iTunes | Google Play | Spotify | Stitcher | Length: 36 minutes | Published: March 4, 2020
Resonance is a student-run podcast aimed at showcasing the science at Baylor through the eyes of young professionals. Each episode is written and recorded by students who have a passion for research and the medical community. Guests on the show include both clinical and basic science research faculty who are experts in their fields.
Dr. Blumenthal-Barby discusses her personal journey and her career as a medical ethicist, as well as current issues surrounding ethics such as genetics technology.
Let's Get Ethical | Transcript
Brandon: And we are here
Erik: And we are here. This is the Baylor College of Medicine Resonance podcast. I am one of your hosts Erik Anderson.
Brandon: And I'm another host Brandon Garcia.
Jason: I'm a writer Jason Shiau.
Erin: And I'm another writer Erin Tang.
Erik: Yeah and so today we're going to be talking with Dr. Blumenthal-Barby about ethics. Jason, Erin you guys want to just take it away.
Jason: Yeah so ethical principle is something that's been part of the medical profession for a really long time ever since Hippocrates with principles like beneficence and non-maleficence and over time the ethical principles that govern medical practice have been refined, and the modern medicine really relies on the foundational principles off of things from people like John Gregory and Thomas Percival from the 18th century.
Brandon: I really feel like there should be like some kind of like stately music playing, can you make sure that happens?
Erik: Yeah 18th century.
Erin: Yeah I think it's crazy that a lot of I mean over all these years a lot of the same ethical principles guide a lot of medical practices both in the US and worldwide. I think we all have a lot of the same core values when it comes to treating patients especially like Jason said with beneficence which is promoting the well-being of others versus non-maleficence which is to do no harm which theoretically sounds similar but are actually like very different in practice I think.
Brandon: I think ethics itself is something that's very interesting because on one hand I feel like it can be kind of intuitive you know when we when we enter into medical school when we start learning about all the different things we are gonna have to do in how we involve patients and stuff like that you start thinking about – I feel like the same person is gonna start thinking oh man like what would it be like if I was in the patient's shoes and I feel like that guides a lot. I don't know I don't know how you guys feel but that kind of guides me and like how I feel about care patient care.
Erik: Well but even that gets tricky because then everybody's different that's the other issue and I think that's something that difficult. We went through the ethics course in the first year and it's like - you think everything's straightforward and then you realize how much gray is out there. In terms of maybe maybe you could really maybe go both ways. And so they teach us I think to it mostly comes down to committees, right? If there's really difficult decisions to be made about, you know, should somebody be continued on life support or something like that – who should make that decision? Pretty interesting
Erin: I agree, I think you know there's never a right answer which is what makes ethics both challenging and very fun. And I think if you look in the news these days there's all kinds of crazy and interesting ethical dilemmas with CRISPR and with genetic testing, 23andme (copyright). Yeah stuff like that. I think it's really interesting to kind of think about what it’s gonna look like in even like five to ten years when a lot of people will have a full kind of family history of, you know, what kind of genetic things they might have, and, you know, bring that to the doctor, and, you know, the craziness that's gonna ensue from that. So I think it's really interesting to think about
Erik: Yeah, who gets that data I think we’re already struggling with that when you get your genome sequenced by 23andme, do they own that data now? And can they do whatever they want with it?
Brandon: I think what's interesting with your talking with like the advancement of technology the fact that like we're on new frontiers. Some of the questions we're having to ask today especially what you just asked with the genome is something that we didn't have to worry about or think about 40-50 years ago that's just didn't exist. So makes me wonder what what kind of ethical things we're gonna have to figure out in the future?
Erin: Yep for sure I think it'll be really interesting to think about, especially with genetics and genetic engineering there are a lot of different possibilities when it comes to in vitro fertilization and all this talk about designer babies. I think it'll be really interesting to talk about all the possibilities that are in store. Maybe not possibilities may be scary kind of outlooks that people have about this kind of stuff.
