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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.
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35Do Formal Advance Directives Affect Resuscitation Decisions and the Use of Resources for Seriously Ill Patients?Journal of Clinical Ethics 5 (1): 23-30. 1994.
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43A Conceptual Model for the Translation of Bioethics Research and ScholarshipHastings Center Report 46 (5): 34-39. 2016.While the bioethics literature demonstrates that the field has spent substantial time and thought over the last four decades on the goals, methods, and desired outcomes for service and training in bioethics, there has been less progress defining the nature and goals of bioethics research and scholarship. This gap makes it difficult both to describe the breadth and depth of these areas of bioethics and, importantly, to gauge their success. However, the gap also presents us with an opportunity to …Read more
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87Propranolol and the prevention of post-traumatic stress disorder: Is it wrong to erase the “sting” of bad memories?American Journal of Bioethics 7 (9). 2007.The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) 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 dru…Read more
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13The Psychological and Moral Consequences of Participating in Human Fetal-Tissue ResearchJournal of Clinical Ethics 4 (4): 356-358. 1993.
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73For Experts Only? Access to Hospital Ethics CommitteesHastings Center Report 21 (5): 17-24. 1991.How closely involved with hospital ethics committees should patients and their families become? Should they routinely have access to committees, or be empowered to initiate consultations? To what extent should they be informed of the content or outcome of committee deliberations? Seeing ethics committees as the locus of competing responsibilities allows us to respond to the questions posed by a patient rights model and to acknowledge more fully the complex moral dynamics of clinical medicine.
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94Philosophical debates about the definition of death: Who cares?Journal of Medicine and Philosophy 26 (5). 2001.Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics w…Read more
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15Do‐Not‐Resuscitate Orders: No Longer Secret But Still a ProblemHastings Center Report 17 (1): 24-33. 1987.Over the past decade, public discussion has focused on the ethics of issuing Do‐Not‐Resuscitate Orders, and the failure of many hospitals to acknowledge their actions openly. Recent efforts on the part of some hospitals to establish formal DNR guidelines that are prudent, fair, and humane, are a helpful beginning, though they cannot account for all the vagaries of illness and human communication. But concerns about DNR should not divert us from looking closely and rigorously at other, more commo…Read more
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87Death and organ procurement: Public beliefs and attitudesKennedy Institute of Ethics Journal 14 (3): 217-234. 2004.: Although "brain death" and the dead donor rule—i.e., patients must not be killed by organ retrieval—have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents ≥18 years were randomly selected and surveyed using random digit dialing (RDD) samp…Read more
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20The Authors ReplyHastings Center Report 45 (6): 4-5. 2015.A response to “CAHPS Surveys: Valid and Valuable Measures of Patient Experience,” byWilliam G. Lehrman and Mark W. Friedberg, and to “Courage, Context, and Contemporary Health Care,” by Jeffrey T. Berger
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56Ethics consultation: from theory to practice (edited book)Johns Hopkins University Press. 2003.In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns -- w…Read more
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28IntroductionKennedy Institute of Ethics Journal 14 (3): 211-215. 2004.In lieu of an abstract, here is a brief excerpt of the content:IntroductionStuart J. Youngner (bio), Laura A. Siminoff (bio), and Renie Schapiro (bio)This issue of the Kennedy Institute of Ethics Journal (KIEJ) centers on a piece of empirical research. The motivation behind the study of Laura Siminoff, Christopher Burant, and Stuart Youngner (2004) was to find out more about what the general public understands and believes about when a person is dead. More specifically, the study tried to determ…Read more
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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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45Back 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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