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451Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health CareHastings Center Report 50 (3): 28-32. 2020.In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements …Read more
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183International Legal Approaches to Neurosurgery for Psychiatric DisordersFrontiers in Human Neuroscience 14. 2021.Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typ…Read more
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108Neuroimaging and disorders of consciousness: Envisioning an ethical research agendaAmerican Journal of Bioethics 8 (9). 2008.The application of neuroimaging technology to the study of the injured brain has transformed how neuroscientists understand disorders of consciousness, such as the vegetative and minimally conscious states, and deepened our understanding of mechanisms of recovery. This scientific progress, and its potential clinical translation, provides an opportunity for ethical reflection. It was against this scientific backdrop that we convened a conference of leading investigators in neuroimaging, disorders…Read more
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93Clinical pragmatism: A method of moral problem solvingKennedy Institute of Ethics Journal 7 (2): 129-143. 1997.: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinic…Read more
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91Death, dying and informatics: misrepresenting religion on MedLine (review)BMC Medical Ethics 6 (1): 1-5. 2005.Background The globalization of medical science carries for doctors worldwide a correlative duty to deepen their understanding of patients' cultural contexts and religious backgrounds, in order to satisfy each as a unique individual. To become better informed, practitioners may turn to MedLine, but it is unclear whether the information found there is an accurate representation of culture and religion. To test MedLine's representation of this field, we chose the topic of death and dying in the th…Read more
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86Beyond Consent in ResearchCambridge Quarterly of Healthcare Ethics 23 (3): 361-368. 2014.Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsi…Read more
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81In Memoriam: Dr. Edmund Pellegrino's Legacy: Secure in the Annals of MedicineKennedy Institute of Ethics Journal 24 (2): 97-104. 2014.I am honored to pay tribute to Dr. Pellegrino and a bit humbled as there are so many others who would want to have this opportunity and who knew Dr. Pellegrino better than I. Tom Beauchamp suggested that I might place Dr. Pellegrino into the broader context of the history of medicine. He wrote Thaddeus Pope:Without being disrespectful of the many celebrated figures from Hippocrates to Percival, my view is that no physician has been more productive in the field or made a greater contribution than…Read more
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81Islam and Informed Consent: Notes from DohaCambridge Quarterly of Healthcare Ethics 17 (3): 273-279. 2008.Informed consent is a perennial topic in bioethics. It has given the field a place in clinical practice and the law and is often the starting point for introductory instruction in medical ethics. One would think that nearly everything has been said and done on this well-worn topic
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79Guest Editorial: The Many Voices of Spanish Bioethics—An IntroductionCambridge Quarterly of Healthcare Ethics 18 (3): 214. 2009.
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77Rethinking disorders of consciousness: New research and its implicationsHastings Center Report 35 (2): 22-24. 2005.
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73Towards a Governance Framework for Brain DataNeuroethics 15 (2): 1-14. 2022.The increasing availability of brain data within and outside the biomedical field, combined with the application of artificial intelligence (AI) to brain data analysis, poses a challenge for ethics and governance. We identify distinctive ethical implications of brain data acquisition and processing, and outline a multi-level governance framework. This framework is aimed at maximizing the benefits of facilitated brain data collection and further processing for science and medicine whilst minimizi…Read more
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73Neuroethics and neuroimaging: Moving toward transparencyAmerican Journal of Bioethics 8 (9). 2008.Without exaggeration, it could be said that we are entering a golden age of neuroscience. Informed by recent developments in neuroimaging that allow us to peer into the working brain at both a structural and functional level, neuroscientists are beginning to untangle mechanisms of recovery after brain injury and grapple with age-old questions about brain and mind and their correlates neural mechanisms and consciousness. Neuroimaging, coupled with new diagnostic categories and assessment scales a…Read more
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66Quality Attestation for Clinical Ethics Consultants: A Two‐Step Model from the American Society for Bioethics and HumanitiesHastings Center Report 43 (5): 26-36. 2013.Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perfor…Read more
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63The Self, Social Media, and Social ConstructionAmerican Journal of Bioethics 12 (10): 38-39. 2012.The American Journal of Bioethics, Volume 12, Issue 10, Page 38-39, October 2012
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60A 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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59Minding Rights: Mapping Ethical and Legal Foundations of ‘Neurorights’Cambridge Quarterly of Healthcare Ethics 32 (4): 461-481. 2023.The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty – often framed as “neurorights” in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Eur…Read more
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57The Effects of Closed-Loop Medical Devices on the Autonomy and Accountability of Persons and SystemsCambridge Quarterly of Healthcare Ethics 25 (4): 623-633. 2016.
