Chicago, Illinois, United States of America
Areas of Specialization
Applied Ethics
Normative Ethics
Areas of Interest
Applied Ethics
Normative Ethics
  •  516
    Speaking of the value of life
    Kennedy Institute of Ethics Journal 21 (2): 181-199. 2011.
    The notion of the value of life is often invoked in discussions regarding medical care for the sick and the dying. This theme has figured in arguments about medical ethics for decades, but many of the phrases associated with this concept have received little serious scrutiny. It is true that some philosophers have declared a few commonly used phrases such as “the sanctity of life,” “the infinite value of life,” and “the value of life itself” to be unclear at best or misguided at worst. Their has…Read more
  •  306
    What is conscience and why is respect for it so important?
    Theoretical Medicine and Bioethics 29 (3): 135-149. 2008.
    The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has do…Read more
  •  185
    Death, Dignity, and the Theory of Value
    Ethical Perspectives 9 (2): 103-130. 2002.
    The word ‘dignity’ arises continuously in the debate over euthanasia and assisted suicide, both in Europe and in North America. Unlike the phrases ‘autonomy’ and ‘slippery slope’, ‘dignity’ is used by those on both sides of the question. For example, the organizations most prominently associated with the campaign that culminated in the recent legalization of euthanasia in Belgium are the Association pour la Droit de Mourir dans la Dignité and Recht op Waardig Sterven. Yet when Belgium passed its…Read more
  •  153
    : On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setti…Read more
  •  135
    Ethics education for medical house officers: long-term improvements in knowledge and confidence
    with E. S. Marx
    Journal of Medical Ethics 23 (2): 88-92. 1997.
    OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and p…Read more
  •  111
    Catholic Health Care: Not Dead Yet
    The National Catholic Bioethics Quarterly 1 (1): 41-50. 2001.
  •  103
    Proportionality, terminal suffering and the restorative goals of medicine
    with Lynn A. Jansen
    Theoretical Medicine and Bioethics 23 (4-5): 321-337. 2002.
    Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the impor…Read more
  •  100
    “Reinventing” the rule of double effect
    In Bonnie Steinbock (ed.), The Oxford Handbook of Bioethics, Oxford University Press. pp. 114--49. 2007.
    The Rule of Double Effect has played an important role in bioethics, especially during the last fifty years. Its major application in bioethics has been in providing physicians who are opposed to euthanasia with a moral justification for using opioid analgesics in treating the pain of patients whose death might thereby be hastened. It has also prominently been applied to certain obstetric cases. The scope of application of double effect is actually much broader than medical ethics, extending to …Read more
  •  99
    Many states in the U.S. have adopted policies regarding human embryonic stem cell (hESC) research in the last few years. Some have arrived at these policies through legislative debate, some by referendum, and some by executive order. New York has chosen a unique structure for addressing policy decisions regarding this morally controversial issue by creating the Empire State Stem Cell Board with two Committees—an Ethics Committee and a Funding Committee. This essay explores the pros and cons of v…Read more
  •  90
    Diseases and natural kinds
    Theoretical Medicine and Bioethics 26 (6): 487-513. 2005.
    David Thomasma called for the development of a medical ethics based squarely on the philosophy of medicine. He recognized, however, that widespread anti-essentialism presented a significant barrier to such an approach. The aim of this article is to introduce a theory that challenges these anti-essentialist objections. The notion of natural kinds presents a modest form of essentialism that can serve as the basis for a foundationalist philosophy of medicine. The notion of a natural kind is neither…Read more
  •  86
    Killing and Allowing to Die: Another Look
    Journal of Law, Medicine and Ethics 26 (1): 55-64. 1998.
    One of the most important questions in the debate over the morality of euthanasia and assisted suicide is whether an important distinction between killing patients and allowing them to die exists. The U.S. Supreme Court, in rejecting challenges to the constitutionality of laws prohibiting physician-assisted suicide, explicitly invoked this distinction, but did not explicate or defend it. The Second Circuit of the U.S. Court of Appeals had previously asserted, also without argument, that no meani…Read more
  •  82
    What is an oath and why should a physician swear one?
    Theoretical Medicine and Bioethics 20 (4): 329-346. 1999.
    While there has been much discussion about the role of oaths in medical ethics, this discussion has previously centered on the content of various oaths. Little conceptual work has been done to clarify what an oath is, or to show how an oath differs from a promise or a code of ethics, or to explore what general role oath-taking by physicians might play in medical ethics. Oaths, like promises, are performative utterances. But oaths are generally characterized by their greater moral weight compared…Read more
  •  80
    A randomized trial of ethics education for medical house officers
    with G. Geller, D. M. Levine, and R. R. Faden
    Journal of Medical Ethics 19 (3): 157-163. 1993.