Brandon: Yeah - you definitely have like either positive or like a dystopian view all this
Erin: Yeah so I think, you know, speaking of which I think the ethics work up that we learned to do use is pretty high yield and we are able to talk to Dr. Blumenthal-Barby.
Jason: Yeah, so today we’re going to talk with Dr. Blumenthal-Barby, who is an associate professor in the department of medical ethics here at Baylor who graduated with an MA from Bowling Green State University in Bowling Green Ohio, and a PhD from Michigan State University in East Lansing, Michigan. And here we have Dr. Blumenthal-Barby.
Erin: So we are here with Dr. Blumenthal-Barby. Thank you for joining us and if you don't mind, could you tell us a little bit about your journey through academia?
Dr. Blumenthal-Barby: Sure - so I actually started out as a health sciences major. I thought I wanted to be a physician assistant, a physical therapist - something like that, and then when I was in college I was required to take a philosophy class, and I was sort of hooked. It was an introduction to ethics and we were talking about things like cultural relativism and whether ethics is something that is totally relative to particular cultures or there's something more absolute to it. We were talking about sort of, you know, practical debates like abortion and euthanasia, and that just really stood out to me as really interesting and sort of challenging in a way that was different from the science classes that I was taking. And I just found myself really wanting to explore more so I took some more classes, ended up doing a minor in philosophy, and then it was time to graduate and I realized that that meant that I had to choose what to do next and I thought I'll just keep studying this a little bit more I'll go and I'll get a master's in philosophy and I can always apply to PA school or PT school after that. And I did my masters at Bowling Green State University which is the same place I did my undergrad so I just stayed on for two more years and the thing that was nice about that program is that it was an applied philosophy program. And so it was very much concerned with sort of asking philosophical questions that related to the real world, like bioethics for example. And they had a joint program with the Cleveland Clinic in Ohio where you could go and spend a semester at the hospital with their bioethics department. So I got to spend an entire semester shadowing the bioethicists, following them around on cases, going to family meetings with them, going to committee and policy meetings with them, and just really see what it meant to do something like philosophy in the real world. And that's when I decided to go for the full PhD and then I did the the PhD in philosophy focusing on bioethics at Michigan State.
Erin: So what does a PhD in bioethics look like?
Dr. Blumenthal-Barby: Yes so the way that the way that PhD programs in philosophy work is you have to do your general requirements and then you specialize. You specialize in ethics, Bioethics, epistemology, logic, political philosophy – something like that. So you spend your first year or two taking really basic philosophy courses like logic and political philosophy and ancient philosophy and all the things you're sort of expected to know, sort of the basic science of philosophy so to speak. And then you can start taking seminars that are more particular to your area. So I took an entire seminar for example on the difference between causing and allowing which turns out to be a really relevant distinction in medicine, right – the difference between allowing a patient to die and causing a patient's death. That's a really deep philosophical question so we spent an entire seminar trying to really dig into that and address it and understand it and think through it. We spent an entire seminar on the ethics of organ transplantation: so what are some of the ethical questions that are raised: When can we take someone's organs? What does it mean for someone to be dead? How do we know when someone's dead? How do we allocate organs to people in a fair way? How do we think about issues like justice and then once you complete all your classes you get to write a dissertation, so you spend your last four years or so; you're not taking classes anymore and you write a dissertation on a particular topic. And my topic was the topic of ambivalence so this was actually based on a case that I saw during my internship in Cleveland where a patient was really indecisive about whether he wanted to live or not after he had been in an accident and paralyzed from the neck down. So he was really ambivalent – he didn't know what he wanted and that was a really challenging case because in bioethics were always taught to respect patient autonomy, but it wasn't clear to me what it meant to respect someone's autonomy when they themselves didn't really know what they wanted. So that's sort of how the PhD worked in philosophy
Erin: Okay – what made you interested in medical as opposed to other kinds of ethics like, legal ethics?
