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21There is limited guidance on how to assess the ethical acceptability of research risks that extend beyond research participants to third parties (or “research bystanders”). Community or stakeholder engagement has been proposed as one way to address potential harms to community members, including bystanders. Despite widespread agreement on the importance of community engagement in biomedical research, this umbrella term includes many different goals and approaches, agreement on which is ethically…Read more
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12Bioethics as a VocationPerspectives in Biology and Medicine 63 (3): 429-443. 2020.In this essay I offer practical guidance aimed at promoting competence and success in the activity of bioethics scholarship. I present a set of maxims or rules of thumb, which I exemplify and explicate by drawing on my own work, encompassing 30 years of practicing bioethics scholarship, formal and informal mentoring, extensive peer reviewing for bioethics, biomedical, and philosophy journals, and several years as Deputy Editor of Perspectives in Biology and Medicine—an interdisciplinary journal …Read more
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124What makes killing wrong?Journal of Medical Ethics 39 (1): 3-7. 2013.What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality
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27Killing versus totally disabling: a reply to criticsJournal of Medical Ethics 39 (1): 12-14. 2013.We are very grateful to the commentators for taking the time to respond to our little article, ‘What Makes Killing Wrong?’ They raise many points, so we cannot respond to them all, but we do want to head off a few misinterpretations.Our critics in this journal avoid one careless misinterpretation, but less informed readers have pressed this misinterpretation in popular venues, so we need to start by renouncing it. We do not deny that killing humans is morally wrong. To the contrary, we argue tha…Read more
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33Research and complicity: the case of Julius HallervordenJournal of Medical Ethics 38 (1): 53-56. 2012.The charge of complicity has been raised in debates over the ethics of fetal tissue transplantation and embryonic stem cell research. However, the applicability of the concept of complicity to these types of research is neither clear nor uncontroversial. This article discusses the historical case of Julius Hallervorden, a distinguished German neuropathologist who conducted research on brains of mentally handicapped patients killed in the context of the Nazi ‘euthanasia’ programme. It is argued t…Read more
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18Introduction to the Special Issue on the Belmont ReportPerspectives in Biology and Medicine 63 (2): 219-219. 2020.The Belmont Report, issued in 1979 by the US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, is a landmark document providing guidance on the ethics of research involving human subjects. It is divided into three sections: “Boundaries between practice and research; “Basic ethical principles” ; and “Applications of these principles with respect to informed consent, assessment of risks and benefits, and selection of subjects.”While the Belmont Report …Read more
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7Revisiting the Distinction and the Connection Between Research and PracticePerspectives in Biology and Medicine 63 (2): 277-292. 2020.The Belmont Report begins with the sentence, “It is important to distinguish between biomedical and behavioral research, on the one hand, and the practice of accepted therapy on the other”. Writing an essay in a journal issue devoted to the 40th anniversary of the Belmont Report offers an opportunity not only to examine critically a theme addressed in this remarkable document—the distinction between research and practice—but also to reflect on the role of this theme as a major dimension of my wo…Read more
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10The Ethics of Everyday Life in the Midst of a PandemicHastings Center Report 50 (3): 6-7. 2020.Elderly individuals are at higher risk of serious illness and death if they become infected by the coronavirus. During the current pandemic, my wife and I, at ages seventy‐two and seventy‐one, respectively, have been paying a person laid off from a job to purchase groceries—a practice that exposes the shopper to risk of infection for our benefit. In this essay, I examine this practice with respect to the normative concepts of treating another person as a means, coercion, exploitation, and compli…Read more
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15Commentary: False Positives in the Diagnosis of Brain DeathCambridge Quarterly of Healthcare Ethics 28 (4): 648-656. 2019.
