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10Disorders of Consciousness, Disability Rights and Triage During the COVID-19 PandemicJournal of Philosophy of Disability 1 211-229. 2021.As a member of the New York State Task Force on Life and the Law and the author of Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness, the author draws upon his work as a clinical ethicist during the COVID-19 Spring surge in New York to analyze the impact of ventilator allocation guidelines proposed by the Task Force on people with disorders of consciousness. While a non-discriminatory methodology was intended by the Task Force, the author concludes that the guidelines …Read more
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10The COVID-19 Crisis and Clinical Ethics in New York CityJournal of Clinical Ethics 31 (3): 228-232. 2020.The COVID-19 pandemic that struck New York City in the spring of 2020 was a natural experiment for the clinical ethics services of NewYork-Presbyterian (NYP). Two distinct teams at NYP’s flagship academic medical centers—at NYP/ Columbia University Medical Center (Columbia) and NYP/ Weill Cornell Medical Center (Weill Cornell)—were faced with the same pandemic and operated under the same institutional rules. Each campus used time as an heuristic to analyze our collective response. The Columbia t…Read more
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9Once and Future Clinical Neuroethics: A History of What Was and What Might BeJournal of Clinical Ethics 30 (1): 27-34. 2019.While neuroethics is generally thought to be a modern addition to the broader field of bioethics, this subdiscipline has existed in clinical practice throughout the course of the 20th century. In this essay, Fins describes an older tradition of clinical neuroethics that featured such physician-humanists as Sir William Osler, Wilder Penfield, and Fred Plum, whose work and legacy exploring disorders of consciousness is highlighted. Their normative work was clinically grounded and focused on the ne…Read more
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9Consciousness, Conflations, and Disability Rights: Denials of Care for Children in the “Minimally Conscious State”Journal of Law, Medicine and Ethics 50 (1): 181-183. 2022.This essay critiques the fiercely utilitarian allocation scheme of Cameron et al. Children have no hope of recovery if their lives are cut short based on administrative protocols that misrepresent the nature of their conditions. Unilateral futility judgements - especially those based on a false predicate - are discriminatory. When considering the best interests of children, we should see possibility in disability and not advance ill-informed utilitarianism.
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9A Survey of Physicians’ Attitudes toward Decision-Making Authority for Initiating and Withdrawing VA-ECMO: Results and Ethical Implications for Shared Decision MakingJournal of Clinical Ethics 27 (4): 281-289. 2016.Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO),…Read more
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8Fee Disclosure at a CostHastings Center Report 44 (6): 3-3. 2014.A commentary on “Financial Side Effects: Why Patients Should Be Informed of Costs,” by Alicia Hall, in the May‐June 2014 issue.
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8Meaningful Use of Electronic Health Records for Quality Assessment and Review of Clinical Ethics ConsultationJournal of Clinical Ethics 29 (1): 52-61. 2018.Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but to our knowledge, electronic health record (EHR) systems are not necessarily designed to easily include CE consultation notes. This article provides a framework for the inclusion of CE consultation notes into the formal EHR, describing a developed system in the Epic EHR that allows for the elaborate…Read more
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8Differences That Make a Difference in Disorders of ConsciousnessAmerican Journal of Bioethics Neuroscience 8 (3): 131-134. 2017.
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8Phases of a Pandemic Surge: The Experience of an Ethics Service in New York City during COVID-19Journal of Clinical Ethics 31 (3): 219-227. 2020.When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics ad…Read more
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7Brain Device Research and the Underappreciated Role of Care Partners before, during, and Post-TrialAmerican Journal of Bioethics Neuroscience 13 (4): 236-239. 2022.The number of clinical trials for experimental brain implants continues to grow, and with this growth comes an increased reliance upon patients with treatment-refractory conditions to volunteer as...
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7Confronting Traumatic Brain Injury: Devastation, Hope and Healing (review)Hastings Center Report 29 (2): 49. 1999.
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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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6Distinguishing Professionalism and Heroism When Disaster StrikesCambridge Quarterly of Healthcare Ethics 24 (4): 373-384. 2015.
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6Logicality and Regulatory Ethics: Lessons from the Bucharest Early Intervention ProjectHastings Center Report 44 (4): 13-17. 2014.
