An Atheist at the Vatican: Mortality, Religion, and Wellness

Dr. Ezekiel Emanuel on end-of-life ethics and why Lent’s ancient reminder—remember you will die—may hold an unexpected key to modern health.

Dr. Ezekiel Emanuel has advised presidents, shaped national health reform, and influenced decades of bioethical debate. Recently, he was invited to the Vatican.

In this wide-ranging conversation, we discuss:

• Why reflecting on mortality should shape lifestyle

• His position on euthanasia and end-of-life care

• The sustainability crisis facing aging societies

• Whether religious practice improves health

• What surprised him most about Rome

More than a policy discussion, this is an exploration of how secular expertise and religious tradition can converge in unexpected ways — especially around mortality, meaning, and the limits of medicine.

Transcript

Intro: Dr. Ezekiel Emanuel is one of the most influential architects of modern American healthcare. Advisor to Presidents. Chair of Medical Ethics and Health Policy at the University of Pennsylvania. A central figure in some of the most consequential healthcare reforms of our time. Recently, he was invited inside the Vatican to address the Pontifical Academy for Life on how nations like the United States and China might build universal healthcare systems that actually work. He calls himself an atheist and a practicing Jew. He disagrees with the Catholic Church on some of its most foundational bioethical claims, including the right to life from conception. And yet, on questions like euthanasia and end-of-life care, there are surprising points of convergence. In this conversation, recorded in our Catholic News Service studio, we talked about his childhood, his rise to the center of American health policy, what he experienced inside the Vatican, what he told Pope Leo, and why his central message is disarmingly simple: Remember that you are going to die. Because as the Lenten season reminds us, the secret to living well may begin with keeping death before your eyes.

Robert Duncan: Dr. Emmanuel, shall I call you Zeke?

Dr. Emanuel: Yeah.

Robert Duncan: Tomorrow in the Catholic calendar is Ash Wednesday. And every Catholic who goes to receive the ashes will hear the words: Remember that you are dust and to dust you shall return. You start your new book, Eat Your Ice Cream, with a reminder that we’re all going to die. What is important to you about that remembrance? And is there something about maybe traditional religion that helps people remember that also?

Dr. Emanuel: I’m an atheist. I’m a practicing atheist. I go to Jewish services most Saturdays in the year. So I don’t find it actually religious. I just think it’s a fact of life. We know that people die. They die all the time. About 2.7 million people will die in the United States this coming year, in 2026. And I think we have a culture, probably driven partially by evolution, driven partially by culture, of trying to minimize our thinking about death.

I actually find it quite helpful to think about the fact that I’ve got 75, 85, 90 years, something in that range, and that it’s not unlimited, and that I think actually can focus you on what’s important and what’s not important. I’m an oncologist, and one of the things you know as an oncologist is you treat a lot of patients, and the ones who are terminally ill, the very focus on what’s most important. Even the ones you cure, they almost always say, you know, I stopped doing X, Y, and Z. I realized they weren’t really important, and I’m really focused on the most important things in life. And I think actually keeping your mortality in front of you and the fact that there will be a decline helps to focus you on important things, trying to do important things in life. And one of the important things of life is not to try to get the next two or three days or an extra week. It’s just that that’s not going to be materially as important as figuring out what you think your purpose is and actualizing it.

Robert Duncan: How has keeping that at the forefront of your mind helped you focus on what your purpose is and helped you live a better life?

Dr. Emanuel: Well, when I was a college freshman, I was sort of flailing around and trying to figure out what to do with my life, actually what course to pursue. There was a lot of pressure on me to do medicine in part because I was very good at science, but that idea didn’t fully satisfy me, and I took a walk. We had a bird sanctuary with a lot of woods, and it was a cold winter day in January, and I took a walk out there and thought. And it really occurred to me, you inherit the world. You come into this world, and so much has been done. We in the 21st century don’t fully realize it. Electricity, indoor plumbing, telecommunications, reliable food supply, weather forecast so you know how to dress and you don’t get caught out, all sorts of things that are there. We live in a democracy, or I hope a democracy, and that hard fought for, people died constantly. And so it occurred to me that my job is to take what I’ve inherited and make it better and make it better for other people. And it could take a variety of roles. I am not, by my character, good at doing that one-on-one-on-one. There are some people, my father was one of those, who loved caring for patients and individuals and getting to know individuals. I have an eldest daughter who that is very, very important for. I tend to think of tens of thousands and hopefully millions of people and try to think what can I do to the social arrangements that are going to help the most people. And then you have a finite amount of time to actually implement that and to try to do it in actuality. And so that, I think, knowing that I don’t have unlimited time here, very helpful. And knowing that I’m not just going to focus on living a few weeks, months, longer. That’s not going to make the difference.

