•  46
    The covert administration of medication occurs with incapacitated patients without their knowledge, involving some form of deliberate deception in disguising or hiding the medication. Covert medication in food is a relatively common practice globally, including in institutional and homecare contexts. Until recently, it has received little attention in the bioethics literature, and there are few laws or rules governing the practice. In this paper, we discuss significant, but often overlooked, eth…Read more
  •  18
    It is a common practice for family members to bring food to hospitalized loved ones. However, in some cases, this food contravenes a patient's dietary plan. Such situations can create significant tension and distrust between health care professionals and families and may lead the former to doubt a family's willingness or ability to support patient recovery. This case‐study essay offers an ethical analysis of these situations. We draw on Hilde Lindemann's work to argue that providing food to fami…Read more
  •  19
    An Open Discussion of the Impact of OpenNotes on Clinical Ethics: A Justification for Harm-Based Exclusions from Clinical Ethics Documentation
    with Savitri Fedson, Joey Elizabeth Burke, Claire Horner, Adira Hulkower, Parker Crutchfield, and Holland Kaplan
    Journal of Clinical Ethics 33 (4): 303-313. 2022.
    The OpenNotes (ON) mandate in the 21st Century Cures Act requires that patients or their legally authorized representatives be able to access their medical information in their electronic medical record (EMR) in real time. Ethics notes fall under the domain of this policy. We argue that ethics notes are unique from other clinical documentation in a number of ways: they lack best-practice guidelines, are written in the context of common misconceptions surrounding the purpose of ethics consultatio…Read more
  • Introduction
    In Jamie Carlin Watson & Laura K. Guidry-Grimes (eds.), Moral Expertise: New Essays from Theoretical and Clinical Bioethics, Springer International Publishing. 2018.
  •  19
    Clarifying a Clinical Ethics Service’s Value, the Visible and the Hidden
    with Jane Jankowski, Marycon Chin Jiro, Thomas May, Arlene M. Davis, Kaarkuzhali Babu Krishnamurthy, Kelly Kent, Hannah I. Lipman, and Marika Warren
    Journal of Clinical Ethics 30 (3): 251-261. 2019.
    Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un- Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was ap…Read more
  •  12
    Posthumous HIV Disclosure and Relational Rupture
    with D. Micah Hester
    Journal of Clinical Ethics 29 (3): 196-200. 2018.
    In response to Anne L. Dalle Ave and David M. Shaw, we agree with their general argument but emphasize a moral risk of HIV disclosure in deceased donation cases: the risk of relational rupture. Because of the importance that close relationships have to our sense of self and our life plans, this kind of rupture can have long-ranging implications for surviving loved ones. Moreover, the now-deceased individual cannot participate in any relational mending. Our analysis reveals the hefty moral costs …Read more
  •  8
    The Case of Ms D: A Family’s Request for Posthumous Procurement of Ovaries
    Journal of Clinical Ethics 27 (1): 51-58. 2016.
    The MedStar Washington Hospital Center clinical ethics team became involved in a case when the family requested the posthumous removal of a patient’s ovaries for future reproductive use. This case presents a novel question for clinical ethicists, since the technology for posthumous female reproduction is still in development. In the bioethics literature, the standard position is to refuse to comply with such a request, unless there is explicit consent or evidence of explicit conversations that d…Read more
  •  9
    Ethical Bargaining and Parental Exclusion: A Clinical Case Analysis
    Journal of Clinical Ethics 26 (3): 250-259. 2015.
    Although there has been significant attention in clinical ethics to when physicians should follow a parent’s wishes, there has been much less discussion of the obligation to solicit viewpoints and decisions from all caregivers who have equal moral and legal standing in relation to a pediatric patient. How should healthcare professionals respond when one caregiver dominates decision making? We present a case that highlights how these problems played out in an ethical bargain. Ethical bargaining o…Read more
  •  43
    The persistence of agency through social institutions and caring for future generations
    International Journal of Feminist Approaches to Bioethics 7 (1): 122-141. 2014.
