challenged Picard’s formula for repaying victims. “The Supreme Court declined to hear the case, but it was very exciting to be cited in the petition,” she says.

Sepinwall acknowledges her concept of shared responsibility for wrongdoings is akin to that of King Solomon. “There is a Jewish pragmatism that infuses some of my thinking,” she notes. “I try to apply creative and fair thinking to both parties.”

All ethics Is local

Montgomery County Board of Commissioners Chair Josh Shapiro draws deeply on his faith, his family and his life experiences for the code of ethics by which he lives and legislates. “Political ethics are twofold,” the 40-year-old Abington resident says. “You live them and you legislate them. You conduct your actions and associations appropriately and try to adopt policies that help institutions function more ethically and responsibly.”

Shapiro was raised in a Conservative home in Upper Dublin, and attended both Forman Hebrew Day School and Akiba Hebrew Academy. His father, Steven (“Dr. Steve”), is pediatrics chair at Abington Memorial Hospital and his mother, Judi, is Teen Learning Community Director at Shaare Shamayim in Northeast Philadelphia. For Shapiro, the concept of tikkun olam is personal, and he feels a deep sense of responsibility to not refrain from the task at hand.

“To whom much is given, much is expected,” Shapiro said. “In fact, my upbringing had such a positive impact on me that my wife and I are raising our four children the same way.” The Shapiros still belong to Beth Sholom Congregation in Elkins Park, and their two school-age children attend Perelman Jewish Day School and Barrack Hebrew Academy.

A career in politics was not what Shapiro envisioned for himself — “I wanted to be a doctor like my father,” he says — but when he got to the University of Rochester, he discovered his true “passion was helping people through the political and governmental process.” Following graduation in 1995, he was a Congressional staffer in Washington for nine years (“I moved to D. C. to work on Capitol Hill for what I thought would be a year,” he laughs) and attended Georgetown Law School at night. During his last five years in Washington, Shapiro was chief of staff to Pennsylvania Congressman Joe Hoeffel.

As he tells the story, by 2002, he realized that instead of being the one walking Hoeffel to the U.S. House floor and whispering in his ear about an upcoming issue, he wanted to be the one being whispered to. With the support of his wife, they packed up, moved home and kicked off his campaign against Republican Jon Fox. Upsetting a former U.S. Congressman in a very Republican district, Shapiro represented the 153rd Legislative District in the Pennsylvania State House of Representatives beginning in 2004. He was re-elected in 2006, 2008 and 2010 and served as deputy speaker of the House from 2006-8.

Shapiro is credited with helping the Democrats win back the majority and the Speakership in the State House, and also with championing reform. As co-chairman of the Speaker’s Commission on Legislative Reform, he sponsored the first major rewrite of the House rules in decades — opening up the proceedings to the public, eliminating perks and making House expenditures subject to public disclosure. He continued this mission as chair of the Legislative Audit Committee, where he secured unanimous support to require the General Assembly to return a nearly $200 million surplus to the taxpayers. He also championed stricter controls over the expenditure of state funds. “I was dedicated to creating a new level of openness and transparency with state finances and putting rules in place that created much more opportunity for the public to be involved in the process,” he says.

Shapiro was elected Montgomery County commissioner in 2011 and unanimously elected to chair the three-member board on Jan. 3, 2012. The challenges that Shapiro inherited from his predecessors included a 2012 budget that initially appeared to be in a $10 million hole, but was based on a number of faulty premises. The adjusted number amounted to what Shapiro termed a “$49.3 million structural deficit.” Remarkably, one year later, not only had the county returned to sound financial footing, but the legacy of contentious and irresponsible governance was all but forgotten. “For those of us who grew accustomed to watching county government move at a glacial pace, with little focus or direction, our pace, progress and persistence over the last year has been amazing,” Shapiro remarked on the anniversary of his first year at the helm.

During its first 100 days, the board introduced new county ethics and procurement policies intended to increase transparency and eliminate patronage and corruption from county government. The procurement policy “levels the playing field,” according to Shapiro, making it easier for businesses in Montgomery County, small businesses and “disadvantaged” businesses (those owned by minorities or women) to compete for government business.

The ethics policy applies to all county employees and draws a clear line between an employee’s political affiliation and his or her job. A section on confidentiality prohibits employees from using their governmental positions to profit personally or benefit politically, and includes a ban on commenting on anything that relates to their work on any form of social media. “We take it seriously and continually talk about placing a premium on making sure it works,” says Shapiro.

As Shapiro sees it, ethical leadership begins at the top. “When leaders place a premium on ethics and responsible government, it trickles down,” he notes. He is quick to point out that there are a number of ethical and responsible people in politics: “The problem is that the bad ones garner more headlines.”

He is also quick to credit his wife, Lori, for keeping him grounded. “When you have a partner who has a moral compass that keeps you focused on doing the right thing, that is the most important thing for a politician,” says Shapiro.

One of the Democrat’s biggest admirers sits across the aisle: Republican Commissioner Bruce Castor, Jr., who credited the change in government with a change in perspective: “I think the accomplishments cited by my colleagues are a result of the attitudes that they brought to the job — to try to do the right thing, and to do it for the right reasons, to benefit the people that work and live in Montgomery County.”

Kit Feldman is a longtime contributor to Inside. This article originally appeared in Inside Magazine, a Jewish Exponent publication.

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