Dr. Blumenthal-Barby: I think was really the internship at Cleveland Clinic where I could see medicine is something that really is present in almost all of our lives, in one way shape or form at some point. And so just being in the hospital and seeing that this is something that people are faced with these really deep questions about what they should do for themselves in different medical situations. Clinicians are faced with really tough questions about how to navigate with patients through difficult value-laden decisions. And so it struck me as something that was very very fundamental to almost everyone's life this is just thinking about ethical issues that arise in medicine.
Jason: So I guess nowadays how do you interact with healthcare professional professionals?
Dr. Blumenthal-Barby: So in ethics, if you're a bioethicists in a medical school you can do a bunch of different things. You can be a consultant where you go into the hospitals so they call you in for a difficult case and they say help us to work through this case with the patients, the patients’ family, the physicians, and you're sort of in the hospital navigating people through a case those people are called ethics consultants. You can also do research where you are doing work to understand some of the normative issues that are arising in the hospital or in practical care in health policy, and trying to provide people with some research that can help inform how those issues should be addressed. And you can also do education which is to educate current practicing physicians and then the next generation of healthcare providers as well about how to think through ethical dilemmas. So my interaction with healthcare professionals is really primarily at the research and education arms of things. I'm not in the hospital – right now I'm not in the hospital doing the on-call consultation. So I'm primarily act interacting with healthcare providers as research partners and collaborators and then also on the education front.
Jason: Do you have any like struggles when you work with that kind of team with a lot of different backgrounds?
Dr. Blumenthal-Barby: I think that the main struggle with working with a very interdisciplinary team is just that you all come from very different perspectives. So, for example, bioethics is – by its very nature bioethics is a field we which means it's an area where people address similar sorts of questions and issues but it's a field that's made of many different disciplines. So discipline is sort of where do you get your methodological training it can be medicine, it can be law, it can be philosophy, anthropology, social science; so there are many disciplines that make up the field of bioethics. And everyone from their discipline has their particular methodology that you have to kind of learn a little bit in order to converse with them, interact with them, collaborate with them, but at the same time you'll never learn it as well as they do. So for example when I'm talking with my physician collaborators there they are they have medical knowledge that I don't have, and they have to sort of translate that to me in a way that I can understand the basic facts of the case to help them think through the ethical issues. Same thing you know the other way around I have to be able to describe ethical concepts and theories in a way that makes sense and is not too abstract and is practical and applied. If you have somebody on the team who is an anthropologist they need to be able to provide you with on-the-ground sort of view of what does it mean to approach this from an anthropological point of view that's not too abstract or overwhelming. So I think that that is one of the challenges of an interdisciplinary field and interdisciplinary work: is just trying to work across all those different disciplines which can be challenging because they're simply not areas that you're knowledgeable about all the time. And you have to be patient with each other and you also have to be humble and respectful to your team members right I mean you can't ridicule somebody because they don't know X, Y, or Z. That's not a good way to collaborate so, so a good amount of humility I think it was really important.
Jason: I guess off of that, do you do you feel like currently like medical professionals that you've worked with that they have they are adequately trained in making ethical decisions?
Erik: Abstractly – we don’t want to mention any names.
