•  7
    Three Kinds of Decision-Making Capacity for Refusing Medical Interventions
    with Abram L. Brummett and Jason Adam Wasserman
    American Journal of Bioethics 1-11. forthcoming.
    According to a standard account of patient decision-making capacity, patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical c...
  •  11
    Core Concepts and Contemporary Issues in Privacy (edited book)
    with Ann Cudd
    Springer Verlag. 2018.
    Privacy is widely valued, especially in individualistic cultures, because people want to control access to their bodies and to information about their personal choices. Privacy can promote a variety of goods. It can protect intimacy among friends and colleagues and create trusting relations of tolerance among strangers. Privacy can promote dignity, since it can be embarrassing to disclose secret or unconsidered thoughts or opinions, or to reveal one’s naked body or other private spaces. Privacy …Read more
  •  8
    The capacity to designate a surrogate is not simply another kind of medical decision-making capacity. A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patie…Read more
  •  143
    Reasons to Accept Vaccine Refusers in Primary Care
    with Jason Adam Wasserman and Douglas Opel
    Pediatrics 6 (146). 2020.
    Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians…Read more
  •  10
    Harming Children to Benefit Others: A Reply
    with Heidi Malm
    American Journal of Bioethics 20 (12). 2020.
    We are pleased to have received such a varied set of commentaries on our target article, “Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices,” and we are thankful for the opportunity to respond to some of them here. We regret that space limitations preclude us from responding to each. In what follows we will begin by addressing commentaries that expand the application of our arguments. We will then correct some seeming misunderstandings about our distinctions, argum…Read more
  •  6
    The field of clinical bioethics strongly advocates for the use of advance directives to promote patient autonomy, particularly at the end of life. This paper reports a study of clinical bioethicists’ perceptions of the professional consensus about advance directives, as well as their personal advance care planning practices. We find that clinical bioethicists are often sceptical about the value of advance directives, and their personal choices about advance directives often deviate from what cli…Read more
  •  12
    Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices
    with Heidi Malm
    American Journal of Bioethics 20 (9): 45-57. 2020.
    Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person’s ability to keep VZV suppressed can be ‘booste…Read more
  •  17
    We agree with Emily Walsh (2020) that the current preferences of patients with dementia should sometimes supersede those patients’ advance directives. We also agree that consensus clinical ethics guidance does a poor job of explaining the moral value of such patients’ preferences. Furthermore, Walsh correctly notes that clinicians are often averse to treating patients with dementia over their objections, and that this aversion reflects clinical wisdom that can inform revisions to clinical ethics…Read more
  •  7
    Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians’ and parents’ decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatm…Read more
  •  3
    Pediatric Assent and Treating Children Over Objection
    with Jason Wasserman and John Vercler
    Pediatrics 144 (5). 2019.
    More than 20 years ago, the pioneering pediatric ethicist William Bartholome wrote a fiery letter to the editor of this journal because he thought a recently published statement on pediatric assent, from the Committee on Bioethics of the American Academy of Pediatrics (AAP), showed insufficient respect for children. That AAP statement, like its 2016 update, asserts that pediatric assent should be solicited only when a child’s dissent will be honored. Bartholome objected that pediatricians…Read more
  •  20
    Context In response to outbreaks of vaccine‐preventable disease and increasing rates of vaccine refusal, some political communities have recently implemented coercive childhood immunization programs, or they have made existing childhood immunization programs more coercive. Many other political communities possess coercive vaccination policies, and others are considering developing them. Scholars and policymakers generally refer to coercive immunization policies as “vaccine mandates.” However, m…Read more
  •  5
    When Do Pediatricians Call the Ethics Consultation Service? Impact of Clinical Experience and Formal Ethics Training
    with Jason Adam Wasserman, Susanna Jain, Katie R. Baughman, and Naomi T. Laventhal
    AJOB Empirical Bioethics 11 (2): 83-90. 2020.
    Background: Previous research shows that pediatricians inconsistently utilize the ethics consultation service (ECS). Methods: Pediatricians in two suburban, Midwestern academic hospitals were asked to reflect on their ethics training and utilization of ECS via an anonymous, electronic survey distributed in 2017 and 2018, and analyzed in 2018. Participants reported their clinical experience, exposure to formal and informal ethics training, use of formal and informal ethics consultations, and pote…Read more
  •  98
    Vaccine mandates, value pluralism, and policy diversity
    with Katie Attwell
    Bioethics 33 (9): 1042-1049. 2019.
    Political communities across the world have recently sought to tackle rising rates of vaccine hesitancy and refusal, by implementing coercive immunization programs, or by making existing immunization programs more coercive. Many academics and advocates of public health have applauded these policy developments, and they have invoked ethical reasons for implementing or strengthening vaccine mandates. Others have criticized these policies on ethical grounds, for undermining liberty, and as symptoms…Read more
  • Perspectives of Public Health Nurses on the Ethics of Mandated Vaccine Education
    with Andrea T. Kozak and Michael J. Deem
    Nursing Outlook 68 (1): 62-72. 2020.
    Background Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. Purpose To attend to the activity and dispositions of the public health staff who provide “waiver ed…Read more
  •  18
    Children’s preferences about medical treatment—like the preferences of other patients—hold moral weight in decision-making that is independent of considerations of autonomy or best interests. In light of this understanding of the moral value of patient preferences, the American Academy of Pediatrics could strengthen the ethical foundation for its formal guidance on pediatric assent.