Robert Duncan: You speak about your family, and that’s, in your autobiography, a very important part of who you are. You have two very successful brothers in very different fields. Can you talk a bit about your upbringing and your family?

Dr. Emanuel: Yeah. So my father came to the United States from, he was born in what was then Palestine and became Israel. He studied medicine in Switzerland and then came to the United States with $24 and a Parker pen. And he was an incredibly hard worker and very much devoted to caring for people. My mother was very active in the civil rights movement when it was quite unusual for a white woman. She was active in the late 50s and early 60s and then became active in the anti-Vietnam War movement. And they were very much committed to social justice. And my mom would regularly take us to demonstrations, regularly talk to us about our privileges. We had a housekeeper, and she was very, very clear about trying to promote her, get her a better job. We would go and visit them. So we were very, very well aware that we weren’t particularly rich. I’d like to say that most of my pants had patches on the patches. But we had privilege, among which was education. And my father was very devoted to travel so we could see the world, and he thought it was the best form of education. That very, very important. My parents were also very, very willing to let us speak our mind, have different views, not agree. Also very, very important. Mostly it was important to, you know, how are you going to justify your view? What’s the reasons you have this view? And then my mother was particularly, I would say, she was the anti-helicopter parent. She would shoo us out of the house, go play. And, you know, we had to figure it out. We had to figure out what we were going to play, negotiate rules, negotiate disagreements, you know, occupy ourselves. We got into plenty of trouble. She was very good about that, too, actually. She was particularly good, especially at school, when we stood up for something, got us in trouble, coming and defending us. And so we learned a lot of independence, a lot of self-motivation, a lot of how to deal with people, and a commitment to social justice.

Robert Duncan: And your mother would take you to Dr. Kings’…

Dr. Emanuel: Yeah, so when Martin Luther King marched in Chicago, we went. And it was, let us say, a not peaceful demonstration, but not because we weren’t peaceful, but just thrown a lot of food and sometimes rocks at us. Yeah, very memorable demonstration.

Robert Duncan: How did you go from the child that you’ve described in this family to wanting to give your life to medicine?

Dr. Emanuel: Involuntarily. I, the son of an immigrant, the son of an immigrant doctor, and I also happen to be very, very good in science. In America, that tends to over-determine you to become a doctor. As I said, I did a lot of summer research in college, going to various labs, including a very famous lab, Cold Spring Harbor, that Jim Watson was the head of. It just didn’t wildly excite me, being lab work. Lab work just was not something that I enjoyed. Other people enjoyed it. I had a roommate at Cold Spring Harbor who really loved it. He described it as his temple. I went to Oxford for two years. I did pretty well. I published three papers, but it also confirmed to me I didn’t like it. But I got into med school, and I hadn’t had a plan B, so I went to med school. Between my first and second year, I went to Washington to do journalism at the New Republic at that time. I realized I didn’t want to be reporting on events. I wanted to actually do events and do the change that I thought was important. So I went back to our med school and took time off to do a Ph.D. in political philosophy, thinking that would be helpful. So that’s the path. I ended up in oncology because oncology, people are very sick. They’re reexamining their deepest values, what their life’s about, helping them in that. Also great science and great bioethical issues. All the big bioethical issues, whether informed consent, end-of-life care, expensive medicine, all show themselves in oncology. So it was the area for me.

Robert Duncan: It sounds like the social justice background, what you came to do in medicine, had more sort of a social impact.