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6The Rise of Hospitalists: An Opportunity for Clinical EthicsJournal of Clinical Ethics 28 (4): 325-332. 2017.Translating ethical theories into clinical practice presents a perennial challenge to educators. While many suggestions have been put forth to bridge the theory-practice gap, none have sufficiently remedied the problem. We believe the ascendance of hospital medicine, as a dominant new force in medical education and patient care, presents a unique opportunity that could redefine the way clinical ethics is taught. The field of hospital medicine in the United States is comprised of more than 50,000…Read more
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5In Remembrance, with Thanks to VoltaireCambridge Quarterly of Healthcare Ethics 25 (1): 108-110. 2016.
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5Praxis Makes Perfect?Hastings Center Report 23 (5): 16-19. 1993.Hospital formulary committees blend cost‐effectiveness analysis, peer review, and continuing medical education to regulate hospital drug purchases and physicians' prescribing patterns in ways that may be instructive to the societal debate on health care reform.
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5Identity Theft, Deep Brain Stimulation, and the Primacy of Post‐trial ObligationsHastings Center Report 54 (1): 34-41. 2024.Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a…Read more
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5Meeting the Challenge of COVID-19: The Response of Two Ethics Consultation Services in New York CityJournal of Clinical Ethics 31 (3): 209-211. 2020.From mid-March through May 2020, New York City was the world’s epicenter of the COVID-19 pandemic, and its hospitals faced an unparalleled surge of patients who were critically ill with the virus. In addition to putting an enormous strain on medical resources, the pandemic presented many ethical issues to emotionally and physically stressed clinicians and hospital administrators. Analyses of the challenges faced by the ethics consultation services of the two campuses of New York Presbyterian Hos…Read more
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5Klinischer Pragmatismus: eine Methode moralischer ProblemlösungIn Nikola Biller-Andorno, Settimio Monteverde, Tanja Krones & Tobias Eichinger (eds.), Medizinethik, Springer Fachmedien Wiesbaden. pp. 111-129. 2021.Der folgende Artikel ist im Jahr 2003 unter dem Titel „Clinical Pragmatism: A Method of Moral Problem Solving“ in dem Sammelband „Pragmatic bioethics“ erschienen, welcher sich mit der Bedeutung der pragmatistischen Philosophie für die Praxis befasst. In dem vom Internisten und Bioethiker Joseph J. Fins, dem Thoraxchirurgen Matthew D. Bacchetta und dem Philosophen und Medizinethiker Franklin G. Miller verfassten Beitrag wird der pragmatistische Ansatz in der klinischen Ethik anhand eines Fallbeis…Read more
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4The Authors ReplyHastings Center Report 43 (6): 6-6. 2013.A response to a commentary by Howard Brody and Luana Colloca about “What's Not Being Shared in Shared Decision‐Making?” from the July‐August 2013.
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4Decisional Humility and the Marginally Represented PatientAmerican Journal of Bioethics 20 (2): 51-53. 2020.Volume 20, Issue 2, February 2020, Page 51-53.
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4On the Lingua Franca of Clinical EthicsJournal of Clinical Ethics 24 (4): 323-331. 2013.In this 25-year retrospective on the state of clinical ethics, and the anniversary of the founding of The Journal of Clinical Ethics, the author comments on the state of the field. He argues that the language of bioethics, as used in practice, seems dated and out of touch with a clinical reality marked by emerging technologies and the advent of new fields like palliative medicine.Reflecting on his experiences as a clinician and clinical ethicist, the author worries about the emergence of a shall…Read more
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4Islam 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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4The Authors ReplyHastings Center Report 44 (2): 4-4. 2014.Reply to a commentary by Kate Robins‐Browne.
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3Guest Editorial: The Many Voices of Spanish Bioethics—An IntroductionCambridge Quarterly of Healthcare Ethics 18 (3): 214-217. 2009.Edmund Pellegrino noted that contemporary medicine is to a large extent a North American product, and so too is the ethics that accompanies it. This was an accurate observation back in the 1980s when he said it. Even today bioethics is to a considerable extent informed by the seminal works of the Anglo-American model, at least seen from the United States. The dissemination of ideas from the Spanish-speaking world has been nearly invisible to the English-speaking world of bioethics, isolated by l…Read more
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Cornell UniversityRegular Faculty
Ithaca, New York, United States of America