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9Differences That Make a Difference in Disorders of ConsciousnessAmerican Journal of Bioethics Neuroscience 8 (3): 131-134. 2017.
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21Deep Brain Stimulation as a Probative Biology: Scientific Inquiry and the Mosaic DeviceAmerican Journal of Bioethics Neuroscience 3 (1): 4-8. 2012.Building upon an earlier critique of the Food and Drug Adminstration (FDA) granting of a humanitarian device exemption for deep brain stimulation in treatment-resistant obsessive compulsive disorder, this article considers how we regulate and finance DBS. It suggests that these devices are mosaic in nature: both potentially therapeutic and probative and that their dual roles need to be appreciated to maximize their therapeutic and investigational potential.
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20Off the Charts: Medical documentation and selective redaction in the age of transparencyPerspectives in Biology and Medicine 61 (1): 118-129. 2018.A 47-year-old woman with a history of anxiety disorder is admitted to the hospital for shortness of breath. On the third day of hospitalization, she asks her physician for a copy of all documents pertaining to her care. What expectation should she have for full disclosure? Are there limits on her access to her medical records and do her physician's concerns about professional privilege matter?The virtues of transparency in medicine have been well described. As proponents of transparency, we favo…Read more
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7Confronting Traumatic Brain Injury: Devastation, Hope and Healing (review)Hastings Center Report 29 (2): 49. 1999.
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25Mosaic Decisionmaking and Reemergent Agency after Severe Brain InjuryCambridge Quarterly of Healthcare Ethics 27 (1): 163-174. 2018.
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1Death, dying and informatics: misrepresenting religion on MedLineBMC Medical Ethics 6 (1): 6. 2005.Background The globalization of medical science carries for doctors worldwide a correlative duty to deepen their understanding of patients' cultural contexts and religious backgrounds, in order to satisfy each as a unique individual. To become better informed, practitioners may turn to MedLine, but it is unclear whether the information found there is an accurate representation of culture and religion. To test MedLine's representation of this field, we chose the topic of death and dying in the th…Read more
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3The Face of Finitude (review)Hastings Center Report 25 (2): 38-38. 2012.Book reviewed in this article: How We Die. By Sherwin B. Nuland. New York: Alfred A. Knopf.
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Protecting human subjects in brain research: a pragmatic perspectiveNeuroethics. Defining the Issues in Theory, Practice and Policy. forthcoming.
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45Neuroethics and the lure of technologyIn Judy Illes & Barbara J. Sahakian (eds.), Oxford Handbook of Neuroethics, Oxford University Press. pp. 895--907. 2011.Neuroethics, as a domain of inquiry, was made necessary by this interdisciplinary march of technology that has been much documented and the resulting synergism, which resulted in the development of neuroimaging, deep brain stimulation, and advanced neuropharmaceutics. Closing the loop from discovery of basic mechanisms of illness to knowledge of structure and function en route to restorative therapeutics is a long way from earlier efforts to use electrical stimulation to address human maladies. …Read more
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13The Physician-Assisted Suicide and Euthanasia Debate: An Annotated Bibliography of Representative ArticlesJournal of Clinical Ethics 5 (4): 329-340. 1994.
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13Introduction to the Special IssuePerspectives in Biology and Medicine 60 (1): 1-1. 2017.Bioethics has been an interdisciplinary field since its inception. From the founding of the Hastings Center in 1969 and the Kennedy Institute of Ethics in 1971, scholars from many disciplines have come together to create a field of study strengthened by its interdisciplinarity. In this special issue of Perspectives in Biology and Medicine, we celebrate the interdisciplinary character of bioethics by means of essays by eight distinguished bioethics scholars hailing from backgrounds in philosophy,…Read more
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20Mediative Fluency and Futility DisputesPerspectives in Biology and Medicine 60 (3): 373-382. 2018.It is generally agreed that physicians should not provide futile interventions, for the obvious reason that an intervention without utility causes harm without benefit. However, despite efforts to standardize a definition, there is a lack of universal consensus as to what constitutes “futility.” Two recent policy statements object to the terminology of futility based on the lack of a universal definition. Schneiderman, Jecker, and Jonsen object to the proposed alternative terminology of “inappro…Read more
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27The Effects of Closed-Loop Medical Devices on the Autonomy and Accountability of Persons and Systems—CORRIGENDUMCambridge Quarterly of Healthcare Ethics 26 (1): 180. 2017.