    We argue that we have obligations to future people that are similar in kind to obligations we have to current people. Modifying Michael Bratman’s account, we argue that as planning agents we must plan for the future to act practically in the present. Because our autonomy and selfhood are relational by nature, those plans will involve building affiliative bonds and caring for others. We conclude by grounding responsibility to future others by the way we plan through our social institutions. Our a…Read more
  •  555
    Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care
    with Katie Savin, Joseph A. Stramondo, Joel Michael Reynolds, Marina Tsaplina, Teresa Blankmeyer Burke, Angela Ballantyne, Eva Feder Kittay, Devan Stahl, Jackie Leach Scully, Rosemarie Garland-Thomson, Anita Tarzian, Doron Dorfman, and Joseph J. Fins
    Hastings 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
  •  522
    Louisiana's “Medically Futile” Unborn Child List: Ethical Lessons at the Post-Dobbs Intersection of Reproductive and Disability Justice
    with Laura Guidry-Grimes, Devan Stahl, and Joel Michael Reynolds
    Hastings Center Report 53 (1): 3-6. 2023.
    Ableist attitudes and structures regarding disability are increasingly recognized across all sectors of healthcare delivery. After Dobbs, novel questions arose in the USA concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. As a case study, we examine the Louisiana’s Department of Public Health August 1st Emergency Declaration, “List of Conditions that shall deem an Unborn Child ‘Medically Futile.’” We raise a number of medica…Read more
  •  9
    Reimagining Commitments to Patients and the Public in Professional Oaths
    Kennedy Institute of Ethics Journal 32 (3): 261-296. 2022.
    ABSTRACT:Robert Veatch argues that physician oaths should not be valued as substantive moral commitments, transformational rituals, or symbolic acts. Further, he insists that oath recitation in medical schools is immoral. I respond to Veatch's criticisms and argue that, with alterations to their content and practice, oaths can have value for articulating moral commitments and building a sense of moral community within the profession. I break down Veatch's multitude of objections to oaths over hi…Read more
  •  21
    Disability bioethics and the commitment to equality
    Theoretical Medicine and Bioethics 43 (4): 209-220. 2022.
    Robert Veatch’s The Foundations of Justice: Why the Retarded and the Rest of Us Have Claims to Equality delves into deep questions of justice through the case of a child with disabilities. I describe what is basically right about this vision, as well as what is problematic from the standpoint of contemporary disability bioethics. From there, I dive into the notion of vulnerability that is at play in his work. He describes disability as necessarily a condition of weakness, lesser-than existence, …Read more
  •  30
    The concept of vulnerability is widely used in bioethics, particularly in research ethics and public health ethics. The traditional approach construes vulnerability as inherent in individuals or the groups to which they belong and views vulnerability as requiring special protections. Florencia Luna and other bioethicists continue to challenge traditional ways of conceptualizing and applying the term. Luna began proposing a layered approach to this concept and recently extended this proposal to o…Read more
  •  21
    Ask any clinical ethics consultant, and they can tell you about their transformative cases. Some stick with us because all roads led nowhere. Cassandra Lee had a history of pulling out lines and tubes and a distaste of warming blankets. Her admission marked her thirtieth over the past year. Many of the challenges facing the hospital caring for her were not unique: significant psychiatric issues, prolonged nonadherence to medical advice, and end‐of‐life decision‐making combined to create an ethic…Read more
  •  34
    In this issue of the Hastings Center Report, Jason Wasserman and Mark Navin argue that patients without decisional capacity can still have relatively stable wishes or inclinations toward one treatment option over another and that these preferences are “not devoid of moral weight and might therefore guide or at least influence treatment decisions when they cannot be defeated by other considerations.” This position is not controversial among most bioethicists. The hard work comes in sussing out th…Read more
  •  18
    At its core, nonideal theory is an attempt not only to address issues of justice, but it also provides us a lens through which we can articulate our limitations as knowers and reasoners, the ways in which we are relational in our autonomy needs, and the ways in which we are deeply dependent upon institutions and social supports for our agency and identities. Bringing this lens into bioethics means shifting our orientation in our scholarship and our practice. This shift will have implications in …Read more
  •  13
    Baby A1 was born prematurely with severe encephalopathy, injured brainstem, and a potentially injured spinal cord. He had no response to pain or other external stimuli. The neonatal team unanimousl...
  •  21
    Journal of Medical Humanities 42 (2): 303-305. 2021.
