•  864
    The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making health resource a…Read more
  •  23
    Rescuing the duty to rescue
    with Tina Rulli
    Journal of Medical Ethics 42 (4): 260-264. 2016.
  •  1158
    Rescuing the Duty to Rescue
    with Tina Rulli
    Journal of Medical Ethics 1-5. 2014.
    Clinicians and health researchers frequently encounter opportunities to rescue people. Rescue cases can generate a moral duty to aid those in peril. As such, bioethicists have leveraged a duty to rescue for a variety of purposes. Yet, despite its broad application, the duty to rescue is under-analyzed. In this paper, we assess the state of theorizing about the duty to rescue. There are large gaps in bioethicists’ understanding of the force, scope, and justification of the two most cited duties t…Read more
  •  4
    How not to count the health benefits of family planning
    Journal of Medical Ethics 49 (1): 41-44. 2022.
    Several influential organisations have attempted to quantify the costs and benefits of expanding access to interventions—like contraceptives—that are expected to decrease the number of pregnancies. Such health economic evaluations can be invaluable to those making decisions about how to allocate scarce resources for health. Yet how the benefits should be measured depends on controversial value judgments. One such value judgment is found in recent analyses from the Disease Control Priority Networ…Read more
  •  214
    Should health research funding be proportional to the burden of disease?
    Politics, Philosophy and Economics 22 (1): 76-99. 2023.
    Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/aids research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: In…Read more
  •  172
    Should health research funding be proportional to the burden of disease?
    Politics, Philosophy and Economics 1 (1): 1-24. 2022.
    Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/AIDS research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: In…Read more
  •  32
    Scope of Consent
    Philosophical Quarterly 73 (1): 290-292. 2022.
    Suppose you come to my house and I invite you in. ‘I’m just heading out’, I say, ‘but make yourself at home’. I have consented to you remaining in my house, but what else? In your home, you put your feet up on the coffee table, so may you now do that in mine? If I complain that you’ve left crumbs from eating biscuits in my bed, can you defend yourself on the grounds that I told you to make yourself at home? These questions concern the scope of my consent. How we should ascertain the scope of som…Read more
  •  326
    How not to count the health benefits of family planning
    Journal of Medical Ethics 1 1-4. 2021.
    Several influential organisations have attempted to quantify the costs and benefits of expanding access to interventions-like contraceptives-that are expected to decrease the number of pregnancies. Such health economic evaluations can be invaluable to those making decisions about how to allocate scarce resources for health. Yet how the benefits should be measured depends on controversial value judgments. One such value judgment is found in recent analyses from the Disease Control Priority Networ…Read more
  •  231
    How to Identify Priority Questions for Bioethics Research
    American Journal of Bioethics 22 (1): 17-18. 2022.
    The organizations that fund bioethics research receive many more eligible grant applications than they can support. Academic positions that support bioethics research are likewise scarce. As a resu...
  •  299
    In “Informed Consent: What Must be Disclosed and What Must be Understood?”, we reject a dogma at the heart of research ethics. We demonstrate that the constitutive claim...
  •  333
    Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria fo…Read more
  •  254
    Avoiding exploitation in multinational covid-19 vaccine trials
    with Alexander A. Iyer, Christine Grady, and David Wendler
    The BMJ 372. 2021.
  •  208
    Return of Positive Test Results to Participants in Sexually Transmitted Infection Prevalence Studies: Research Ethics and Responsibilities
    with Joshua Grubbs, Cornelis A. Rietmeijer, and Peter H. Kilmarx
    Sexually Transmitted Diseases. 2021.
    Background: In prevalence studies of sexually transmitted infections (STIs), investigators often provide syndromic management for symptomatic participants, but may not provide specific treatment for asymptomatic individuals with positive laboratory test results due to the delays between sample collection and availability of results as well as logistical constraints in recontacting study participants. Methods: To characterize the extent of this issue, 80 prevalence studies from the World Health O…Read more
  •  26
    A Theory of Bioethics
    Cambridge University Press. 2021.
    This volume offers a carefully argued, compelling theory of bioethics while eliciting practical implications for a wide array of issues including medical assistance-in-dying, the right to health care, abortion, animal research, and the definition of death. The authors' dual-value theory features mid-level principles, a distinctive model of moral status, a subjective account of well-being, and a cosmopolitan view of global justice. In addition to ethical theory, the book investigates the nature o…Read more
  •  426
    COVID-19 vaccine trial ethics once we have efficacious vaccines
    with David Wendler, Jorge Ochoa, Christine Grady, and Holly Taylor
    Science 370 (6522): 1277-1279. 2020.
    Some placebo-controlled trials can continue ethically after a candidate vaccine is found to be safe and efficacious
  •  1276
    Respect for Persons
    The Oxford Handbook of Research Ethics. 2020.