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58Phase 1 oncology trials and informed consentJournal of Medical Ethics 39 (12): 761-764. 2013.Ethical concerns have been raised about the quality of informed consent by participants in phase 1 oncology trials. Interview surveys indicate that substantial proportions of trial participants do not understand the purpose of these trials—evaluating toxicity and dosing for subsequent efficacy studies—and overestimate the prospect of therapeutic benefit that they offer. In this article we argue that although these data suggest the desirability of enhancing the process of information disclosure a…Read more
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34A Communitarian Approach to Physician-Assisted DeathCambridge Quarterly of Healthcare Ethics 6 (1): 78-87. 1997.The standard argument in favor of the practice of voluntary physician-assisted death, by means of assisted suicide or active euthanasia, rests on liberal, individualistic grounds. It appeals to two moral considerations: (1) personal self-determination—the right to choose the circumstances and timing of death with medical assistance; and (2) individual well-being—relief of intolerable suffering in the face of terminal or incurable, severely debilitating illness. One of the strongest challenges to…Read more
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13On Collaboration in Bioethics ScholarshipPerspectives in Biology and Medicine 62 (1): 31-40. 2019.I came to bioethics scholarship in 1990 at age 42. My first two published papers were solo-authored. But subsequently most of my bioethics research, including 223 articles and 22 book chapters written with many coauthors, has been collaborative; and my one monograph book, Death, Dying, and Organ Transplantation, was a collaborative venture with Robert Truog. As my academic field is philosophy, where collaborative work is rare, I had no background for doing this. I lacked any formal mentorship in…Read more
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47Drawing the line on physician-assisted deathJournal of Medical Ethics 45 (3): 190-197. 2019.Drawing the line on physician assistance in physician-assisted death continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the t…Read more
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12Reining in the Placebo EffectPerspectives in Biology and Medicine 61 (3): 335-348. 2018.The placebo effect, in recent years, has been the focus of extensive scientific inquiry and public fascination, as reflected in articles in the news media. Authors writing about placebo effects often mention the goal of harnessing the placebo effect for the benefit of patients in clinical practice. This suggests that the placebo effect is like a powerful horse, which needs to be put in harness in order to do useful work. However, developing an accurate understanding of what has been labelled, of…Read more
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34A Prescription for Ethical LearningHastings Center Report 43 (s1): 28-29. 2013.We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate …Read more
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36Medical Futility and "Brain Death"Perspectives in Biology and Medicine 60 (3): 400-402. 2018.I’m writing to underscore one point, which should be obvious, but which all too often has been neglected in the literature on medical futility. The futility of an action or an intervention is always relative to some goal. Consider the classical example of futility: carrying water in a sieve. If your goal is to transport a quantity of water without spilling some or all of it, then it is futile to do so by placing it in a sieve. But we can readily imagine children carrying water in the backyard in…Read more
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135Reframing Consent for Clinical Research: A Function-Based ApproachAmerican Journal of Bioethics 17 (12): 3-11. 2017.Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and …Read more
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15Challenging the Conventional Wisdom: From Philosophy to BioethicsPerspectives in Biology and Medicine 60 (1): 3-18. 2017.Kierkegaard famously declared that life is lived forwards but understood backwards. The retrospective look at one's career necessarily takes the form of a narrative reconstruction. Our lives are messier than the stories we tell about them.I first took up serious study of philosophy as a sophomore at Columbia College in 1967. The extensive core curriculum at Columbia exposes all students to a sampling of classic texts in philosophy. Some inkling of a more than passing interest in philosophy, whic…Read more
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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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13Facing DeathPerspectives in Biology and Medicine 59 (4): 581-586. 2016.Something has changed in America with respect to facing death. As I write this review of When Breath Becomes Air by Paul Kalanithi, it is number one on the New York Times nonfiction bestseller's list; number 10 is Being Mortal by Atul Gawande, on the list for 62 weeks. A few years ago, Christopher Hitchens's Mortality, a remarkable narrative of his living in the face of dying from esophageal cancer, also was a bestseller. While denial of death was thought to be an American characteristic, this m…Read more
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35The Ethics of Clinical Trials Research in Severe Mood DisordersBioethics 31 (6): 443-453. 2017.Mood disorders, including major depressive disorder and bipolar disorder, are highly prevalent, frequently disabling, and sometimes deadly. Additional research and more effective medications are desperately needed, but clinical trials research in mood disorders is fraught with ethical issues. Although many authors have discussed these issues, most do so from a theoretical viewpoint. This manuscript uses available empirical data to inform a discussion of the primary ethical issues raised in mood …Read more
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35Should a Legal Option of Physician-Assisted Death Include Those Who Are "Tired of Life"?Perspectives in Biology and Medicine 59 (3): 351-363. 2016.Recently, Canada’s National Post described in detail the death by lethal injection of a 94-year-old man, living alone, who had multiple medical problems but was not terminally ill. His son helped find a physician willing to administer lethal medication soon after his father told him he “wasn’t planning on adding another digit” to his age. The physician who complied with the request is a leading advocate for assisted death in Canada, who reportedly has been responsible for more than 30 life-termi…Read more
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42A narrative review of the empirical evidence on public attitudes on brain death and vital organ transplantation: the need for better data to inform policyJournal of Medical Ethics 41 (4): 291-296. 2015.
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13Protocol review within the context of a research programIRB: Ethics & Human Research 20 (4): 7. 1998.
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25Monotonicity of drive effects in the instrumental conditioning of attitudesBulletin of the Psychonomic Society 16 (5): 381-382. 1980.
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21Communication and conditioning: Correlated reinforcementBulletin of the Psychonomic Society 10 (1): 37-38. 1977.
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32Drive effects on instrumental response speed induced by intermittent disagreement in conversationBulletin of the Psychonomic Society 9 (1): 5-7. 1977.
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25Letters to the EditorProceedings and Addresses of the American Philosophical Association 59 (4). 1986.
Areas of Interest
Applied Ethics |