  • Introduction: Conceptualizing Privacy Harms and Values
    with Ann Cudd
    In Mark Navin & Ann Cudd (eds.), Core Concepts and Contemporary Issues in Privacy, Springer Verlag. pp. 1-13. 2018.
    Privacy is widely valued, especially in individualistic cultures, because people want to control access to their bodies and to information about their personal choices. Privacy can promote a variety of goods. It can protect intimacy among friends and colleagues and create trusting relations of tolerance among strangers. Privacy can promote dignity, since it can be embarrassing to disclose secret or unconsidered thoughts or opinions, or to reveal one’s naked body or other private spaces. Privacy …Read more
  •  2
    Dismissal Policies for Vaccine Refusal -- A Reply
    with Michael J. Deem and John D. Lantos
    JAMA Pediatrics 172 (11): 1101-1102. 2018.
    Marshall and O’Leary’s thoughtful response to our article suggests that dismissal policies are ethically justifiable because they might induce parents to immunize their children. This outcome is conceivable, but we have only anecdotes about how often it occurs. Such evidence became the thin reed on which the American Academy of Pediatrics rested its new policy of tolerating the practice of dismissing vaccine-hesitant parents. It seems likely that relatively few parents would agree to vaccinate b…Read more
  •  24
    Considering Whether the Dismissal of Vaccine-Refusing Families Is Fair to Other Clinicians
    with Michael J. Deem and John D. Lantos
    JAMA Pediatrics 172 (6): 515-516. 2018.
    A recent American Academy of Pediatrics (AAP) clinical report states that it is an acceptable option for pediatric care clinicians to dismiss families who refuse vaccines. This is a clear shift in guidance from the AAP, which previously advised clinicians to “endeavor not to discharge” patients solely because of parental vaccine refusal. While this new policy might be interpreted as encouraging or recommending dismissal of vaccine-refusing families, it instead expresses tolerance for diverse pro…Read more
  •  13
    When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient’s best interests. We argue that, even when there is input from a surrogate, patient preferenc…Read more
  •  34
    Cooptation or solidarity: food sovereignty in the developed world
    with J. M. Dieterle
    Agriculture and Human Values 35 (2): 319-329. 2018.
    This paper builds on previous research about the potential downsides of food sovereignty activism in relatively wealthy societies by developing a three-part taxonomy of harms that may arise in such contexts. These are direct opposition, false equivalence, and diluted goals and methods. While this paper provides reasons to resist complacency about wealthy-world food sovereignty, we are optimistic about the potential for food sovereignty in wealthy societies, and we conclude by describing how weal…Read more
  •  1270
    In a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Gi…Read more
  •  21
    Reasons to Amplify the Role of Parental Permission in Pediatric Treatment
    American Journal of Bioethics 17 (11): 6-14. 2017.
    Two new documents from the Committee on Bioethics of the American Academy of Pediatrics expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the impor…Read more
  •  900
    The Ethics of Vaccination Nudges in Pediatric Practice
    HEC Forum 29 (1): 43-57. 2017.
    Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability o…Read more
  •  276
    Local Food and International Ethics
    Journal of Agricultural and Environmental Ethics 27 (3): 349-368. 2014.
    Many advocate practices of ‘local food’ or ‘locavorism’ as a partial solution to the injustices and unsustainability of contemporary food systems. I think that there is much to be said in favor of local food movements, but these virtues are insufficient to immunize locavorism from criticism. In particular, three duties of international ethics—beneficence, repair and fairness—may provide reasons for constraining the developed world’s permissible pursuit of local food. A complete account of why (a…Read more
  •  902
    Recent increases in the rates of parental refusal of routine childhood vaccination have eroded many countries’ “herd immunity” to communicable diseases. Some parents who refuse routine childhood vaccines do so because they deny the mainstream medical consensus that vaccines are safe and effective. I argue that one reason these vaccine denialists disagree with vaccine proponents about the reasons in favor of vaccination is because they also disagree about the sorts of practices that are conducive…Read more
  •  28
    Sincerity, accuracy and selective conscientious objection
    Journal of Military Ethics 12 (2). 2013.
    Conscientious objectors to military service are either general objectors or selective objectors. The former object to all wars; the latter object to only some wars. There is widespread popular and political support in western liberal democracies for exemptions for general objectors, but currently there is little support for exemptions for selective objectors. Many who advocate exemptions for selective objectors attempt to build upon the strength of support that is enjoyed by exemptions for gener…Read more
  •  136
    HPV and the Ethics of CDC’s Vaccination Requirements for Immigrants
    Kennedy Institute of Ethics Journal 25 (2): 111-132. 2015.
    Joseph Carens’ groundbreaking article on immigration ethics begins with the observation that “[b]orders have guards and the guards have guns”. I begin my article with a similar observation: border guards have syringes. Aliens who do not want to be turned away by a border guard’s gun must often agree to be injected with vaccines. While Carens challenges the popular consensus that states have an expansive moral right to forcibly restrict migration, my focus is narrower. I will evaluate the claim t…Read more
  •  137
    Parents in the US and other societies are increasingly refusing to vaccinate their children, even though popular anti-vaccine myths – e.g. ‘vaccines cause autism’ – have been debunked. This book explains the epistemic and moral failures that lead some parents to refuse to vaccinate their children. First, some parents have good reasons not to defer to the expertise of physicians, and to rely instead upon their own judgments about how to care for their children. Unfortunately, epistemic self-relia…Read more