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54Commercialism in the Clinic: Finding Balance in Medical ProfessionalismCambridge Quarterly of Healthcare Ethics 16 (4): 425. 2007.There is a palpable malaise in American medicine as clinical practice veers off its moorings, swept along by a new commercialism that is displacing medical professionalism and its attendant moral obligations. Although the sociology of this phenomenon is complex and multifactorial, I argue that this move toward medical commercialism was accelerated by the abortive efforts of the Clinton Administration's Health Security Act. Through an analysis of performative speech I show that, although the Clin…Read more
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52A leg to stand on: Sir William Osler and Wilder penfield's "neuroethics"American Journal of Bioethics 8 (1). 2008.If ever I summon before me my highest ideals of men and medicine, I find them sprung from the spirit of Osler. —Wilder Penfield, M.D. Neuroethics is a recently coined term that is shaping our cultu...
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50Patently controversial: Markets, morals, and the president's proposal for embryonic stem cell researchKennedy Institute of Ethics Journal 12 (3): 265-278. 2002.: This essay considers the implications of President George W. Bush's proposal for human embryonic stem cell research. Through the perspective of patent law, privacy, and informed consent, we elucidate the ongoing controversy about the moral standing of human embryonic stem cells and their derivatives and consider how the inconsistencies in the president's proposal will affect clinical practice and research
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50Transgender Patients, Hospitalists, and Ethical CarePerspectives in Biology and Medicine 59 (2): 234-245. 2016.A 28-year-old female-to-male transgender patient presents to the emergency room with one day of pleuritic chest pain and shortness of breath. The patient is found to have an acute pulmonary embolus and is admitted is to the academic hospitalist teaching service for further management.The transgender population is diverse in gender identity, expression, and sexual orientation. Although estimates vary, one study suggests that 0.3% of adults identify as transgender. The U.S. National Transgender Di…Read more
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50The Humanities and the Future of Bioethics EducationCambridge Quarterly of Healthcare Ethics 19 (4): 518-521. 2010.Let’s face it, the humanities are in trouble. Last year, in The Chronicle of Higher Education, Thomas H. Benton warned prospective graduate students to avoid doctoral studies in the humanities. His rationale: a job market down 40%, the improbability of tenure, the more certain prospect of life as an adjunct, and eventual outright exile from one’s chosen field. Benton, the pen name of William Pannapacker, an associate professor of English at Hope College in Holland, Michigan, pulled no punches. H…Read more
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49Lessons from the Injured Brain: A Bioethicist in the Vineyards of NeuroscienceCambridge Quarterly of Healthcare Ethics 18 (1): 7. 2009.I would like to share some reflections on how bioethics fosters dialogue between the sciences and humanities by talking a bit about my work as a physician-ethicist collaborating with neuroscientists studying severe brain injury and mechanisms of recovery. If I am successful in this Pilgrim's Progress, I hope I will convince you that the injured brain can teach us much about ourselves. It is not something I was prepared to believe as a medical student, when I was more certain of things than I am …Read more
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49In Praise of the Humanities in Academic MedicineCambridge Quarterly of Healthcare Ethics 22 (4): 355-364. 2013.
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48Iberian Influences on Pan-American Bioethics: Bringing Don Quixote to Our ShoresCambridge Quarterly of Healthcare Ethics 15 (3): 225-238. 2006.
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44Baseball and BioethicsCambridge Quarterly of Healthcare Ethics 14 (4): 434-443. 2005.David and I were at a conference on Amelia Island in Florida back in 1995. The meeting, sponsored by the University of Florida, was entitled, “Physician-Assisted Death: Implications for Patients, Care Providers, and Society,” a title that seems quaint given the controversy over the right to die engendered by the Schiavo case. But that's a different talk for a different time
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Cornell UniversityRegular Faculty
Ithaca, New York, United States of America