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47The Effects of Closed-Loop Medical Devices on the Autonomy and Accountability of Persons and SystemsCambridge Quarterly of Healthcare Ethics 25 (4): 623-633. 2016.
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16Rethinking Disorders of Consciousness: New Research and Its ImplicationsHastings Center Report 35 (2): 22. 2005.
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12How We DieHastings Center Report 25 (2): 38. 1995.Book reviewed in this article: How We Die. By Sherwin B. Nuland. New York: Alfred A. Knopf.
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28My Time in MedicinePerspectives in Biology and Medicine 60 (1): 19-32. 2017.Autobiographical essays can be an indulgence. Often self-congratulatory and low on self-reflection, they seldom serve a purpose other than to stoke nostalgia. So when given this opportunity to write about my life in medicine and bioethics, I decided I would take stock, and not simply celebrate whatever accomplishments I might have had. Rather, I would use this opportunity to look for themes that linked the decades together. My hope was that the process might assemble the mosaic that has been my …Read more
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13Giving Voice to ConsciousnessCambridge Quarterly of Healthcare Ethics 25 (4): 583-599. 2016.Abstract:In the 2015 David Kopf Lecture on Neuroethics of the Society for Neuroscience, Dr. Joseph Fins presents his work on neuroethics and disorders of consciousness through the experience of Maggie and Nancy Worthen, a young woman who sustained a severe brain injury and her mother who cared for her. The central protagonists in his book,Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness(Cambridge University Press, 2015), their experience is emblematic of the challenge…Read more
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4Iberian Influences on Pan-American Bioethics: Bringing Don Quixote to Our ShoresCambridge Quarterly of Healthcare Ethics 15 (3): 225-238. 2006.In early 2005, at the same Academy Awards ceremony in which Clint Eastwood's Million-Dollar Baby was named best film, a Spanish movie called Mar adentro by the young director Alejandro Amenábar received the Oscar for best foreign film of 2004. Though worlds apart esthetically, both films explore the themes of paraplegia and lives deemed not worth living, a cinematic coincidence that speaks of the enduring importance of issues such as these
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45Lights, camera, inaction? Neuroimaging and disorders of consciousnessAmerican Journal of Bioethics 8 (9). 2008.Without exaggeration, it could be said that we are entering a golden age of neuroscience. Informed by recent developments in neuroimaging that allow us to peer into the working brain at both a structural and functional level, neuroscientists are beginning to untangle mechanisms of recovery after brain injury and grapple with age-old questions about brain and mind and their correlates neural mechanisms and consciousness. Neuroimaging, coupled with new diagnostic categories and assessment scales a…Read more
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13DNR and ECMO: A Paradox Worth ExploringJournal of Clinical Ethics 25 (1): 13-19. 2014.Extracorporeal membrane oxygenation (ECMO) provides continuous circulation and/or oxygenation to adults with cardiac failure, pulmonary dysfunction, or both. The technology is similar to the traditional heart-lung bypass machines used during surgical procedures, however ECMO may be used outside the confines of the operating room and for extended periods of time. This paper explores the complexities, both clinical and ethical, of a donot-resuscitate (DNR) order for patients with cardiopulmonary f…Read more
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34Ideology and Microbiology: Ebola, Science, and Deliberative DemocracyAmerican Journal of Bioethics 15 (4): 1-3. 2015.
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22Approximation and Negotiation: Clinical Pragmatism and DifferenceCambridge Quarterly of Healthcare Ethics 7 (1): 68-76. 1998.When addressing cultural and religious differences in the clinical setting we need to be realists. Despite our public homage to pluralism and good intentions, it is just not possible to overcome all the differences that might exist and achieve perfect understanding of others. Try as we may, we will never be able to see perfectly the world through another's eyes. Instead of reaching for such perfection, we should instead reach for an approximation of shared understanding that will promote discour…Read more
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39Clinical pragmatism: Bridging theory and practiceKennedy Institute of Ethics Journal 8 (1): 37-42. 1998.: This response to Lynn Jansen's critique of clinical pragmatism concentrates on two themes: (1) contrasting approaches to moral epistemology and (2) the connection between theory and practice in clinical ethics. Particular attention is paid to the status of principles and the role of consensus, with some closing speculations on how Dewey might view the current state of bioethics
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Cornell UniversityRegular Faculty
Ithaca, New York, United States of America