Ezekiel Emanuel

His two younger brothers are former Chicago mayor Rahm Emanuel and Hollywood-based talent agent Ari Emanuel. He has an adopted sister, Shoshana Emanuel, who has cerebral palsy. His father’s brother, Emanuel, was killed in the 1936 Arab Riots in the British Mandate of Palestine, after which the family changed its name from Auerbach to Emanuel in his honor.

As children, the three Emanuel brothers shared a bedroom and spent summers together in Israel. All three brothers took ballet lessons in their childhood, which Emanuel says "hardened us and taught us that if you do something unusual, people will take potshots at you." Emanuel and his brother Rahm frequently argue about healthcare policy. Emanuel mimics his brother's end of the conversation: "You want to change the whole healthcare system, and I can’t even get SCHIP [State Children’s Health Insurance Program] passed with dedicated funding? What kind of idiot are you?"

In his book The Ends of Human Life Emanuel used the AIDS patient "Andrew" as an example of moral medical dilemmas. Andrew talked to a local support group and signed a living will asking that life sustaining procedures be withdrawn if there is no reasonable expectation of recovery. The will was not given to anyone but kept in his wallet, and no one was given power of attorney. There were questions about his competence since he had AIDS dementia when he signed the will. Still, Andrew's lover said that he had talked about such situations, and asked that Andrew be allowed to die. Andrew's family strongly disagreed that Andrew wanted to die. Dr. Wolf previously saved Andrew's life, but promised to help him avoid a "miserable death". The ICU wanted guidance from Dr. Wolf as to how aggressively they should try to keep Andrew alive, as his chances of surviving a cardiac arrest were about zero. Two other critical patients were recently refused admission because of a bed shortage. There was a question as to whether Andrew's lover was representing Andrew's wishes or his own. There was also a question as to whether Andrew’s parents knew Andrew better than others, or whether they were motivated by guilt from rejecting Andrew's identification as a gay male. The cost of aggressive treatment was $2,000 per day.

Emanuel said the Hippocratic Oath and the codes of modern medical societies require doctors to maintain client patient confidentiality, refrain from lying to a patient, keep patients informed and obtain their consent, in order to protect the patient from manipulation and discrimination. Emanuel said that a doctor’s oath would never allow him to administer a lethal injection for capital punishment as a doctor, although the issue would be different if he were asked to serve on a firing squad not as a doctor but rather as a citizen. He said that in the case of mercy killing there are rare cases where the medical obligation to relieve suffering would be in tension with the obligation to save a life, and that a different argument (an argument that intentional killing "should not be used to achieve the legitimate ends of medicine") would be required instead.

PolitiFact described McCaughey's claim as a "ridiculous falsehood." FactCheck.org said, "We agree that Emanuel’s meaning is being twisted. In one article, he was talking about a philosophical trend, and in another, he was writing about how to make the most ethical choices when forced to choose which patients get organ transplants or vaccines when supplies are limited." An article on Time.com said that Emanuel "was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources ... 'My quotes were just being taken out of context.'" A decade ago, when many doctors wanted to legalize euthanasia or physician-assisted suicide, Emanuel opposed it. Emanuel said the "death panel" idea is "an outright lie, a complete fabrication. And the paradox, the hypocrisy, the contradiction is that many of the people who are attacking me now supported living wills and consultations with doctors about end-of-life care, before they became against it for political reasons." "I worked pretty hard and against the odds to improve end-of-life care. And so to have that record and that work completely perverted—it's pretty shocking."

Emanuel's previous statements on rationing were about the "allocation of very scarce medical interventions such as organs and vaccines" such as who should get a "liver for transplantation". Ezekiel said that McCaughey's euthanasia claims were a "willful distortion of my record". Jim Rutennberg said that Emanuel's critics oversimplified complex issues, such as who should get a kidney. Such rationing was said to be unavoidable because of scarcity, and because a scarce resource such as a liver is "indivisible". Emanuel said that McCaughey took words out of context, omitting qualifiers such as "Without overstating it (and without fully defending it) ... Clearly, more needs to be done ..." Emanuel once compared the word "rationing" to George Carlin’s seven words you can't say on television. In 1994 Emanuel said in testimony before the Senate Finance Committee, "Just because we are spending a lot of money on patients who die does not mean that we can save a lot of money on end of life care."

Favoring the worst off could be accomplished by favoring the sickest first or by favoring the youngest first. Favoring the sickest appeals to the rule of rescue, but organ transplants don’t always work well with the sickest patients. Also, a different patient could become equally sick in the future. Favoring the youngest saves the most years of life, but a twenty-year-old has a more developed personality than an infant.

