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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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112Clinical equipoise and the incoherence of research ethicsJournal of Medicine and Philosophy 32 (2). 2007.The doctrine of clinical equipoise is appealing because it appears to permit physicians to maintain their therapeutic obligation to offer optimal medical care to patients while conducting randomized controlled trials (RCTs). The appearance, however, is deceptive. In this article we argue that clinical equipoise is defective and incoherent in multiple ways. First, it conflates the sound methodological principle that RCTs should begin with an honest null hypothesis with the questionable ethical no…Read more
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82The clinician-investigator: Unavoidable but manageable tensionKennedy Institute of Ethics Journal 13 (4): 329-346. 2003.: The "difference position" holds that clinical research and therapeutic medical practice are sufficiently distinct activities to require different ethical rules and principles. The "similarity position" holds instead that clinical investigators ought to be bound by the same fundamental principles that govern therapeutic medicine—specifically, a duty to provide the optimal therapeutic benefit to each patient or subject. Some defenders of the similarity position defend it because of the overlap b…Read more
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54Paul Litton and Franklin G. Miller Reply to Madeline M. MottaJournal of Law, Medicine and Ethics 33 (4): 635-635. 2005.
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146Moral fictions and medical ethicsBioethics 24 (9): 453-460. 2009.Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of m…Read more
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19Forgoing Debriefing in Deceptive Research: Is It Ever Ethical?Ethics and Behavior 23 (2): 98-116. 2013.The use of deception in research is generally permitted so long as participants are debriefed at the conclusion of their participation. Several authoritative research ethics guidelines allow investigators to omit debriefing under certain circumstances, however. Here we examine various justifications for forgoing debriefing in deceptive research, including concerns about subject pool contamination, the risk that revealing the deception will be harmful or distressing to participants, and issues of…Read more
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13Letters: "Unduly Iterative Ethical Review?"Kennedy Institute of Ethics Journal 6 (2): 209-209. 1996.In lieu of an abstract, here is a brief excerpt of the content:“Unduly Iterative Ethical Review?”Franklin G. MillerMadam:Renée C. Fox and Nicholas A. Christakis have written a provocative article, “Perish and Publish: Non-Heart-Beating Organ Donation and Unduly Iterative Ethical Review” (KIEJ, December 1995). The language of their argument and some of the implicit assumptions on which it rests deserve critical scrutiny. They describe the articles presenting and commenting on the University of Pi…Read more
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30Clarifying the Nocebo Effect and Its Ethical ImplicationsAmerican Journal of Bioethics 12 (3): 30-31. 2012.The American Journal of Bioethics, Volume 12, Issue 3, Page 30-31, March 2012.
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7Striking the Right Balance in Research Ethics and RegulationAmerican Journal of Bioethics 10 (8): 65-65. 2010.This Article does not have an abstract
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44Principles of early stopping of randomized trials for efficacy: A critique of equipoise and an alternative nonexploitation ethical frameworkKennedy Institute of Ethics Journal 15 (2): 161-178. 2005.: Recent controversial decisions to terminate several large clinical trials have called attention to the need for developing a sound ethical framework to determine when trials should be stopped in light of emerging efficacy data. Currently, the fundamental rationale for stopping trials early is based on the principle that equipoise has been disturbed. We present an analysis of the ethical and practical problems with the "equipoise disturbed" position and describe an alternative ethical framework…Read more
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5Recruiting Research ParticipantsIn Ezekiel J. Emanuel (ed.), The Oxford textbook of clinical research ethics, Oxford University Press. pp. 397. 2008.
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34Placebo Effects and the Ethics of Therapeutic Communication: A Pragmatic PerspectiveKennedy Institute of Ethics Journal 26 (1): 79-103. 2016.Doctor–patient communication is a crucial component in any therapeutic encounter. Physicians use words to formulate diagnoses and prognoses, to disclose the risks and benefits of medical interventions, and to explain why, how, and when a therapy will be administered to a patient. Likewise, patients communicate to describe their symptoms, to make sense of their conditions, to report side effects, to explore other therapeutic options, and to share their feelings. Throughout the history of medicine…Read more
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174Misconceptions about coercion and undue influence: Reflections on the views of irb membersBioethics 27 (9): 500-507. 2012.Payment to recruit research subjects is a common practice but raises ethical concerns relating to the potential for coercion or undue influence. We conducted the first national study of IRB members and human subjects protection professionals to explore attitudes as to whether and why payment of research participants constitutes coercion or undue influence. Upon critical evaluation of the cogency of ethical concerns regarding payment, as reflected in our survey results, we found expansive or inco…Read more
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47Professional Integrity and Physician‐Assisted DeathHastings Center Report 25 (3): 8-17. 1995.The practice of voluntary physician‐assisted death as a last resort is compatible with doctors' duties to practice competently, to avoid harming patients unduly, to refrain from medical fraud, and to preserve patients' trust. It therefore does not violate physicians' professional integrity.
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81The internal morality of medicine: An introductionJournal of Medicine and Philosophy 26 (6). 2001.This Article does not have an abstract
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65When and Why Is Research without Consent Permissible?Hastings Center Report 46 (2): 35-43. 2016.The view that research with competent adults requires valid consent to be ethical perhaps finds its clearest expression in the Nuremberg Code, whose famous first principle asserts that “the voluntary consent of the human subject is absolutely essential.” In a similar vein, the United Nations International Covenant on Civil and Political Rights states that “no one shall be subjected without his free consent to medical or scientific experimentation.” Yet although some formulations of the consent p…Read more
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6Editors' IntroductionPerspectives in Biology and Medicine 59 (1): 1-1. 2016.On June 16, 1966, the New England Journal of Medicine published “Ethics and Clinical Research” by Henry K. Beecher. Beecher’s account of 22 examples of unethical contemporary clinical research shook up the medical profession and helped pave the way for U.S. federal regulation of research involving human subjects. Five decades later, in this issue of Perspectives in Biology and Medicine, we pay tribute to the lasting significance of this whistle-blowing article and to the remarkable contributions…Read more
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42Treatment-resistant depression and physician-assisted deathJournal of Medical Ethics 41 (11): 885-886. 2015.
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41Symposium on equipoise and the ethics of clinical trialsJournal of Medicine and Philosophy 32 (2). 2007.This Article does not have an abstract
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44The internal morality of medicine: Explication and application to managed careJournal of Medicine and Philosophy 23 (4). 1998.Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of …Read more
Areas of Interest
Applied Ethics |