Dr. Blumenthal-Barby: No particular names or institutions. I will say I think that medical schools nowadays – most medical schools have ethics as a required course so students are introduced to the idea that a lot of times when you practice medicine values a part of the decisions that you make. And whenever values are part of the decisions that you make you should pause, give it some thought, give it some reflection, engage patients, engage ethicists – things like that. So I think people are increasingly aware of that fact, which is progress. And people are increasingly trained for some of the kind of basic terms and concepts that you use, like informed consent: what does informed consent mean? How do you know if a patient can make their own decisions? That's the notion of decision-making capacity. How do you deal with pediatric patients and children? What are the norms and the boundaries for decision-making with them? I feel that there is an increasing amount of knowledge about how to deal with some of those basic situations and facts. And I also think that people are increasingly trained at Baylor, for example as you all know, we have a curriculum that trains people to think about ethical dilemmas in a systematic fashion. I think that one of the challenges out there or where I would say that people sometimes have less training or less prepared is when they think about ethics as something that is merely opinion or reflex, or merely following the law because ethics is none of those things it's not just your opinion it's not your knee-jerk reaction or your emotional reaction to how a case should be handled or what is right or wrong, and it's not simply a matter of looking up what the law is. It's really having a systematic way to think through the issues at stake, the pros and the cons on both sides of the debate or on the different courses of action, and come to a reasoned judgement about what to do that's a very thoughtful judgement. So I think that there maybe can be more progress made in that because a lot of times when people think about ethics they think they just need to look up, you know, some professional standard or some law or something like that rather than really giving it, giving it more now more deeper analysis. But I do think that that there's a lot of progress that has been made and that people are prepared to think through ethical dilemmas. I will say that there is also a difference between kind of thinking through an ethical dilemma and then what you actually do. This is I'm sure that you all heard about this a lot the notion of the hidden curriculum. You can you can know what the right thing to do is you should know that you should that a patient needs to give consent. You should know that you know patients need to be treated with respect and not have jokes made about them. But what do you do in a situation where especially as a learner you witness a situation where you don't think that proper consent was obtained or you witness somebody laughing or snickering about a patient? That requires a different step, beyond ethical analysis. That's just really a character step of courage and creating a culture where people feel like they can talk openly about those things, they can talk with other people when they see those things happen. That is something that I think medicine needs to constantly improve on and that in some ways is the harder part than the analysis part.
Erik: Yeah I definitely thought – I mean I know you guys – the cases that you picked in the ethics course were hand-picked because of their difficulty but I was definitely amazed by how just ambiguous that the right decision the quote “right decision” could be and it was a… I hope every case isn't going to be like that.
Dr. Blumenthal-Barby: There are there are some – fortunately there are some what we call consensus cases where it's really obvious what the right thing to do is, but there there are lots of times really tough cases but, you know, people are never alone in thinking through those cases. You've got colleagues you've most hospitals nowadays have an ethics committee and everyone is there to be a support system. I think that's another misconception when people think about ethics I think the ethics police or something like that. I mean in institutions today ethics is really there to help people think through a problem together as part of the team and they should be used. They're a great resource.
Erik: I have a question about that, and forgive me if we were supposed known this because of the course that we took, but you know we learned about the systematic way that you go through an ethical case and then we also learn that that is basically the way that the ethics counsel is going to approach it. So at that point once you've brought it to the ethics counsel and (or committee) and they decide what to do, are you – does that take away the legal, I guess, repercussions off of the doctor, the attending doctor?
Dr. Blumenthal-Barby: Well – let me preface that I'm not a lawyer but that having been said it is always so the ethics committee and ethicists always make recommendations to physicians. So it is always a recommendation that is made to you as a physician. Now obviously just from a process point of view if you go against the recommendation that a lot of people have gotten together to think very hard about, you should probably question yourself, think about that a little bit more. And at the same time you know it's still your action and your responsibility as if we're talking about physicians as is the case with an attending physician, but if you have gone through, you know, your due diligence and gone through a really robust process to have other people help you think through it that probably lends some support from a legal perspective as well.
Erin: I'm curious like working with all these ethical cases on a day to day do you feel like you like when you're just making like everyday decisions that you like have ethics on your mind? I don't understand actually how that works because when I was taking the ethics class like I thought about it all the time. Yeah even when I'm at the grocery store I’d think about ethics. When I was making everyday decisions I feel.
Dr. Blumenthal-Barby: It's a great question well it's even worse - because I'm a philosopher ethicist, but I also work on decision making. And so it's even worse because I study decision making, and so I would say that that makes decision-making much more difficult in my own personal life. I think a great example is, and I hope it's not too sad of a story I feel okay about it now; I probably would have been crying a week ago, but last week I had to make the decision about whether or not to euthanize my 19 year old cat.