Emanuel said the Complete Lives system was not meant to apply to health care in general, but only to a situation where "we don’t have enough organs for everybody who needs a transplant. You have one liver, you have three people who need the liver - who gets it? The solution isn’t ‘We get more livers.’ You can’t. It’s a tragic choice."

In a 2017 article Conflict of Interest for Patient-Advocacy Organizations Emanuel found that financial support of patient-advocacy organizations from drug, device, and biotechnology organizations was widespread (83% of reviewed organizations). Later that year, he argued in another article Why There are No "Potential" Conflicts of Interest that conflicts of interest exist whether or not bias or harm has actually occurred.

In 2016, Emanuel wrote in the article Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe that existing data on physician-assisted suicide does not indicate widespread abuse. This article also noted that physician-assisted suicide has been increasingly legalized while remaining relatively rare and largely confined to oncology patients.

Betsy McCaughey described Ezekiel Emanuel as a "Deadly Doctor" in a New York Post opinion article. The article, which accused Emanuel of advocating healthcare rationing by age and disability, was quoted from on the floor of the House of Representatives by Representative Michele Bachmann of Minnesota. Sarah Palin cited the Bachmann speech and said that Emanuel's philosophy was "Orwellian" and "downright evil", and tied it to a health care reform end of life counseling provision she claimed would create a "death panel". Emanuel said that Palin's death panel statement was "Orwellian". Palin later said that her death panel remark had been "vindicated" and that the policies of Emanuel are "particularly disturbing" and "shocking". On former Senator Fred Thompson's radio program, McCaughey warned that "the healthcare reform bill would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner." She said those sessions would help the elderly learn how to "decline nutrition, how to decline being hydrated, how to go in to hospice care ... all to do what's in society's best interest or in your family's best interest and cut your life short." As The New York Times mentioned, conservative pundits were comparing Nazi Germany's T4 euthanasia program to Obama’s policies as far back as November 2008, calling them "America's T4 program—trivialization of abortion, acceptance of euthanasia, and the normalization of physician assisted suicide."

Emanuel is the son of Benjamin M. Emanuel and Marsha (Smulevitz) Emanuel. His father, Benjamin M. Emanuel, is a Jerusalem-born pediatrician who was once a member of the Irgun, a Jewish paramilitary organization that operated in Mandate Palestine. He provided free care to poor immigrants and led efforts to get rid of lead paint due to its negative consequences for children and as of 2010 lived in a suburb of Chicago. Emanuel’s mother, Marsha, a nurse and psychiatric social worker who was raised in the North Lawndale community on Chicago's West Side, was active in civil rights, including the Congress of Racial Equality (CORE). She attended marches and demonstrations with her children. In a 2009 interview Emanuel recalled that in his childhood "worrying about ethical questions was very much part and parcel of our daily routine."

Emanuel is a divorced father of three daughters. His daughter Gabrielle, a 2010 graduate of Dartmouth College, won a Rhodes scholarship in November 2010. His daughter Rebekah, a graduate of Yale University won a George J. Mitchell Scholarship in 2008. Another daughter Natalia, a 2013 graduate of Yale University, won a Marshall scholarship in November 2013, and is currently a Ph.D. student at Harvard University.

In 2009, Govind Persad, Alan Wertheimer and Ezekiel Emanuel co-wrote another article on a similar topic in the journal The Lancet. Ezekiel was one of three authors who co-wrote Principles for allocation of scarce medical interventions, which examines eight theoretical approaches for dealing with "allocation of very scarce medical interventions such as organs and vaccines." All eight approaches were judged to be less than perfect, and the Complete Lives system combines most of them.

In the 2008 Journal of the American Medical Association article "The Perfect Storm of Overutilization" Emanuel said, "Overall, US health care expenditures are 2.4 times the average of those of all developed countries ($2759 per person), yet health outcomes for US patients, whether measured by life expectancy, disease-specific mortality rates, or other variables, are unimpressive." He said that expensive drugs and treatments that provide only marginal benefits are the largest problems. Fee-for-service payments, physician directed pharmaceutical marketing, and medical malpractice laws and the resultant defensive medicine encourage overutilization. Direct-to-consumer marketing by pharmaceutical companies also drives up costs.

In a 2007 slideshow Conflicts of Interest, Emanuel said that there were conflicts of interest between a physician's primary responsibilities (providing optimal care for patients, promoting patient safety and public health) and a physician's secondary interests (publishing, educating, obtaining research funding, obtaining a good income and political activism). Emanuel said that while it is difficult to know when conflicts of interest exist, the fact that they do is "the truth". When there is no doubt of a conflict, the issue is not a mere conflict of interest, but fraud.

