•  3
    Clinician Perspectives on Opioid Treatment Agreements: A Qualitative Analysis of Focus Groups
    with Nathan Richards, Martin Fried, Larisa Svirsky, Nicole Thomas, and Patricia J. Zettler
    AJOB Empirical Bioethics. 2023.
    Background Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, li…Read more
  •  3
    Deciding for the incompetent
    In Kalle Grill & Jason Hanna (eds.), The Routledge Handbook of the Philosophy of Paternalism, Routledge. 2018.
    This chapter explores whether it is possible to treat incompetent persons paternalistically. What is often seen to be wrong about acting paternalistically towards others is that one is treating these others as if they cannot make their own decisions about their own good. So how should one think about situations where one must make decisions on behalf of people who indeed cannot make their own decisions about their own good – especially if these people are still to some extent capable of expressi…Read more
  •  8
    E-Cigarettes, the FDA, Public Health, and Harm Reduction: A Response to the Open Peer Commentaries
    with Larisa Svirsky and Micah L. Berman
    American Journal of Bioethics 23 (1): 1-4. 2022.
    We appreciate that all our commentators accepted the central framework we argued for, namely that the FDA has multiple roles and attendant responsibilities, and we are excited to see this framework...
  •  5
    The Importance of Defining Actionability as Related to Disclosure of Secondary Findings Identified in Research
    with Jordan Brown
    American Journal of Bioethics 22 (10): 93-95. 2022.
    As the age of genomic medicine has advanced rapidly, many questions pertaining to the reportability of both clinical and research findings have emerged. For example, the integration of genomic test...
  •  249
    Disability, Wellbeing, and (In)Apt Emotions
    In Jessica Flanigan (ed.), The Ethics of Ability and Enhancement., Palgrave Macmillan. pp. 57-78. 2018.
    Many people view disabilities as misfortunes, call this the standard view. In this paper, I examine one criticism that has been launched against the Standard View. Rather than determine in advance whether having a disability is good or bad for a person, some critics argue that the Standard View is reflective of and brings about inappropriate emotional responses toward people with disabilities and their circumstances. For instance, philosophers have recently argued that in holding the standard vi…Read more
  •  13
    Review of Metagnosis: Revelatory Narratives of Health and Identity (review)
    Kennedy Institute of Ethics Journal 32 (1): 1-8. 2022.
    Danielle Spencer's book, "Metagnosis: Revelatory Narratives of Health and Identity," does many things. It is a work of autotheory, putting Spencer's own embodied narrative in constant conversation with the testimony of others along with a remarkably diverse set of critical and theoretical approaches. In the book, Spencer coins a new term, "metagnosis", which occurs when one is newly diagnosed in adulthood with a lifelong condition. The book explores Spencer's own metagnostic experience involving…Read more
  •  8
    Surrogate Perspectives on Patient Preference Predictors: Good Idea, but I Should Decide How They Are Used
    with Allan Rivlin, Philip Candilis, Neal W. Dickert, Claire Drolen, Benjamin Krohmal, Mark Pavlick, and David Wendler
    AJOB Empirical Bioethics 13 (2): 125-135. 2022.
  •  283
    Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surro…Read more
  •  375
    Supported Decision-Making: Non-Domination Rather than Mental Prosthesis
    with Allison M. McCarthy
    American Journal of Bioethics Neuroscience 14 (3): 227-237. 2023.
    Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of …Read more
  •  453
    ‘First Do No Harm’: physician discretion, racial disparities and opioid treatment agreements
    with Adrienne Sabine Beck and Larisa Svirsky
    Journal of Medical Ethics 48 (10): 753-758. 2022.
    The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potentia…Read more
  •  467
    Transformative Choices and the Specter of Regret
    Journal of the American Philosophical Association 8 (1): 72-91. 2022.
    When people are making certain medical decisions – especially potentially transformative ones – the specter of regret may color their choices. In this paper, I ask: can predicting that we will regret a decision in the future serve any justificatory role in our present decision-making? And if so, what role? While there are many pitfalls to such reasoning, I ultimately conclude that considering future retrospective emotions like regret in our decisionmaking can be both rational and authentic. Rath…Read more
  •  293
    E-Cigarettes and the Multiple Responsibilities of the FDA
    with Larisa Svirsky and Micah L. Berman
    American Journal of Bioethics 22 (10): 5-14. 2021.
    This paper considers the responsibilities of the FDA with regard to disseminating information about the benefits and harms of e-cigarettes. Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public that e-cigarettes are far less harmful than cigarettes. We argue, by contrast, that the FDA’s obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountab…Read more
  •  32
    Those arguing that conscientious objection in medicine should be declared unethical by professional societies face the following challenge: conscientious objection can function as an important reforming mechanism when it involves health care workers refusing to participate in certain medical interventions deemed standard of care and legally sanctioned but which undermine patients’ rights. In such cases, the argument goes, far from being unethical, conscientious objection may actually be a profes…Read more
  •  45
    The Scoundrel and the Visionary: On Reasonable Hope and the Possibility of a Just Future
    Journal of Political Philosophy 27 (3): 294-317. 2018.
    John Rawls, among others, has argued that one of aims political philosophy is that it provides reasonable hope in the possibility of justice in the future. But what makes hope reasonable? What sorts of theories of justice are best suited to foster reasonable hope in us? To answer these questions, this paper investigates Rawls’s conception of reasonable hope and the kinds of unreasonableness Rawls sought to guard against with his account of a realistic utopia. Rawls's idea of reasonable hope goes…Read more
  •  464
    We often find ourselves in situations where it is up to us to make decisions on behalf of others. How can we determine whether such decisions are morally justified, especially if those decisions may change who it is these others end up becoming? In this paper, I will evaluate one plausible kind of justification that may tempt us: we may want to justify our decision by appealing to the likelihood that the other person will be glad we made that specific choice down the line. Although it is temptin…Read more
  •  152
    On valuing impairment
    with Sean Aas
    Philosophical Studies 175 (5): 1113-1133. 2018.
    In The Minority Body, Elizabeth Barnes rejects prevailing social constructionist accounts of disability for two reasons. First, because they understand disability in terms of oppressive social responses to bodily impairment, they cannot make sense of disability pride. Second, they maintain a problematic distinction between impairment and disability. In response to these challenges, this paper defends a version of the social model of disability, which we call the Social Exclusion Model. On our ac…Read more
  •  16
    ‘Hey everybody, don't get pregnant’: Zika, WHO and an ethical framework for advising
    with Katie Byron
    Journal of Medical Ethics 43 (5): 334-338. 2017.
    The WHO recently made news by apparently advising couples in Zika affected areas to delay pregnancy. On closer inspection, however, it is not so clear what advice was actually being offered in their interim guidance regarding the prevention of the sexual transmission of Zika. In this paper, we lay out a framework for considering the ethical issues that arise in the context of advising and use it to evaluate the WHO guidance. We argue that advising is not merely an informative act. The choices th…Read more
  •  31
    The Medical Surrogate as Fiduciary Agent
    Journal of Law, Medicine and Ethics 45 (3): 402-420. 2017.
    Within bioethics, two prevailing approaches structure how we think about the role of medical surrogates and the decisions that they must make on behalf of incompetent patients. One approach views the surrogate primarily as the patient's agent, obediently enacting the patient's predetermined will. The second approach views the surrogate as the patient's custodian, judging for herself how to best safeguard the patient's interests. This paper argues that both of these approaches idealize away some …Read more