Dr. Blumenthal-Barby: I’m good now but I decided to do it, and it was a really interesting experience to go through making that decision as an ethicist and as someone who has thought a lot about euthanasia, about dying and a good death, and about rights of individual beings, and creatures, and about respect and about suffering; it definitely complicated the situation and the decision-making in ways that I think you know if I wasn't a philosopher ethicist that probably would have been a more straightforward decision. For sure, I mean I'm able fortunately to go grocery shopping.
Erin: I see.
Dr. Blumenthal-Barby: But I see your point.
Erin: Yeah I guess you talked about like some of the things that you work in decision-making capacity. What is your personal area of interest in ethics, and how or why did you like get to that interest?
Dr. Blumenthal-Barby: My specific area of interest I do most of my research on is on the ethics of kind of shaping and manipulating patient decision-making. And I know manipulating is a strong word and I don't mean anything by that or anything bad other than just understanding when you study decision psychology and you study all of the sort of heuristics and shortcuts that people use to make decisions, and I can give you some examples, you start to realize that you can use that knowledge inevitably when you talk with patients and you engage in decision making with patients as you all will, you can sort of use that knowledge to think about how you frame decisions with patients. So for example, we know that people tend to choose what they perceive as the middle-of-the-road option. So, this happens all the time when you're choosing a cable plan, right, they know what plan they want to get you to choose and they make one plan seem really, really cheap and one plan seem really, really expensive, and they know you're gonna choose that middle-of-the-road plan. Maybe you don't need that middle-of-the-road plan; maybe you would have been fine with the cheap plan, but we have this heuristic that we use when we make decisions to go with what feels like middle-of-the-road. So this could translate to decision making with patients that you're presenting options to patients – you have one that seems really aggressive, one that seems very minimal, and one that seems middle-of-the-road. They're going to be biased towards that middle-of-the-road option. We also know that people have a tendency to do what they think other people are doing or other people are choosing. So if you just tell people you know here are your options: most patients in your situation would choose option A. That makes the patient more disposed to choose option A. Just really simple things. One more example when you frame risks to patients, we know that patients are more influenced by – people are more influenced by what's called lost frame rather than gain frame. So you're telling patient about a risk of surgery; if you frame it as the percent chance of mortality they're going to be more afraid and less likely to consent than if you give them the odds of survival, which is the exact same piece of information it's just framed a little bit differently. So I'm interested in, and I could go on because it's this whole field of decision science, decision psychology, behavioral economics, judgment, and decision making, where psychologists are telling us about the ways that people make decisions. And I think that medicine is particularly interesting because we ask people to make decisions all the time. And we ask them to make very high stakes important decisions and then that raises all these ethical questions of: well how should I frame the information? What are the boundaries of using some of those insights during the consent and decision-making processes to shape decisions? This the whole field has gotten the name of nudging. Nudging decision-making engaging in so-called choice architecture. There were some popular books that were published. The book nudge, for example, is a really popular book that talks all about this if you're interested. But that's my main research area.
Erin: do you think it's ethical to nudge people, I guess?
Dr. Blumenthal-Barby: I do; part of the reason that I think that is because I think as I was sort of giving a sense of by my answer I think that nudging to some extent is inevitable because you have to frame information, you have to present, you know you have to decide whether you're going to tell somebody the odds of survival or mortality. You have to decide the order that you're going to present information to people in. You have to decide the tone that you're going to use when you present information. You have to decide when they ask you what would you do or what would other patients do; you have to decide what you're gonna tell them. Are you gonna tell them what all other patients do, what most patients like them do, what you would do, what you think they should do? So I think to some extent it's inevitable, which is why I think – I mean it's a little bit of a tautology that doesn't make it ethical it just makes it inevitable and then the decision, the ethical decision is sort of how to think about how to do that responsibly. So to what end do we nudge people – do we nudge people to do whatever we want them to do because we think it's best? Or to be trying to figure out what's important to them and what their values are and then nudge them to a decision that is most in line with their values. I think that's probably the more ethical approach. And what are the boundaries of it? I mean you can you can imagine that we could, for example, I know a few years ago there was a campaign to get parents to vaccinate their children that put together some pretty horrific videos of what might happen if you don't vaccinate your children. Now that's a nudge and it might be effective but it might also alienate, I don't know it's an empirical question, but it might also alienate parents to having a negative view about the medical establishment, it could further fracture their relationship with their physician if they feel like their physician is being too disrespectful or manipulative or something like that. So I do think that nudging is not only do I think it's epically defensible I think it's in some senses ethically obligatory that we in the medical field; part of our obligation is to protect and promote patients interests and if we understand the psychology of decision making we can use that to do it.
