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822For the Common Good: Philosophical Foundations of Research EthicsOxford University Press. 2021.The foundations of research ethics are riven with fault lines emanating from a fear that if research is too closely connected to weighty social purposes an imperative to advance the common good through research will justify abrogating the rights and welfare of study participants. The result is an impoverished conception of the nature of research, an incomplete focus on actors who bear important moral responsibilities, and a system of ethics and oversight highly attuned to the dangers of research…Read more
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447Patient-Funded Trials: Opportunity or Liability?Cell Stem Cell 17 (2): 135-137. 2015.Patient-funded trials are gaining traction as a means of accelerating clinical translation. However, such trials sidestep mechanisms that promote rigor, relevance, efficiency, and fairness. We recommend that funding bodies or research institutions establish mechanisms for merit review of patient-funded trials, and we offer some basic criteria for evaluating PFT protocols
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343Cutting to the Core: Exploring the Ethics of Contested SurgeriesRowman & Littlefield Publishers. 2006.When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery
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207The independence of practical ethicsTheoretical Medicine and Bioethics 22 (2): 87-105. 2001.After criticizing three common conceptions of therelationship between practical ethics and ethical theory, analternative modeled on Aristotle's conception of the relationshipbetween rhetoric and philosophical ethics is explored. Thisaccount is unique in that it neither denigrates the project ofsearching for an adequate comprehensive ethical theory norsubordinates practical ethics to that project. Because the purpose of practical ethics, on this view, is tosecure the cooperation of other persons …Read more
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207Artificial intelligence in medicine: Overcoming or recapitulating structural challenges to improving patient care?Cell Reports Medicine 100622 (3): 1-8. 2022.There is considerable enthusiasm about the prospect that artificial intelligence (AI) will help to improve the safety and efficacy of health services and the efficiency of health systems. To realize this potential, however, AI systems will have to overcome structural problems in the culture and practice of medicine and the organization of health systems that impact the data from which AI models are built, the environments into which they will be deployed, and the practices and incentives that st…Read more
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185Ethical Issues in Near-Future Socially Supportive Smart Assistants for Older AdultsIEEE Transactions on Technology and Society. forthcoming.Abstract:This paper considers novel ethical issues pertaining to near-future artificial intelligence (AI) systems that seek to support, maintain, or enhance the capabilities of older adults as they age and experience cognitive decline. In particular, we focus on smart assistants (SAs) that would seek to provide proactive assistance and mediate social interactions between users and other members of their social or support networks. Such systems would potentially have significant utility for users…Read more
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182Artificial Intelligence and Black‐Box Medical Decisions: Accuracy versus ExplainabilityHastings Center Report 49 (1): 15-21. 2019.Although decision‐making algorithms are not new to medicine, the availability of vast stores of medical data, gains in computing power, and breakthroughs in machine learning are accelerating the pace of their development, expanding the range of questions they can address, and increasing their predictive power. In many cases, however, the most powerful machine learning techniques purchase diagnostic or predictive accuracy at the expense of our ability to access “the knowledge within the machine.”…Read more
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163Moral Knowledge and the Acquisition of Virtue in Aristotle's "Nicomachean" and "Eudemian Ethics"Review of Metaphysics 54 (3). 2001.IN BOTH THE EUDEMIAN ETHICS AND THE NICOMACHEAN ETHICS, Aristotle says that the aim of ethical inquiry is a practical one; we want to know what virtue is so that we may become good ourselves and thereby do well and be happy. By classifying ethical inquiry as a practical endeavor, Aristotle is rejecting a view that he attributes to Socrates according to which ethics is a kind of theoretical science. In theoretical sciences, such as geometry or astronomy, the knowledge of a particular subject matt…Read more
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128Amenable to reason: Aristotle's rhetoric and the moral psychology of practical ethicsKennedy Institute of Ethics Journal 10 (4): 287-305. 2000.: An Aristotelian conception of practical ethics can be derived from the account of practical reasoning that Aristotle articulates in his Rhetoric and this has important implications for the way we understand the nature and limits of practical ethics. An important feature of this conception of practical ethics is its responsiveness to the complex ways in which agents form and maintain moral commitments, and this has important implications for the debate concerning methods of ethics in applied et…Read more
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112Sham Surgery and Genuine Standards of Care: Can the Two be Reconciled?American Journal of Bioethics 3 (4): 61-64. 2003.
