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18A Physician/Ethicist Responds: A Student's Rights Are Not So SimpleKennedy Institute of Ethics Journal 2 (1): 13-18. 1992.
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72Clinical Ethics Consultation: Examining how American and Japanese experts analyze an Alzheimeras caseBMC Medical Ethics 9 (1): 2-. 2008.BackgroundFew comparative studies of clinical ethics consultation practices have been reported. The objective of this study was to explore how American and Japanese experts analyze an Alzheimer's case regarding ethics consultation.MethodsWe presented the case to physicians and ethicists from the US and Japan (one expert from each field from both countries; total = 4) and obtained their responses through a questionnaire and in-depth interviews.ResultsEstablishing a consensus was a common goal amo…Read more
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31Response to Open Commentaries for "Propranolol and the Prevention of Post-Traumatic Stress Disorder: Is It Wrong to Erase the 'Sting' of Bad Memories?"American Journal of Bioethics 7 (9): 1-3. 2007.The National Institute of Mental Health reports that approximately 5.2 million Americans experience post-traumatic stress disorder each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important et…Read more
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30The stakes are not very high in this gameAmerican Journal of Bioethics 7 (4). 2007.This Article does not have an abstract
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46Back to the Future: Obtaining Organs from Non-Heart-Beating CadaversKennedy Institute of Ethics Journal 3 (2): 103-111. 1993.In lieu of an abstract, here is a brief excerpt of the content:Back to the Future:Obtaining Organs from Non-Heart-Beating CadaversRobert M. Arnold (bio) and Stuart J. Youngner (bio)Organ Transplantation requires viable donor organs. This simple fact has become the Achilles' heel of transplantation programs. Progress in immunology and transplant surgery has outstripped the supply of available organs. Between 1988 and 1991, for example, the number of transplant candidates on waiting lists increase…Read more
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4Physician-Assisted Death in Perspective: Assessing the Dutch Experience (edited book)Cambridge University Press. 2012.This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. S…Read more
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109Intrinsic Conflicts of Interest in Clinical Research: A Need for DisclosureKennedy Institute of Ethics Journal 13 (2): 83-91. 2003.: Protection of human subjects from investigators' conflicts of interest is critical to the integrity of clinical investigation. Personal financial conflicts of interest are addressed by university policies, professional society guidelines, publication standards, and government regulation, but "intrinsic conflicts of interest"—conflicts of interest inherent in all clinical research—have received relatively less attention. Such conflicts arise in all clinical research endeavors as a result of the…Read more
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28Ethics Without Borders? Why The United States Needs an International Dialogue on Living Organ DonationIn Akira Akabayashi (ed.), The Future of Bioethics: International Dialogues, Oxford University Press. 2014.
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56Some Must DieZygon 38 (3): 705-724. 2003.The transplantation and procurement of human organs has become almost routine in American society. Yet, organ transplantation raises difficult ethical and psychosocial issues in the context of “controlled” death, including the blurring of boundaries between life and death, self and other, healing and harming, and killing and letting die. These issues are explored in the context of the actual experiences of organ donors and recipients, brain death, the introduction of non‐heartbeating donor proto…Read more
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37Task Force on Standards for Ethics Consultation: Response to “Ethics Consultation: The Least Dangerous Profession?” (review)Cambridge Quarterly of Healthcare Ethics 5 (2): 284. 1996.
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65The Dead Donor Rule: Should We Stretch It, Bend It, or Abandon It?Kennedy Institute of Ethics Journal 3 (2): 263-278. 1993.The dead donor rule—that persons must be dead before their organs are taken—is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbol…Read more
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31Patients?Attitudes Toward Hospital Ethics CommitteesJournal of Law, Medicine and Ethics 12 (1): 21-25. 1984.
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38Should Psychiatrists Serve as Gatekeepers for Physician‐Assisted Suicide?Hastings Center Report 28 (4): 24-31. 1998.Mandating psychiatric evaluation for patients who request physician‐assisted suicide may not offer the clearcut protection from possible coercion or other abuse that proponents assert. Competence itself is a complex concept and determinations of decisionmaking capacity are not straightforward, nor is the relationship between mental illness and decisionmaking capacity in dying patients clearly understood. And casting psychiatrists as gatekeepers in end‐of‐life decisions poses risks to the profess…Read more
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42The Texas Advanced Directive Law: Unfinished BusinessAmerican Journal of Bioethics 15 (8): 34-38. 2015.The Texas Advance Directive Act allows physicians and hospitals to overrule patient or family requests for futile care. Purposefully not defining futility, the law leaves its determination in specific cases to an institutional process. While the law has received several criticisms, it does seem to work constructively in the cases that come to the review process. We introduce a new criticism: While the law has been justified by an appeal to professional values such as avoiding harm to patients, a…Read more
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70A Pilot Evaluation of Portfolios for Quality Attestation of Clinical Ethics ConsultantsAmerican Journal of Bioethics 16 (3): 15-24. 2016.Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and sugge…Read more
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35The Definition of DeathIn Bonnie Steinbock (ed.), The Oxford handbook of bioethics, Oxford University Press. 2007.Two factors, medical science's growing control over the timing of death and the increasingly desperate need for organs, have led to a reopening of the debate about the definition of death and have forced a consideration of aspects of the determination of death that had never been addressed before. Without the pressing need for organs, the definition of death would have remained on the back shelf, the conversation of a few interested philosophers or theologians. This article examines some new que…Read more
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27Original ArticlesHastings Center Report 29 (6): 14-21. 1999.One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.
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11Commentary on" Is Mr. Spock Mentally Competent?"Philosophy, Psychiatry, and Psychology 5 (1): 89-92. 1998.
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Organizational ethics: promises and pitfallsIn Mark P. Aulisio, Robert M. Arnold & Stuart J. Youngner (eds.), Ethics consultation: from theory to practice, Johns Hopkins University Press. 2003.
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21Patient‐Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?Hastings Center Report 45 (3): 43-51. 2015.The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost. We begin this paper with an overview of the concept of patient satisfaction, which remains poorly and variously defined. Next, we trace the evolution of patient‐satisfaction surveys, including both their useful and problematic aspects. We then describe the effects of these surveys, the most troubling of which …Read more
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32Response to Open Peer Commentaries on “The Texas Advanced Directive Law: Unfinished Business”American Journal of Bioethics 15 (9): 6-7. 2015.
Cleveland, Ohio, United States of America