    This chapter explores the foundation and content of the duty to respect persons. The authors argue that it is best understood as a duty to recognize people’s rights. Respect for persons therefore has specific implications for how competent and non-competent persons ought to be treated in research. For competent persons it underlies the obligation to obtain consent to many research procedures. The chapter gives an analysis of the requirements for obtaining valid consent. It then considers respect…Read more
  •  2477
    Informed Consent: What Must Be Disclosed and What Must Be Understood?
    American Journal of Bioethics 21 (5): 46-58. 2021.
    Over the last few decades, multiple studies have examined the understanding of participants in clinical research. They show variable and often poor understanding of key elements of disclosure, such as expected risks and the experimental nature of treatments. Did the participants in these studies give valid consent? According to the standard view of informed consent they did not. The standard view holds that the recipient of consent has a duty to disclose certain information to the profferer of c…Read more
  •  299
    Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of fir…Read more
  •  447
    International Clinical Research and Justice in the Belmont Report
    Perspectives in Biology and Medicine 63 (2): 374-388. 2020.
    The Belmont Report was written by a US Commission charged by the US Congress to advise on research supported by the US government. Its focus was understandably domestic. In the 40 years since its publication, clinical research has become increasingly international. Many clinical trials have sites in multiple countries, and many of the host countries are relatively impoverished. Such research raises some distinctive ethical issues. This paper outlines some of the key ethical challenges that have …Read more
  •  258
    Emergency care research ethics in low- and middle-income countries
    with Blythe Beecroft, Timothy C. Hardcastle, Jon Mark Hirshon, Adnan A. Hyder, Jennifer A. Newberry, and Carla Saenz
    BMJ Global Health 4. 2019.
    A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk–benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) communi…Read more
  •  235
    Stillbirth should be given greater priority on the global health agenda
    with Zeshan U. Qureshi, Hannah Blencowe, Maureen Kelley, Joy E. Lawn, Anthony Costello, and Tim Colbourn
    British Medical Journal 351. 2015.
    Stillbirths are largely excluded from international measures of mortality and morbidity. Zeshan Qureshi and colleagues argue that stillbirth should be higher on the global health agenda.
  •  270
    Allocation of scarce biospecimens for use in research
    with Leah Pierson, Sophia Gibert, Benjamin Berkman, and Marion Danis
    Journal of Medical Ethics 47 (11): 740-743. 2021.
    Hundreds of millions of rare biospecimens are stored in laboratories and biobanks around the world. Often, the researchers who possess these specimens do not plan to use them, while other researchers limit the scope of their work because they cannot acquire biospecimens that meet their needs. This situation raises an important and underexplored question: how should scientists allocate biospecimens that they do not intend to use? We argue that allocators should aim to maximise the social value of…Read more
  •  61
    Global Health Priority-Setting: Beyond Cost-Effectiveness (edited book)
    with Ole F. Norheim and Ezekiel J. Emanuel
    Oxford University Press. 2019.
    Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce health care resources s…Read more
  •  1658
    How Payment For Research Participation Can Be Coercive
    American Journal of Bioethics 19 (9): 21-31. 2019.
    The idea that payment for research participation can be coercive appears widespread among research ethics committee members, researchers, and regulatory bodies. Yet analysis of the concept of coercion by philosophers and bioethicists has mostly concluded that payment does not coerce, because coercion necessarily involves threats, not offers. In this article we aim to resolve this disagreement by distinguishing between two distinct but overlapping concepts of coercion. Consent-undermining coercio…Read more
  •  2036
    First Come, First Served?
    Ethics 130 (2): 179-207. 2020.
    Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, and that the first person in a queue for a resource does not ipso facto have a right to receive that resource first. However, waiting time can and sometimes should play a role in justifying allocation decisions. First, there is a duty …Read more
  •  627
    Putting a number on the harm of death
    In Espen Gamlund & Carl Tollef Solberg (eds.), Saving People from the Harm of Death, Oxford University Press. pp. 61-75. 2019.
    Donors to global health programs and policymakers within national health systems have to make difficult decisions about how to allocate scarce health care resources. Principled ways to make these decisions all make some use of summary measures of health, which provide a common measure of the value (or disvalue) of morbidity and mortality. They thereby allow comparisons between health interventions with different effects on the patterns of death and ill health within a population. The constructio…Read more
  •  260
    We respond to open peer commentaries on our target article, "Health Research Priority Setting: The Duties of Individual Funders"
  •  552
    Health Research Priority Setting: The Duties of Individual Funders
    with Leah Pierson
    American Journal of Bioethics 18 (11): 6-17. 2018.
    The vast majority of health research resources are used to study conditions that affect a small, advantaged portion of the global population. This distribution has been widely criticized as inequitable and threatens to exacerbate health disparities. However, there has been little systematic work on what individual health research funders ought to do in response. In this article, we analyze the general and special duties of research funders to the different populations that might benefit from hea…Read more