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106The Place of Philosophy in Bioethics TodayAmerican Journal of Bioethics 22 (12): 10-21. 2021.In some views, philosophy’s glory days in bioethics are over. While philosophers were especially important in the early days of the field, so the argument goes, the majority of the work in bioethics today involves the “simple” application of existing philosophical principles or concepts, as well as empirical work in bioethics. Here, we address this view head on and ask: What is the role of philosophy in bioethics today? This paper has three specific aims: (1) to respond to skeptics and make the …Read more
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86Justice and the human development approach to international researchHastings Center Report 35 (1): 24-37. 2005.: The debate over when medical research may be performed in developing countries has steered clear of the broad issues of social justice in favor of what seem more tractable, practical issues. A better approach will reframe the question of justice in international research in a way that makes explicit the links between medical research, the social determinants of health, and global justice
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79The ambiguity and the exigency: Clarifying 'standard of care' arguments in international researchJournal of Medicine and Philosophy 25 (4). 2000.This paper examines the concept of a 'standard of care' as it has been used in recent arguments over the ethics of international human-subjects research. It argues that this concept is ambiguous along two different axes, with the result that there are at least four possible standard of care arguments that have not always been clearly distinguished. As a result, it has been difficult to assess the implications of opposing standard of care arguments, to recognize important differences in their sup…Read more
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69The prevailing discourse around AI ethics lacks the language and formalism necessary to capture the diverse ethical concerns that emerge when AI systems interact with individuals. Drawing on Sen and Nussbaum's capability approach, we present a framework formalizing a network of ethical concepts and entitlements necessary for AI systems to confer meaningful benefit or assistance to stakeholders. Such systems enhance stakeholders' ability to advance their life plans and well-being while upholding …Read more
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66Social value, clinical equipoise, and research in a public health emergencyBioethics 33 (3): 326-334. 2018.The 2016 CIOMS International ethical guidelines for health‐related research involving humans states that ‘health‐related research should form an integral part of disaster response’ and that, ‘widespread emergency use [of unproven interventions] with inadequate data collection about patient outcomes must therefore be avoided’ (Guideline 20). This position is defended against two lines of criticism that emerged during the 2014 Ebola outbreak. One holds that desperately ill patients have a moral ri…Read more
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65Clinical Equipoise: Foundational Requirement or Fundamental ErrorIn Bonnie Steinbock (ed.), The Oxford handbook of bioethics, Oxford University Press. 2007.Any view of equipoise faces perhaps the most radical and far-reaching objections from moral foundations. These objections hold that the equipoise requirement conflates the ethics of medical research and the ethics of clinical medicine. Once this conflation is recognized, this position holds, research can be given a new foundation on the imperative to avoid exploiting research participants. This article argues that what is novel in this critique is not as successful as its proponents claim and th…Read more
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64Adversaries at the Bedside: Advance Care Plans and Future WelfareBioethics 30 (8): 557-567. 2016.Advance care planning refers to the process of determining how one wants to be cared for in the event that one is no longer competent to make one's own medical decisions. Some have argued that advance care plans often fail to be normatively binding on caretakers because those plans do not reflect the interests of patients once they enter an incompetent state. In this article, we argue that when the core medical ethical principles of respect for patient autonomy, honest and adequate disclosure of…Read more
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63Research at the Auction Block: Problems for the Fair Benefits Approach to International ResearchHastings Center Report 40 (4): 34-45. 2010.The “fair benefits” approach to international research is designed to produce results that all can agree are fair without taking a stand on divisive questions of justice. But its appealing veneer of collaboration masks ambiguities at both a conceptual and an operational level. An attempt to put it into practice would look a lot like an auction, leaving little reason to think the outcomes will satisfy even minimal conditions of fairness.