Dr. Emanuel: Yeah. As I said, I’m not the kind of person, just from a satisfaction standpoint, helping people one-on-one was great. I really love my patients. Hopefully they all love me. I still keep in touch with some of them. I get letters out of the blue. But that wasn’t sufficient motivation. I wasn’t feeling like the system had problems that I could see, and part of what called me to is, well, how do you solve this problem? Initially I started out trying to fix end-of-life care. It was not good for cancer patients but wasn’t good for anyone in America. When I started out, 72%, 75% of Americans died in the hospital. We were resuscitating people who it was quite clear they weren’t going to make it. So I set out to try to change that.

From there you also see the inequalities of the system, the fact that it’s actually not working for a lot of people, so try to fix that.

Robert Duncan: You came to advise at the highest level, right? President Obama and other ways as well.

Dr. Emanuel: It was a great honor to be able to serve and work on the Affordable Care Act. I think it did a lot of good. It clearly gave a lot of people insurance. It also held costs down. But it also had problems. A lot of the things we hoped we could achieve we didn’t. It certainly made the health care system more complicated, which I think was a chief defect. We kept asking, well, are we simplifying the system? Are we making it easier to use? Are we getting rid of a lot of administrative problems in the system? We didn’t ask those questions. We didn’t ask them enough if we ever asked them. I think that has come home to roost to some large extent now.

Robert Duncan: So all of that is a prelude of maybe this particular moment which you find yourself in Rome in the Vatican, I suppose. They called you. They emailed you. How did this come about?

Dr. Emanuel: Yeah. I knew someone who worked for the Pontifical Academy for Life. I had been here once before under his auspices, and he asked me to come and talk about what we could learn from other health care systems in order to guarantee health care for all.

Robert Duncan: Was it surprising given what you said about your faith background, not being Catholic, that the Vatican would reach out to you?

Dr. Emanuel: Yes. It wasn’t something that I had put on my list of things. Well, the Catholic Church is going to call and ask me to advise on health care.

Robert Duncan: When they made the invitation, what specifically did you want to bring? I mean, given the sort of uniqueness of this opportunity, what did you want to communicate?

Dr. Emanuel: Well, I think the reason they brought me is because I have studied. I published a book called Which Country is the World’s Best Health Care. I studied 11 health care systems, including the United States and 10 others. And lessons about how different systems function. As I say in that book, no system is ideal. They all have defects. Every system you study has some squeaky wheel, some problem that really doesn’t work very, very well, and that people complain about. Sometimes there is more than one. I mean, the United States, as I put it today in my presentation, we have five goals in any health care system. Universal coverage, reasonable cost, consistent high quality, reducing disparities, and satisfaction. The United States doesn’t fulfill any one of the five.

There are many other health care systems in the world that fulfill two, three, maybe even four. And there’s a lot we can learn about what the problems are. I think many of the problems have been misdiagnosed or not put together coherently. It’s not just one problem. I’ve identified three major problems. But that’s critical to understanding how to get a good system. And every system in the world, no matter what they spend on health care, complains about the costs. Costs are going up everywhere. It corresponds with aging. As people age, they have more illnesses and therefore will intersect with the system more, will cost more. And how to figure that out is a preoccupation of all countries. And it can help by looking at what other countries do.

Robert Duncan: How do you see the Vatican’s strategic role in the public health policies that you want to promote?

Dr. Emanuel: Well, I think the Vatican can be a source of moral conscience and a source of certainly setting out ideals. But it also can be a source of helping actually implement them.

There’s an extensive Catholic health network around the world, not just in the United States. We do have a lot of Catholic health care systems. One of the questions I think every health care system has to ask is, how is it differentiated because it’s called a Catholic as opposed to some other kind of secular or other denominational health care system? What’s distinctive about it? In the Catholic faith, abortion tends to be the one, but that would seem to be a thin reed to stand on as distinctive. I think a big question is how do they structure what they do and how does it help people who are left out, people who sometimes don’t know where to turn. I think that has to be distinctive. And the Vatican can help in those moments.

Robert Duncan: One of the questions that came up in the press conference had to do with Catholic teaching and public health, especially on bioethical questions. You not being a Catholic, I wonder how you see the challenges of collaborating sometimes with the Catholic Church.