    We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Know…Read more
  •  77
  •  71
    The varieties of human dignity: a logical and conceptual analysis
    Medicine, Health Care and Philosophy 16 (4): 937-944. 2013.
    The word ‘dignity’ is used in a variety of ways in bioethics, and this ambiguity has led some to argue that the term must be expunged from the bioethical lexicon. Such a judgment is far too hasty, however. In this article, the various uses of the word are classified into three serviceable categories: intrinsic, attributed, and inflorescent dignity. It is then demonstrated that, logically and linguistically, the attributed and inflorescent meanings of the word presuppose the intrinsic meaning. Th…Read more
  •  68
    Conscience, tolerance, and pluralism in health care
    Theoretical Medicine and Bioethics 40 (6): 507-521. 2019.
    Increasingly, physicians are being asked to provide technical services that many believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without …Read more
  •  64
    Tolerance, Professional Judgment, and the Discretionary Space of the Physician
    Cambridge Quarterly of Healthcare Ethics 26 (1): 18-31. 2017.
  •  64
    Do the ward notes reflect the quality of end-of-life care?
    with M. Dwyer and E. Marx
    Journal of Medical Ethics 22 (6): 344-348. 1996.
    OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the p…Read more
  •  62
    End-of-Life Decision Making: When Patients and Surrogates Disagree
    with Peter B. Terry, Margaret Vettese, John Song, Jane Forman, Karen B. Haller, Deborah J. Miller, and R. Stallings
    Journal of Clinical Ethics 10 (4): 286-293. 1999.
  •  61
  •  57
    The logos of the genome: Genomes as parts of organisms
    Theoretical Medicine and Bioethics 27 (6): 535-540. 2006.
  •  57
    Patient expectations of benefit from phase I clinical trials: Linguistic considerations in diagnosing a therapeutic misconception
    with K. P. Weinfurt, Kevin A. Schulman, and Neal J. Meropol
    Theoretical Medicine and Bioethics 24 (4): 329-344. 2003.
    The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may rece…Read more
  •  54
    Terri Schiavo and the Roman Catholic Tradition of Forgoing Extraordinary Means of Care
    Journal of Law, Medicine and Ethics 33 (2): 359-362. 2005.
    Media coverage and statements by various Catholic spokespersons regarding the case of Terri Schiavo has generated enormous and deeply unfortunate confusion regarding Church teaching about the use of life-sustaining treatments. Two weeks ago, for example, I received a letter from the superior of a community of Missionary Sisters of Charity, who operate a hospice here in the United States The Missionary Sisters of Charity are the community founded by Mother Theresa, the 20th Century saint whose pr…Read more
  •  52
    Moral Status, Justice, and the Common Morality: Challenges for the Principlist Account of Moral Change
    with Kevin E. Hodges
    Kennedy Institute of Ethics Journal 23 (3): 275-296. 2013.
    The idea that ethics can be derived from a common morality, while controversial, has become very influential in biomedical ethics. Although the concept is employed by several theories, it has most prominently been given a central role in principlism, an ethical theory endorsed by Tom Beauchamp and James Childress in Principles of Biomedical Ethics (2009).1 This text has become a cornerstone of medical ethics education, an achievement that has been commended by critics and supporters alike. It ar…Read more
  •  51
    Are withholding and withdrawing therapy always morally equivalent?
    with J. Sugarman
    Journal of Medical Ethics 20 (4): 218-224. 1994.
    Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact t…Read more
  •  48
    What's so special about medicine?
    Theoretical Medicine and Bioethics 14 (1): 379-380. 1993.
    Health care has increasingly come to be understood as a commodity. The ethical implications of such an understanding are significant. The author argues that health care is not a commodity because health care (1) is non-proprietary, (2) serves the needs of persons who, as patients, are uniquely vulnerable, (3) essentially involves a special human relationship which ought not be bought or sold, (4) helps to define what is meant by necessity and cannot be considered a commodity when subjected to ri…Read more
  •  47
    Futility and the varieties of medical judgment
    Theoretical Medicine and Bioethics 18 (1-2): 63-78. 1997.
    Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory of futility accordi…Read more
  •  43
    The ethical obligation of the dead donor rule
    with Anne L. Dalle Ave and James L. Bernat
    Medicine, Health Care and Philosophy 23 (1): 43-50. 2020.
    The dead donor rule (DDR) originally stated that organ donors must not be killed by and for organ donation. Scholars later added the requirement that vital organs should not be procured before death. Some now argue that the DDR is breached in donation after circulatory determination of death (DCDD) programs. DCDD programs do not breach the original version of the DDR because vital organs are procured only after circulation has ceased permanently as a consequence of withdrawal of life-sustaining …Read more