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58Equipose and international human-subjects researchBioethics 15 (4). 2001.This paper examines the role of equipoise in evaluating international research. It distinguishes two possible formulations of the equipoise requirement that license very different evaluations of international research proposals. The interpretation that adopts a narrow criterion of similarity between clinical contexts has played an important role in one recent controversy, but it suffers from a number of problems. An alternative interpretation that adopts a broader criterion of similarity does a …Read more
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58Editor's introduction: Theory and engagement in bioethicsTheoretical Medicine and Bioethics 22 (2): 65-68. 2001.
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57Addressing ethical challenges in HIV prevention research with people who inject drugsJournal of Medical Ethics 44 (3): 149-158. 2018.Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in researc…Read more
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55The Ethics of Advertising for Health Care ServicesAmerican Journal of Bioethics 14 (3): 34-43. 2014.Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and pat…Read more
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49Bringing science and advocacy together to address health needs of people who inject drugsJournal of Medical Ethics Recent Issues 44 (3): 165-166. 2018.In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs, 1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process. 2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include ac…Read more
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48Does Research Ethics Rest on a Mistake? The Common Good, Reasonable Risk and Social JusticeAmerican Journal of Bioethics 5 (1). 2005.This Article does not have an abstract
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45Two dogmas of research ethics and the integrative approach to human-subjects researchJournal of Medicine and Philosophy 32 (2). 2007.This article argues that lingering uncertainty about the normative foundations of research ethics is perpetuated by two unfounded dogmas of research ethics. The first dogma is that clinical research, as a social activity, is an inherently utilitarian endeavor. The second dogma is that an acceptable framework for research ethics must impose constraints on this endeavor whose moral force is grounded in role-related obligations of either physicians or researchers. This article argues that these dog…Read more
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43Recent debates over the use of sham surgery as a control for studies of fetal tissue transplantation for Parkinson’s disease have focused primarily on rival interpretations of the US federal regulations governing human-subjects research. Using the core ethical and methodological considerations that underwrite the equipoise requirement, we nd strong prima facie reasons against using sham surgery as a control in studies of cellular-based therapies for Parkinson’s disease and more broadly in clinic…Read more
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43Addressing ethical challenges in HIV prevention research with people who inject drugsJournal of Medical Ethics Recent Issues 44 (3): 149-158. 2018.Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in researc…Read more
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43Bringing science and advocacy together to address health needs of people who inject drugsJournal of Medical Ethics 44 (3): 165-166. 2018.In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs,1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process.2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acqu…Read more
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40Groundhog Day for Medical Artificial IntelligenceHastings Center Report 48 (3). 2018.Following a boom in investment and overinflated expectations in the 1980s, artificial intelligence entered a period of retrenchment known as the “AI winter.” With advances in the field of machine learning and the availability of large datasets for training various types of artificial neural networks, AI is in another cycle of halcyon days. Although medicine is particularly recalcitrant to change, applications of AI in health care have professionals in fields like radiology worried about the futu…Read more
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40There is near universal agreement within the scientific and ethics communities that a necessary condition for the moral permissibility of cross-national, collaborative research is that it be responsive to the health needs of the host community. It has proven difficult, however, to leverage or capitalize on this consensus in order to resolve lingering disputes about the ethics of international medical research. This is largely because different sides in these debates have sometimes provided differe…Read more
Areas of Specialization
Ethics of Artificial Intelligence, Misc |
Value Theory |
Biomedical Ethics |
Applied Ethics |
Normative Ethics |
Areas of Interest
Value Theory |
Biomedical Ethics |
Applied Ethics |
Normative Ethics |