Dr. Emanuel: I don’t have a problem collaborating with them. I do have a problem — we have to figure out how we disagree. The United States is a pluralistic country, just to take abortion, a concrete case. I think this has often been characterized as a secular Catholic issue. I mean, I’m Jewish and Jews don’t have the same problem. We don’t view life as starting at conception. We have a very different view about life quickening, heartbeats and stuff more important, but also we’ve over millennia had lots of arguments about weighing the mother versus the fetus, infant, and baby. And the mother takes precedence. It’s a very different perspective. I’m also, I happen to be, as a matter of fact, against euthanasia and assisted suicide for a whole lot of reasons. I think it’s a mistake.

I think this is one of those fuzzy areas where it’s not clear what the profession and what society, some states have legalized it, some states haven’t. They’ve legalized assisted suicide, not euthanasia. And I do think it’s one of those places where we really are genuinely, as a society, uncertain. I’ve had patients ask me and I’ve explained to them why I don’t think it’s going to be necessary for them, and if it comes up, then we can talk about how to care for them.

Robert Duncan: Do these conceptual sort of philosophical divergences with the Church ever come up in meetings like the one you’ve been at? Did any of the priests or hierarchy, the bishops that are present ever challenge you on any of the issues, or do you ever have constructive dialogues?

Dr. Emanuel: In this conference so far, no. I haven’t been challenged. I mean, we haven’t really talked about abortion or euthanasia. On euthanasia, I think I actually have, my justification or reasons are different than the Church’s as far as I understand it, but I think we come to the same conclusion about that.

Robert Duncan: What are yours?

Dr. Emanuel: On euthanasia? I can imagine, I mean, if you’re an oncologist, it’s hard to say you can’t imagine circumstances, or you haven’t experienced circumstances where if a patient said, I want euthanasia or assisted suicide, you can’t imagine. That seems like a pretty legitimate. On the other hand, I think almost all the cases that you read about, that I read about, I find I don’t think you need them. First of all, it’s a very complicated issue. Most people think that the reason to give euthanasia or assisted suicide is excessive pain. It turns out that is very rarely the reason for people. The reason for people is mostly wanting to control self-determination, wanting their control at the end, their worry about the loss of autonomy. I don’t find that a very persuasive argument, especially if you are terminally ill and you are going to die. The other thing is we clearly know there’s a big debate in the 90s and 2000s whether there was a slippery slope. If you legalize it for this patient, will it…? There is no debate today, can be no debate today, only people who want to put their heads in the sand. There is a slippery slope. Once you do it for a defined group, well, now we can do it for people who are mentally ill. We can do it for infants who have these problems and things like that. So there’s no doubt it’s a slippery slope. The conditions expand that you find acceptable, and I find that unacceptable. I think if you can imagine legitimate cases for euthanasia, they should be pretty darn narrow, and the idea. So I prefer to have it illegal, and for any person who engages in it, any physician who engages, to have to justify it. It turns out in America we’ve had one person who’s been convicted in this, Mr. Kevorkian, a guy who did not stick to any of the rules, violated them on TV. So I think actually it shows that if you have a good reason, most juries and most prosecutors would like, well, it’s not worth prosecuting. There was a good reason behind it. So that’s the kind of circumstance. Does it put someone in potential jeopardy? Yeah, but you should take this exceedingly seriously.

“There … can be no debate today, only people who want to put their heads in the sand. There is a slippery slope. Once you do (euthanasia) for a defined group, well, now we can do it for people who are mentally ill. We can do it for infants who have these problems.”

Robert Duncan: What about your trip so far has surprised you? I mean, to Rome and working with the Vatican at this visit.