Erik: Are there any ethical dilemmas in particular that you lose sleep over?
Dr. Blumenthal-Barby: I do not lose sleep over very much to be honest, but you know, I would say those sorts of dilemmas that I would lose sleep over are less ethical dilemmas and more tough cases. And this is part of the reason why I've focused actually more on research and education than being over in the hospital doing consulting because I think that when you get in the middle of a really tough case, and it's oftentimes not the analytical dilemma about what's the right thing to do, but it's just dealing with people in a very emotionally difficult and fragile point in their decision-making in a really difficult ethical decision that I think what caused me to lose sleep, definitely. And I remember a couple of cases when I was a graduate student and I was shadowing the consultant that were really, really tough and they did cause me to lose sleep at the time and one was the one that I mentioned that I wrote my dissertation about which was this man who literally for months sort of was just in tears and torn about whether he should live life like this or not and one day he would tell us I don't want to live like this please disconnect the ventilator, and the team would be ready to disconnect the ventilator and then the next day he would say “no no I think I want to live like this”. And everyone felt like they wanted to help him make the right decision, but no one knew what the right decision was and it was incredibly difficult for him, obviously you could tell by his emotional distress of being in tears every day. And it was incredibly difficult for his family who were trying to be supportive of him but didn't know what he wanted. And I also think really tough cases were cases where family members were probably not ready to let go of a family member but people after a lot of thought about the case all came to the conclusion that it was probably best for the family member if they, based on their values and their prognosis, did not continue to have life-sustaining treatment. But the family was having a tough time saying goodbye and those are tough cases because you want to promote kind of what's in the patient's best interest but you also want to be sensitive to human beings who are there family members who are actually in the situation will have to deal with. You know, the emotions that go on days and years after you're not involved in the case anymore. So those were definitely cases where, and I'm sure that all of you have I mean have and will encounter those cases just par for the course as being practitioners in medicine, would definitely caused you to lose sleep.
Jason: So I guess on the education side, what is your favorite part of teaching students?
Dr. Blumenthal-Barby: Oh, my favorite part of teaching students is just the students. They are I mean you all are so, I think, I mean you're smart but you're also really willing to intellectually challenge yourselves I think. I mean – I'm amazed when I would do the ethics lectures how people would come down afterwards and still have more questions. And I would get emails from people that would, you know, they would ask sort of well “what about this case” or “what about that case”. So it's all the you know the permutations of even just thinking beyond whatever immediate issue we were we were sort of working on; there's an intellectual curiosity there and an energy that is really invigorating, which is part of why I love teaching so much. And I also love that – I think many students especially at Baylor are also so interested in research as well and that's been really rewarding. We have the ethics pathway for our medical students who are interested in furthering their study in scholarship and ethics, and part of that is a research project that they do in their fourth year. And I'll often have students email me in their very first year right when they get here and they'll say I know I want to do the ethics pathway I know I'm interested in research, you know, like can I start and how do I get started and all those sorts of things. So I think just the intellectual energy and curiosity, and the investment are all what make it really, really rewarding to teach and interact with you all.
Jason: Are there any frustrating parts?
Dr. Blumenthal-Barby: No none.
Erik: When students invite you on podcast.
