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45The Unintended Consequences of Chile’s Neurorights Constitutional Reform: Moving beyond Negative Rights to CapabilitiesNeuroethics 15 (3): 1-11. 2022.As scholars envision a new regulatory or statutory neurorights schema it is important to imagine unintended consequences if reforms are implemented before their implications are fully understood. This paper critically evaluates provisions proposed for a new Chilean Constitution and evaluates this movement against efforts to improve the diagnosis of, and treatment for, individuals with disorders of consciousness within the broader context of disability law, international human rights, and a capab…Read more
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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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45Baseball and BioethicsCambridge Quarterly of Healthcare Ethics 14 (4): 434-443. 2005.David and I were at a conference on Amelia Island in Florida back in 1995. The meeting, sponsored by the University of Florida, was entitled, “Physician-Assisted Death: Implications for Patients, Care Providers, and Society,” a title that seems quaint given the controversy over the right to die engendered by the Schiavo case. But that's a different talk for a different time
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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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43The Ethical Imperative to Think about ThinkingCambridge Quarterly of Healthcare Ethics 23 (4): 386-396. 2014.While the medical ethics literature has well explored the harm to patients, families, and the integrity of the profession in failing to disclose medical errors once they occur, less often addressed are the moral and professional obligations to take all available steps to prevent errors and harm in the first instance. As an expanding body of scholarship further elucidates the causes of medical error, including the considerable extent to which medical errors, particularly in diagnostics, may be at…Read more
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39The Patient's WorkCambridge Quarterly of Healthcare Ethics 16 (1): 44-52. 2007.In The Healer's Power, Howard Brody placed the concept of power at the heart of medicine's moral discourse. Struck by the absence of “power” in the prevailing vocabulary of medical ethics, yet aware of peripheral allusions to power in the writings of some medical ethicists, he intuited the importance of power from the silence surrounding it. He formulated the problem of the healer's power and its responsible use as “the central ethical problem in medicine.” Through the prism of power he refracte…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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34Ideology and Microbiology: Ebola, Science, and Deliberative DemocracyAmerican Journal of Bioethics 15 (4): 1-3. 2015.
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34Disorders of Consciousness, Past, Present, and FutureCambridge Quarterly of Healthcare Ethics 28 (4): 603-615. 2019.Abstract:This paper, presented as the 2019 Cambridge Quarterly Neuroethics NetworkCharcot Lecture, traces the nosology of disorders of consciousness in light of 2018 practice guidelines promulgated by the American Academy of Neurology, the American College of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research. By exploring the ancient origins of Jennett and Plum’s persistent vegetative state and subsequent refinements in the classific…Read more
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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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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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30Reinvigorating ethics consultations: An impetus from the “quality” debate (review)HEC Forum 18 (4): 298-304. 2006.
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30Review of John H. Evans, The History and Future of Medical Ethics: A Sociological View 1 (review)American Journal of Bioethics 13 (6): 58-59. 2013.
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30Credentialing the Clinical Ethics Consultant: An Academic Medical Center Affirms Professionalism and PracticeJournal of Clinical Ethics 23 (2): 156-164. 2012.In response to national trends calling for increasing accountability and an emerging dialogue within bioethics, we describe an effort to credential clinical ethicists at a major academic medical center. This effort is placed within the historical context of prior calls for credentialing and certification and efforts currently underway within organized bioethics to engage this issue. The specific details, and conceptual rationale, behind the New York-Presbyterian Hospital’s graduated credentialin…Read more
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29The Therapeutic “Mis”conception: An Examination of its Normative Assumptions and a Call for its RevisionCambridge Quarterly of Healthcare Ethics 27 (1): 154-162. 2018.Dissecting Bioethics, edited by Tuija Takala and Matti Hayry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The department is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people’s actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are particularly …Read more
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29When Negative Rights Become Positive Entitlements: Complicity, Conscience, and CaregivingJournal of Clinical Ethics 23 (4): 308-315. 2012.Clinicians have an obligation to ensure that patients with adequate capacity can make autonomous decisions. Thus, patients who choose to forego treatment and leave hospitals “against medical advice” are typically allowed to do so. But what happens when they require clinicians’ assistance to physically leave? Is it incumbent upon clinicians to not only respect and fulfill patients’ requests with which they disagree, but to physically assist in their fulfillment? We attempt to develop an ethical f…Read more
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29The economics of clinical ethics programs: a quantitative justificationCambridge Quarterly of Healthcare Ethics 6 (4): 451-. 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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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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27Toward a Social Bioethics Through Interpretivism: A Framework for Healthcare EthicsCambridge Quarterly of Healthcare Ethics 33 (1): 6-16. 2024.Recent global events demonstrate that analytical frameworks to aid professionals in healthcare ethics must consider the pervasive role of social structures in the emergence of bioethical issues. To address this, the authors propose a new sociologically informed approach to healthcare ethics that they term “social bioethics.” Their approach is animated by the interpretive social sciences to highlight how social structures operate vis-à-vis the everyday practices and moral reasoning of individuals…Read more
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27Conflicts of Interest in Deep Brain Stimulation Research and the Ethics of TransparencyJournal of Clinical Ethics 21 (2): 125-132. 2010.In this article we will draw on experiences from our own research on deep brain stimulation of the central thalamus in the minimally conscious state. We describe ethical challenges faced in clinical research involving medical devices and offer several cautionary notes about its funding and the interplay of market forces and scientific inquiry and suggest some reforms.
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27Deep 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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26“Humanities are the Hormones:” Osler, Penfield and “Neuroethics” RevisitedAmerican Journal of Bioethics 8 (1): 5-8. 2008.If ever I summon before me my highest ideals of men and medicine, I find them sprung from the spirit of Osler. —Wilder Penfield, M.D. Neuroethics is a recently coined term that is shaping our cultu...
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25Resuscitating Patient Rights during the Pandemic: COVID-19 and the Risk of Resurgent PaternalismCambridge Quarterly of Healthcare Ethics 30 (2): 215-221. 2021.The COVID-19 Pandemic a stress test for clinical medicine and medical ethics, with a confluence over questions of the proportionality of resuscitation. Drawing upon his experience as a clinical ethicist during the surge in New York City during the Spring of 2020, the author considers how attitudes regarding resuscitation have evolved since the inception of do-not-resuscitate orders decades ago. Sharing a personal narrative about a DNR quandry he encountered as a medical intern, the author consid…Read more
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Cornell UniversityRegular Faculty
Ithaca, New York, United States of America