Dr. Emanuel: Those are two different things. So here’s one. You come to Rome, and the first thing you are confronted by is you’ve got all these ruins that are 2,000 years old. You have to step back and say it’s amazing that they built something that lasted 2,000 years, right? You go to New York, Washington, Chicago. Anything there going to last 2,000 years? And the answer is no, quite clearly no. We don’t think in that kind of timeline. We don’t build for that kind of timeline. We don’t think about, well, what’s necessary for that kind of timeline. And that, I think, changes your mental attitude a lot. We think, well, if it’s going to last 30 or 40 years, that’s great. But I think that actually changes your perspective. And again, going back to what am I going to do? I inherit a lot from the past. What am I going to do to further that and perpetuate it? The second thing, and this probably is far from what you are thinking, but the second thing that strikes you is how little perch the cell phone has in this place. You go to restaurants. You go to wine bars here. And the overwhelming sense is people are actually talking to one another. They’re not on their phones doing parallel play. And I think that’s pretty amazing. It’s a very different phenomenon than exists in the United States where you can go into a restaurant and each side is sort of doing the phone thing. And the result is obviously a lot more social connection. It’s also structurally here. You’ve got a lot more piazzas. You’ve got a lot more parks. There are a lot more venues. I mean, a lot of narrow streets where people are just cheek by jowl interacting. And I think that’s pretty amazing.

Robert Duncan: I don’t want to jump ahead too much, but one of the things in your book that you say is important to general well-being is social health. So there’s something about these medieval societies’ architecture that we engineered it for.

Dr. Emanuel: Yes. Well, partly they didn’t have a car. I mean, one of the big differences between cities developed after 1900 and cities before is the car. And yes, that’s overwhelming. But it also ended up designed to bring people together. You had central fountains. You had central water supplies. There are lots of things that encourage people to interact, and you see it. It still exists in the 21st century, again, thinking about how you design cities and how you design places that people are encouraged to interact. I mean, I think one of the big issues, a question that was asked at the press conference about the rich and poor. One of the things that’s happened in society is the segregation, not on race basis but on income basis, on experience basis. So we are, especially in the United States, very much segregated by political affiliation, by income, and other things. And the opportunity to intermingle very much reduced. It used to be sports was, when I was growing up in Chicago, going to a Cubs game, sitting in the bleachers, was a buck, $1. All right? This is the 1960s. Anyone could afford a dollar for three hours of entertainment. And you mix with lots of different kinds of people for a buck. Very hard to do today. Very hard to do. So I think those kind of opportunities, kind of really important to figure out how we can bring them back to American society, society in general, that phenomena. We are at the far extreme in the United States, but exists everywhere.

Robert Duncan: I’ve heard a lot of arguments over the years about the ways in which classical civilization got being human right from the perspective of classical architecture, beauty in these civilizations. But I’ve never heard quite the argument that they were good for human beings because of — from a perspective of public health.

Dr. Emanuel: Yeah, I think it’s actually, I don’t know if it’s medieval so much as, you know, pre-car, by and large, where it takes you, you know, you can experience this in American cities. I live in Philadelphia, right? You walk in Philadelphia, you’ve got a grid in center city, and it’s definitely, you can easily walk to places. The roads are narrow, the whole city is pretty narrow, and it actually affords lots more opportunities to interact.

Robert Duncan: So you’ve talked about Rome, but what about the Vatican? What about your experience here working with Vatican officials has been noteworthy? Has there been anything that surprised you or…?

Dr. Emanuel: I mean, well, I will say, first of all, I was very impressed by the Pope’s speech. This was an opportunity for the Pope. He gave us 10 minutes, but he clearly, he cares broadly and he wants to make sure that we are inclusive of people from all different backgrounds and that we do think of the fact that it’s very important to focus on the common good so everyone can have opportunities for health, for a long life. That clearly came out, and I think very, very thoughtful in that regard. I would say the people I’ve interacted with in planning this and in participating, very much open to hearing views. There’s nothing particularly Catholic or not Catholic about my views. It wasn’t, if there’s any strong moral undertone to my view, it’s like heavily emphasizing children and prioritizing health care for children, which I think we all tend to underdo because it tends to be sick people who are sick people, old people who tend to have more illnesses. But I think also there is an importance of making sure health care doesn’t financially burden people. We think often in poor countries that people have to pay a lot of money to get health care services, but the same is true in rich countries. And I think making sure that doesn’t become the norm is very, very important. I do think the other thing is this sort of care of how are we going to deal with an aging society is one of those very, very strong themes here. I don’t think we’ve answered it by any stretch of the imagination, but it’s a very, very strong theme that everyone’s going to, all societies are going to have to confront over the next few decades.