Dr. Blumenthal-Barby: Oh no the podcast is amazing I think there should be more of this sort of thing. Frustrating cards – I would say from my particular perspective of teaching ethics, the frustrating part is when students ask me what the right answer is, or what the legal answer is.
Erik: My bad.
Dr. Blumenthal-Barby: That being said, I think ask the legal question, but then like don't let end there. I think that it's just the law gets things really wrong sometimes, right? Or it's silent on things, or something like that. And I also think that to some extent it's, you know, what I would do in a particular situation it's relevant and I should be able to explain why I would do what I would do and that might be insightful for somebody making their own personal decision about what to do. But it's really me so I feel like the question of you know like what should I do based on what you would do is only step one to everyone reaching their own personal decision about what the right thing to do is in a particular circumstance. But those are two very, very minor things. I mean the students are really amazing and I have not – I've been working I've been working at Baylor for 10 years now and I actually was directing the ethics course up until about – for probably five years or something like that and so I got a lot of direct interaction with students and there were very, very few frustrating parts which is great.
Erin: What about frustrating parts of your job in general?
Dr. Blumenthal-Barby: The most frustrating part of my job I think is just more kind of the bureaucratic side of things of, you know, having to kind of comply with certain processes and procedures and systems and things like that, and how much time that takes. But that's all just kind of part of you know trying to be in a responsible culture where everything has to be tracked and recorded and things like that. It's kind of probably like in your world like EMR work or something like that, right? So it's and it's annoying but it's part of the larger picture.
Erin: I was actually pretty curious like with like – a lot of my friends are getting like 23andme testing as like birthday gifts, and like whatever gifts. And I'm just curious like what you feel about the ethics of I guess like big data and genetic testing and how that's gonna affect healthcare in the future.
Dr. Blumenthal-Barby: I think that it is probably going to affect health care significantly in a lot of different ways. I mean imagine that patients are going to be coming to their physicians with the results of these tests and asking their physicians to help them make sense of these results. And so I think that's going to take a lot of time it's going to take a lot of patience. It's also going to take a lot of education. And I think to relate it directly to the work that I do on judgment and decision making, you know when people get an enormous amount of information certain biases kick in. They're gonna focus on –it's hard to deal with complex and large amounts of information, and so people do certain strange things in response to that. They'll focus on a particular thing it's like a focusing effect and they ignore everything else. So I think we're gonna have to be aware of that. People have what's called a curiosity bias where they're just they want data and information for the sake of data and information, and that feeds into the focusing effect. And I think that people are also; another thing that they do is they'll use information as a form of denial: so if they get a lot of information and there's a particular piece of it that's really threatening or concerning, they'll focus on all the other parts. I mean we know this from decision science and I think we'll see this more and more when people have large amounts of information. And then I think we're gonna have to make decisions about how to when we get information where patients are at risk for something that we're significantly worried about how to make that stand out to them. And so this is giving them that information and saying your risk of developing this is 30% and the average risk is 1%. So finding ways; if you just say 30% I don't know what they think of 30% maybe they think that's not that big, especially when you've given them the risk of, you know, a dozen other conditions and there are results and variance for that. So I think actually communication and risk communication and understanding how to do that effectively will also be really, really important. And supporting people's decision-making as they get all of this information. It’s gonna be really challenging, but exciting
Erin: Well thank you so much Dr. Blumenthal-Barby for joining us, and I think we really learned a lot about ethics and ethical decision-making so thank you for joining us.
Dr. Blumenthal-Barby: Thank you all.
Erik: Alright; that is it for now, we would like to thank everyone out there who took the time to listen to this episode of the podcast. Special thanks to Jason and Erin for writing the episode. thank you to our faculty advisor Dr. Poythress for helping us put everything together. Thank you to the Baylor communications department for helping with the production and the website. And thank you again to Dr. Blumenthal-Barby for taking the time to be interviewed by us. We hope everyone enjoyed it and we hope you tune in again soon. Goodbye for now.