In a 2007 article Conflict of Interest in Industry-sponsored Drug Development Emanuel said that there is a conflict between the primary interests of drug researchers (conducting and publishing good test results and protecting the patient) and secondary concerns (obligations to family and medical societies and money from industries). However, industry sponsored tests are more likely to use double-blind protocols and randomization, and more likely to preset study endpoints and mention adverse effects. Also, there is no evidence that patients are harmed by such studies. However, there is evidence that money influences how test results are interpreted. Emanuel mentioned the Selfox study on the use of calcium channel blockers in treating hypertension, in which authors with a financial interest in the results reported much better results than the rest. Worse yet, test results sponsored by industry are likely to be widely published only if the results are positive. For example, in a Whittington study for data on selective serotonin reuptake inhibitors, negative results were much less likely to be published than positive results. However, in The Obligation to Participate in Biomedical Research the authors Schaefer, Emanuel and Wertheimer said that people should be encouraged to view participation in biomedical research as a civic obligation, because of the public good that could result.

According to Emanuel, the most important life-saving cancer drugs are rationed not by "death panels" but by The Medicare Prescription Drug, Improvement and Modernization Act of 2003, signed by President George W. Bush. The act limits Medicare payments for generic cancer drugs, which cuts profits from producing them and results in shortages.

After completing his post-doctoral training, Emanuel pursued a career in academic medicine, rising to the level of associate professor at Harvard Medical School in 1997. He soon moved into the public sector, and held the position of Chief of the Department of Bioethics at the Clinical Center of the U.S. National Institutes of Health. Emanuel served as Special Advisor for Health Policy to Peter Orszag, the former Director of the Office of Management and Budget in the Obama administration. Emanuel entered the administration with different views from President Barack Obama on how to reform health care, but was said by colleagues to be working for the White House goals. Since September 2011, Emanuel has headed the Department of Medical Ethics & Health Policy at the University of Pennsylvania, where he also serves as a Penn Integrates Knowledge Professor, under the official title Diane S. Levy and Robert M. Levy University Professor.

Emanuel wrote Where Civic Republicanism and Deliberative Democracy Meet (1996) for the Hastings Center Report. In this article Emanuel questioned whether a defect in our medical ethics causes the failure of the US to enact universal health care coverage. The macro level of the issue is the proportion of total gross national product allotted to health care, the micro level is which individual patient will receive specific forms of health care, e.g., "whether Mrs. White should receive this available liver for transplantation." In between are the basic or essential health care services that should be provided to each citizen. The end-stage renal disease program is an example of a service that increases the total cost of health care, and reduces the amount that can be spent on basic or essential health care.

Of the 1996 Hastings Center Report, Emanuel said, "I was examining two different, abstract philosophical positions to see what they might offer in the context of redoing the health-care system and trying to reduce resource consumption in health care. It's as abstractly philosophical as you can get on a practical question. I qualified it in 27 different ways, saying it wasn't my view." He also said, "As far as rationing goes, it's nothing I've ever advocated for the health system as a whole, and I've talked about rationing only in the context of situations where you have limited items, like limited livers or limited vaccine, and not for overall health care."

Emanuel graduated from Amherst College in 1979 and subsequently received his M.Sc. from Exeter College, Oxford in Biochemistry. He simultaneously studied for an M.D. and a Ph.D. in Political Philosophy from Harvard University, receiving the degrees in 1988 and 1989, respectively. He was a member of the first cohort of Faculty Fellows at the Edmond J. Safra Center for Ethics at Harvard from 1987–88. Emanuel completed an internship and residency at Beth Israel Hospital in internal medicine. Subsequently, he undertook fellowships in medicine and medical oncology at the Dana–Farber Cancer Institute, and is a breast oncologist. Emanuel received dozens of honors and awards, including the Toppan Dissertation Prize, the Harvard award for best political science dissertation of 1988 and the Dan David Prize for his contribution to the field of bioethics in 2018.

Ezekiel Jonathan "Zeke" Emanuel (born September 6, 1957) is an American oncologist, bioethicist and senior fellow at the Center for American Progress. He is the current Vice Provost for Global Initiatives at the University of Pennsylvania and chair of the Department of Medical Ethics and Health Policy. Previously, Emanuel served as the Diane and Robert Levy University Professor at Penn. He holds a joint appointment at the University of Pennsylvania School of Medicine and the Wharton School and was formerly an associate professor at the Harvard Medical School until 1998 when he joined the National Institutes of Health.