Robert Duncan: You bring up the issue of aging populations and population decline. That’s something clearly present in Europe with regard to the birth rate. Was that something that came up during these meetings and how is the Vatican thinking about that?

Dr. Emanuel: Well, it is certainly come up right from the start. Dr. Colombo from OECD talked about the demands, mainly because of the aging population, the workforce gap with the amount of aging people. And that, I think, plus the number of workers who are going to support that, the ratio is going down. And so how we balance this and where the resources come from, I think, is a big issue. And I know we haven’t resolved it. I think no country has a secret message on that.

Robert Duncan: You talked about Pope Leo. Did you meet him afterwards? Did you have a chance to shake his hand?

Dr. Emanuel: Yes.

Robert Duncan: What did you say to him?

Dr. Emanuel: I did three things. I said that I was from Chicago. We actually grew up in the city around about the same time. He was on the south side. I was on the north side. That’s why he roots for the White Sox and I root for the Cubs. I gave him a jersey, collecting sports memorabilia, I think, from many people. But I’m 100% sure he doesn’t have it. It’s a jersey from the women’s professional basketball team in Chicago, the Chicago Sky. I gave him a jersey with Pope Leo and the Roman numeral 14 for him on there. Graciously accepted. And I gave him a copy of my book, Eat Your Ice Cream.

Robert Duncan: What did he say to you?

Dr. Emanuel: He was just very gracious about it.

Robert Duncan: Can we talk a bit about your book?

Dr. Emanuel: Sure.

Robert Duncan: There’s been a lot of interest in the media about it because you’re pushing back a little bit on the health and wellness industry and some of the scams or over promises that are out there. Can you tell me why you wrote it and sort of summarize in your own words a bit about this over interest perhaps in American culture with health and wellness?

Dr. Emanuel: Yeah. So there are really three streams that come together that motivated me to write the book. The first is I am a doctor. Lots of people ask me questions about what I should do. I relate one of them, you know, what diet are you on? What diet should I be on? I get asked about all sorts of supplements. I get asked about all sorts of activities. So constant requests for information about that which suggests that people aren’t getting something that they reliably trust. Second, many years ago I was at a conference, many years ago, about three or four years ago I was at a conference, and Arianna Huffington asked me a question about why isn’t there more wellness taught in medical school. And I said, well, you know, first of all, it’s pretty simple. There are six things. Second of all, no one is making a lot of money. You know, the health care system, hospitals aren’t making money on this. Drug companies aren’t making money on this. So there’s no real motivation within the health care system. And truth be told, we don’t focus on wellness in health care and medicine. And the last thing was actually the pivotal proximate cause, as I think you would say in the Catholic Church, was Peter Attia’s book, Outlive. Two years ago I got it. I had just finished teaching. Finals hadn’t come in. Grading wasn’t happening. And I read the book and it made me pissed off. No other word for it. I was just infuriated. First of all, all this emphasis on three things, physical things, exercise, which was the dominant thing, a little on food and a little on sleep. And I’m like leaving out the biggest, most important thing in health care and wellness and longevity, and that is social interaction. And so I then took the next three weeks before grades were due and I basically scribbled out the first version, the first draft of the book. And I just had to do some research, but I had most of it I had known. And if you look at the data on social interaction, it’s overwhelming that it’s the most important thing from a longevity standpoint, from a health standpoint, and from a happiness standpoint. And you can see lots and lots of studies about the social isolation is bad, increases your risk of mortality, social interaction is good, decreases your risk of mortality, plus increases your happiness factor in all sorts of interactions. And that’s true, by the way, even whether you’re an introvert or an extrovert. When introverts are asked to behave extroverted, initiate a conversation with a stranger, turns out they’re happier, even though they anticipate that they won’t be happy. It’ll be energy. I won’t learn anything. They’ll rebuff me. All of that turns out generally not, I mean, sometimes it’s true, but generally not to be true. People actually like talking. You actually turn out to be happier because you’ve communicated even with someone who’s not, you know, you don’t know.

Robert Duncan: So you have described yourself as a atheist, but practicing Jew.

Dr. Emanuel: Yeah.

Robert Duncan: And I wonder because some social scientists have pointed out that the decline in religious practice has led to some of the isolation that we see today as church or synagogue would have been the way in which you interacted with your broader community outside of your family, most regularly apart from work.

