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94Clinical pragmatism: A method of moral problem solvingKennedy Institute of Ethics Journal 7 (2): 129-143. 1997.: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinic…Read more
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16A Surgeon's DilemmaHastings Center Report 46 (3): 9-10. 2016.A thirty-year-old single mother with recurrent, metastatic, treatment-refractory cancer presents to the emergency room with severe difficulty breathing due to an obstructive tumor in her neck, compounded by progressive disease in her lungs and a new pulmonary embolism. She cannot be safely intubated and would require an emergent awake tracheotomy. Even if the airway can be successfully secured surgically, the likelihood that she will be able to be weaned from mechanical ventilation is very low. …Read more
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74Neuroethics and neuroimaging: Moving toward transparencyAmerican 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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81Islam and Informed Consent: Notes from DohaCambridge Quarterly of Healthcare Ethics 17 (3): 273-279. 2008.Informed consent is a perennial topic in bioethics. It has given the field a place in clinical practice and the law and is often the starting point for introductory instruction in medical ethics. One would think that nearly everything has been said and done on this well-worn topic
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49In Praise of the Humanities in Academic MedicineCambridge Quarterly of Healthcare Ethics 22 (4): 355-364. 2013.
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31Everyday DisastersCambridge Quarterly of Healthcare Ethics 14 (2): 207-213. 2005.“That's my dad on the floor.”And there he was unconscious in a pool of blood in the bathroom. A paramedic who had accompanied him to the john was holding him off the ground, the USMC tattoo on his forearm cradling his head. My sister shrieked, and I went down on my knees to see about his airway. “We need a doctor here. Cardiac Team!” Could this really be happening to him? To us? Jesus Christ
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17What's Wrong with Evidence‐Based Medicine?Hastings Center Report 46 (1). 2016.Medicine in the last decades of the twentieth century was ripe for a data sweep that would bring systematic analysis to treatment strategies that seemingly had stood the test of time but were actually unvalidated. Coalescing under the banner of evidence-based medicine, this process has helped to standardize care, minimize error, and promote patient safety. But with this advancement, something of the art of medicine has been lost
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4The Authors ReplyHastings Center Report 44 (2): 4-4. 2014.Reply to a commentary by Kate Robins‐Browne.
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24Border Zones of Consciousness: Another Immigration Debate?American Journal of Bioethics 7 (1): 51-54. 2007.
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3Iberian 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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43Lights, 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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21Approximation 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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24What's Not Being Shared in Shared Decision‐Making?Hastings Center Report 43 (4): 13-16. 2013.What's not to like about shared decision‐making? These programs employ specially crafted decision aids to educate patients about their treatment options and then merge the newly informed patient preferences, both general and treatment‐specific, with guidance from physicians to optimize medical decisions. Sounds great, right? Even better, recent evidence indicates that shared decision‐making programs may also help bend the proverbial cost curve by reducing the use of medical interventions that pa…Read more
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36Clinical 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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77Rethinking disorders of consciousness: New research and its implicationsHastings Center Report 35 (2): 22-24. 2005.
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30Brain Injury and the culture of Neglect: musings on an uncertain FutureSocial Research: An International Quarterly 78 (3): 731-746. 2011.Our essay will address both the right-to-die movement in America and the emerging culture of neglect in the treatment of a class of patients with disorders of consciousness with which the right-to-die movement is entwined. We trace the etiology of these two themes through changes in our scientific understanding of brain injury and recovery against a growing societal acculturation to dominion over one's self at life's end
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48Iberian Influences on Pan-American Bioethics: Bringing Don Quixote to Our ShoresCambridge Quarterly of Healthcare Ethics 15 (3): 225-238. 2006.
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7The Economics of Clinical Ethics Programs: A Quantitative JustificationCambridge Quarterly of Healthcare Ethics 6 (4): 451-460. 1997.The restructuring of the healthcare marketplace has exerted pressure directly and indirectly on clinical ethics programs. The fiscal orientation and emphasis on efficiency, outcome measures, and cost control have made it increasingly difficult to communicate arguments in support of the existence or growth of ethics programs. In the current marketplace, arguments that rely on the claim that ethics programs protect patient rights or assist in the professional formation of practitioners often resul…Read more
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Cornell UniversityRegular Faculty
Ithaca, New York, United States of America