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13Ethics Pocket Cards: An Educational Tool for Busy CliniciansJournal of Clinical Ethics 25 (2): 148-151. 2014.The adage “an ounce of prevention is worth a pound of cure” is widely used in healthcare settings and can be applied to the work of institutional clinical ethics committees. The model of clinical ethics consultation, however, is inherently reactive: a crisis or question emerges, and ethics experts are called to help. In an effort to employ a proactive component to the model of clinical ethics consultation (as well as to standardize our educational interventions), we developed ethics pocket cards…Read more
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11Accuracy of a Decision Aid for Advance Care Planning: Simulated End-of-Life Decision MakingJournal of Clinical Ethics 22 (3): 223-238. 2011.PurposeAdvance directives have been criticized for failing to help physicians make decisions consistent with patients’ wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients’ wishes into treatment decisions.MethodsWe recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior k…Read more
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58Index of suspicion: Feeling not believingTheoretical Medicine and Bioethics 25 (4): 277-310. 2004.Throughout the U.S., state laws require professionals who work with children to report cases of suspected child abuse to child protection services. Both practically and conceptually, however, significant problems arise from a lack of clarity regarding the threshold that has been set for reporting. Specifically, there is no consensus as to what constitutes reasonable suspicion, and little direction for how mandated reporters should gauge their legal and professional responsibilities when they har…Read more
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36Doing What We Can With Advance Care PlanningAmerican Journal of Bioethics 10 (4): 1-2. 2010.No abstract
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7Reasonable Suspicion of Child abuse: Finding a Common LanguageJournal of Law, Medicine and Ethics 39 (1): 62-69. 2011.A father brings his six-year-old daughter and her older sister to their pediatrician to be evaluated for a history of cough, runny nose, and low-grade fever. In addition to signs of a cold, the girl's nasal bridge is quite swollen and bruised. When asked how her nose was injured, she shrugs, and her father's only conjecture is that she sleepwalks and might have bumped into something. The father sits impatiently and as questioning progresses becomes increasingly defensive, at one point angrily de…Read more
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36Reasonable Suspicion of Child Abuse: Finding a Common LanguageJournal of Law, Medicine and Ethics 39 (1): 62-69. 2011.In the United States, the implementation of a successful system of mandated reporting of suspected child abuse continues to be plagued by the absence of a clear standard for when one must report. All 50 states of the U.S. have laws requiring certain individuals to report suspected child abuse. However, at present, there are variable thresholds for mandated reporting and no clear consensus on how existing thresholds should be interpreted. Because “child abuse” is often present as a possible etiol…Read more
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30Review of Jeffrey P. Spike, Thomas R. Cole, Richard Buday, Freeman Williams, and Mary Ann Pendino, The Brewsters 1 (review)American Journal of Bioethics 13 (3): 52-54. 2013.
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21Four approaches to doing ethicsJournal of Medicine and Philosophy 21 (1): 7-39. 1996.Within the field of medical ethics there is a startling amount of diversity regarding which issues and relationships are deemed relevant for ethical inquiry and analysis, what strategies are appropriate for examining and resolving ethical conflict, what should be the goals for medical ethics, even who should participate in that project. What I will try to make clear in this paper is that how we go about this process of doing medical ethics, of examining, reflecting, decisionmaking, and behaving,…Read more
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146Too soon to give up: Re-examining the value of advance directivesAmerican Journal of Bioethics 10 (4). 2010.In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future , translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping indivi…Read more
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13Exploring the Limits of AutonomyHastings Center Report 42 (3): 16-18. 2012.Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotic…Read more