Dr. Emanuel: Yeah. Those are the three.

Robert Duncan: So I wonder if your own choice to go to synagogue has something to do with your own personal health and wellness program.

Dr. Emanuel: It’s not consciously, it wasn’t consciously as a mechanism to do wellness. I actually find reading the, what we call in Judaism, the Torah, but the five books of Moses, I think Old Testament quite meaningful, quite challenging to think through. I think there’s a lot of wisdom in that book. There is a reason it’s remains the world’s biggest bestseller. There’s a lot of stories there that have a lot of deep meaning. And they’re like, you know, ancient Greek myths or stories, very pithy descriptions of very deep issues. And therefore lots of people have been able to spin out interpretations and try to understand that. And so I find that quite enriching. And it’s as much intellectually enriching and morally enriching. So I don’t go to synagogue. I don’t go to synagogue, well, it’s going to keep me healthy. That’s not the reason.

Robert Duncan: It sounds like it could be a valid reason though.

Dr. Emanuel: Oh, for many people it is. Exactly. I mean, I think for many people, that’s as you point out, that’s a place where they have social connection. That’s a place where they can stay mentally engaged. That’s a place of community. Absolutely.

Robert Duncan: When I think about the title of your book, Eat Your Ice Cream, I think about feasting and how Christianity and Judaism share, albeit in different ways, feasts and fasts throughout the year. And when this podcast airs, Catholics will be halfway through Lent, looking forward perhaps to indulging in the thing that they gave up at Easter. And I wonder if you think that this ancient division of the year between feasts and fasts has some health or wellness message for contemporary society.

Dr. Emanuel: Well, and the Muslims have Ramadan and the Eid. So I think these are important communal activities. So in Judaism, we have Passover, which celebrates the leaving of Egypt, the gaining of freedom. And we eat lots of different foods. We deprive ourselves of certain foods. I think, again, I’m not sure how much was wellness and how much is sort of a communal activity, getting people together, but also thinking about what you’re eating, thinking about the meaning of that food. You know, in Judaism, we have a prayer before we eat, a blessing typically over bread. But if you’re not having bread over all the foods that you have, you have a grace after meals. I think those actually are very valuable practices. And they’re practices to make you appreciate that and pause for a minute before you get to serving and everything to appreciate that. You know, we’re lucky enough that we don’t have to go hungry and to appreciate the fact that we have this food. I think that’s a wonderful item. The sort of sequencing, I mean, for me, the sequencing of religion, I mean, there are lots of Jewish holidays, which I do not appreciate, Hanukkah being one of them. I don’t know that it’s actually a holiday we ought to celebrate. Led to a lot of problems in ancient Israel. But the idea of repentance, you know, that we are imperfect, I think is incredibly important. Thinking about moral growth over a year, thinking about how we’ve deviated over the year. I also think it’s kind of important, and this is a difference between Judaism and Catholicism. We only do it once a year and we do it in the fall. And if you think about repenting as a way of starting anew, I think it also, so why is it in the fall after you’ve harvested, you’re not planting? You know, part of that I do think is there’s this, you know, if you’ve planted a garden, you put in the bulbs and then you have to wait. And so it gives you a moment or many months of reflection about the kind of changes you want to put in place to grow.

Robert Duncan: So I’d like to return to where we began the conversation, reflecting on our mortality as part of the recipe for living a meaningful life. I wonder if in your work as an oncologist and dealing with difficult end of life related questions, you have ever been challenged in terms of your worldview or changed your mind about something in that, dare I say, privileged thin space, as some have described it to me, between this world and eternity that is often there in a patient’s last moments of life. What have you learned in those situations and how has it shaped you?