  •  375
    Against Personal Ventilator Reallocation
    with Joel Michael Reynolds and Katie Savin
    Cambridge Quarterly of Healthcare Ethics 30 (2): 272-284. 2020.
    The COVID-19 (Coronavirus disease of 2019) pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclud…Read more
  •  24
    Against Personal Ventilator Reallocation—ADDENDUM
    with Joel Michael Reynolds and Katie Savin
    Cambridge Quarterly of Healthcare Ethics 30 (2): 403-403. 2021.
  •  7
    Covert Consciousness and Covert Ethics
    Perspectives in Biology and Medicine 63 (3): 553-569. 2020.
    Clinical and ethical reasoning often follows the grooves, the forks, the paths of decision trees. Health-care professionals and clinical ethicists can come to rely on them, especially in intricate cases with complex problems that need to be broken down into analyzable steps. Despite their usefulness, decision trees can lead everyone astray if they are rooted in outdated medicine. In his 2015 book, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness, Joseph Fins illumina…Read more
  •  47
    Applying Nonideal Theory to Bioethics: Living and Dying in a Nonideal World (edited book)
    with Elizabeth Victor
    Springer. 2021.
    This book offers new essays exploring concepts and applications of nonideal theory in bioethics. Nonideal theory refers to an analytic approach to moral and political philosophy (especially in relation to justice), according to which we should not assume that there will be perfect compliance with principles, that there will be favorable circumstances for just institutions and right action, or that reasoners are capable of being impartial. Nonideal theory takes the world as it actually is, in all…Read more
  •  37
    Background: Caregivers and administrators in long-term facilities have fragile moral work in caring for residents with dementia. Residents are susceptible to barriers and vulnerabilities associated with the most intimate aspects of their lives, including how they express themselves sexually. The conditions for sexual agency are directly affected by caregivers’ perceptions and attitudes, as well as facility policies. Objective: This article aims to clarify how to approach capacity determinations …Read more
  •  36
    Ethical complexities in assessing patients’ insight
    Journal of Medical Ethics 45 (3): 178-182. 2019.
    The question of whether a patient has insight is among the first to be considered in psychiatric contexts. There are several competing conceptions of clinical insight, which broadly refers to a patient’s awareness of their mental illness. When a patient is described as lacking insight, there are significant implications for patient care and to what extent the patient is trusted as a knower. Insight is currently viewed as a multidimensional and continuous construct, but competing conceptions of i…Read more
  •  33
    Moral Expertise: New Essays from Theoretical and Clinical Bioethics (edited book)
    Springer International Publishing. 2018.
    This collection addresses whether ethicists, like authorities in other fields, can speak as experts in their subject matter. Though ethics consultation is a growing practice in medical contexts, there remain difficult questions about the role of ethicists in professional decision-making. Contributors examine the nature and plausibility of moral expertise, the relationship between character and expertise, the nature and limits of moral authority, how one might become a moral expert, and the trust…Read more
  •  76
    Vulnerabilities Compounded by Social Institutions
    International Journal of Feminist Approaches to Bioethics 5 (2): 126-146. 2012.
    How can social institutions complicate and worsen vulnerabilities of particular individuals or groups? We begin by explicating how certain diagnoses within mental health and medicine operate as interactive kinds of labels and how such labels can create institutional barriers that hinder one's capacity to achieve wellbeing. Interactive-kind modeling is a conceptual tool that elucidates the ways in which labeling can signal to others how the labeled person ought to be treated, how such labeling co…Read more
  •  27
    Expectation and Suffering With LVAD Deactivation
    with Nneka Sederstrom
    American Journal of Bioethics 15 (7): 74-76. 2015.
  •  32
    Another Roadblock to Including Women in Research
    Hastings Center Report 42 (5). 2012.
    Scientists, clinicians, and bioethicists are worried about how so‐called personhood measures would limit access to certain types of contraception, research involving stem cells, and access to fertility treatments. While these measures have been struck down in Colorado, South Dakota, California, and Mississippi, the bill signed into law in Oklahoma in February deserves critical scrutiny, particularly into the ways these legal measures influence eligibility for clinical research. Oklahoma's bill s…Read more