Dr. Emanuel: I do think the most important experience about being close to death, first of all, is people who survive have been in near death experiences and survive. I think the reorientation that that brings is a constant reminder to me about, you know, are you spending time thinking about the right things or doing the right things in the world? Or find a justification for why I’m doing something. And I think that’s a kind of important element. I will say the other thing that is very motivating to me, and I don’t know if it experiences for the same people, if you’re an oncologist, and I began treating patients in my early 30s, having someone who’s younger than you die is really transformative. It’s the sense of tragedy. This is very much, remember, a 19-year-old Yale student who was being treated for acute leukemia and unfortunately the chemotherapy on the first round didn’t work. It was in the second, very low chances that it was going to work. That really is powerful about focusing on kids and focusing on young adults and adolescents in particular. The snuffing out of life when it’s just about to take off. You know, you’ve done all this preparation through college and then you’re about to launch your own life separate from your parents. And that snuffing out I think is very, it weighs on you a lot. Even though you didn’t cause the disease, you did your best to fight it. But that is a transition moment that’s really important. Getting kids to that moment, giving them a safe, healthy launch, I think very much a motivator for me. I couldn’t treat pediatrics. It would just drive me nuts if I had to treat young kids. But I think trying to get kids or people who are younger to live a full life is very much important. And that has changed the way I think about health care. You know, at this conference, a lot of discussion about life expectancy and stuff. I actually think that’s a terrible metric. Life expectancy has gone up, it’s whatever, 84 in Japan and Switzerland and 79 in the United States. That’s not the right measure. The measure is who are the people at the bottom? Who are the people who are dying before 75? That’s the people we ought to really be thinking about and trying to do the most. You know, when someone, a recent actor who died at 49 from colorectal cancer, that’s a real problem. We are missing something here. That’s a totally curable disease. We should not be having young people die of that disease. Same thing of cervical cancer. We shouldn’t be having young people die of, women die of cervical cancer. And so I spend a lot of time thinking about, you know, a real metric ought to be how much are we bringing people up to so that they can live a full life. 75 is certainly full enough. 90 is, you know, if you’re in good health, better. But, you know, getting to 75, people should not be dying in their 40s and 50s.

Robert Duncan: I asked you earlier, what did you want to bring to the Vatican in terms of a message? And you said you were invited to speak on a certain key topic. But of all your experiences, having met the Pope, what do you think you will bring back, besides maybe stories about pistachio gelato, to either to your profession or into your personal life? Is there anything you’ll be bringing back with you?

Dr. Emanuel: Again, I think this Pope does seem to me to be very committed to a kind of equality, making sure people have enough for a good life and for their own life. I think that commitment and to the extent that it permeates what the Holy See does and the kind of leadership it can provide is very, very important. I do think, I sense certainly in the United States among the Catholics I know, a kind of hope for him that he humanizes the Catholic Church and is successful. I will say I’ve spent a lot of time thinking, well, if you were the Pope, maybe my egotistical, if you were the Pope, what would you do that would be really transformative? You know, I don’t know a lot about church history. It’s not been part of my education. But thinking about, you know, you had Vatican II. What equivalent could you do? It doesn’t have to be in the Catholic, you know, necessarily changing the theology, but could be very much in changing its role in the world. Anyway, I think it’s a very important question for everyone. Obviously the Pope is the top, but, you know, every bishop, every person who works for an organization like the Church. I have learned here, one of the important, is there’s been an increase in attendance at church, which certainly in France and Germany, and I think people aren’t quite sure why, but I do think there’s an important … if there’s a failure of liberalism, one of it is it doesn’t give a lot of meaning to life, leaves it to the individual to fill that in. We all have the challenge of, well, what, that’s a big question. You know, what’s the meaning of life? What’s the meaning of my life? And, you know, the Church can help people, I think, in that. There’s obviously a very long tradition of service in the Church, a long tradition of, you know, wrestling with big questions in various aspects. And I think reorienting the Church to help the world address that, I think, and help Catholics in particular, is very, very important. I mean, there are a billion Catholics in the world, right? An enormous, and in the United States, 25% or more of the population. So a lot of people listening and wanting, I think, guidance.

Robert Duncan: So I think that’s a really nice place to end. So, Dr. Ezekiel Emanuel, thank you for sitting down with Catholic News Service and for sharing a bit about your life and your work and your visit to the Vatican.

Dr. Emanuel: Thank you. Not all the questions I had anticipated. Many, many unusual ones.

Robert Duncan: I hope good ones, though.

Dr. Emanuel: Yes. Yeah. Challenged me.