•  6
    Conscientious Objection to Aggressive Interventions for Patients in a Vegetative State
    with Jason Adam Wasserman, Abram L. Brummett, and Daniel Londyn Menkes
    American Journal of Bioethics 1-12. forthcoming.
    Some physicians refuse to perform life-sustaining interventions, such as tracheostomy, on patients who are very likely to remain permanently unconscious. To explain their refusal, these clinicians often invoke the language of “futility”, but this can be inaccurate and can mask problematic forms of clinical power. This paper explores whether such refusals should instead be framed as conscientious objections. We contend that the refusal to provide interventions for patients very likely to remain p…Read more
  •  11
    Making salient ethics arguments about vaccine mandates: A California case study
    with Katie Attwell
    Bioethics 37 (9): 854-861. 2023.
    Vaccine mandates can take many forms, and different kinds of mandates can implicate an array of values in diverse ways. It follows that good ethics arguments about particular vaccine mandates will attend to the details of individual policies. Furthermore, attention to particular mandate policies—and to attributes of the communities they aim to govern—can also illuminate which ethics arguments may be more salient in particular contexts. If ethicists want their arguments to make a difference in po…Read more
  •  5
    This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized salary of respondents with a clinical doctorate is $188,310.08 (SD=$88,556.67), $146,134.85 (SD=$5…Read more
  •  2
    Healthcare Ethics Consultation as Public Philosophy
    In Lee McIntyre, Nancy McHugh & Ian Olasov (eds.), A Companion to Public Philosophy, Wiley. 2022.
    Healthcare ethics consultation is therefore one of the most consequential, institutionally accepted, and widespread forms of public philosophy in the United States. In this chapter, the authors begin with an overview of the development of healthcare ethics and its emergence as a concrete practice embedded in healthcare settings. They then describe the core ethical principles that inform the everyday practice of ethics consultations and the generally accepted steps involved in conducting a consul…Read more
  •  14
    Reciprocity, Vulnerability, and the Moral Significance of Herd Immunity
    Journal of Applied Philosophy 40 (4): 725-745. 2023.
    This article proposes a novel defense of vaccine mandates: such policies are justifiable because they protect the capabilities of individuals who cannot cultivate individual immunity against infection. We begin by considering a nearby argument that has recently enjoyed popularity, which claims individuals have an enforceable obligation to get vaccinated because they have benefited from community protection (often referred to as ‘herd immunity’), and thus they ought to do their fair share in sust…Read more
  •  7
    Capacities to Refuse Treatment: A Reply
    American Journal of Bioethics 24 (3): 15-19. 2023.
    The three of us work as academics and clinical ethicists. In our clinical ethics work, we often encounter patients who lack decision-making capacity, but who nonetheless have strong preferences abo...
  •  7
    Australian states exclude unvaccinated children from early education and care via ‘No Jab No Play’ policies, but some offer exemptions for the socially disadvantaged. Such mandatory vaccination policies provoke heated arguments about morality and potential downstream impacts, and the politics of which kinds of people get exempted from mandates are often fraught. Synthesising existing frameworks for considering the role of moral principles and rational-technical justifications in policymaking, we…Read more
  •  10
    Ethics of age de-escalation in pediatric vaccine trials
    with Ami Harbin and Naomi Laventhal
    Vaccine. forthcoming.
    In the development of new vaccines, many trials use age de-escalation: after establishing safety and efficacy in adult populations, progressively younger cohorts are enrolled and studied. Age de-escalation promotes many values. The responsibility to protect children from potential risks of experimental vaccines is significant, not only given increased risks of adverse effects but also because parents and medical professionals have a moral responsibility to protect children from harms associated …Read more
  •  2
    School staff as vaccine advocates: Perspectives on vaccine mandates and the student registration process
    with Aaron Scherer, Ethan Bradley, and Katie Attwell
    Vaccine 41 (5): 1169-1175. 2023.
    Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anon…Read more
  •  17
    Vaccine Refusal Is Not Free Riding
    Erasmus Journal for Philosophy and Economics 14 (1). 2021.
    Vaccine refusal is not a free rider problem. The claim that vaccine refusers are free riders is inconsistent with the beliefs and motivations of most vaccine refusers. This claim also inaccurately depicts the relationship between an individual’s immunization choice, their ability to enjoy the benefits of community protection, and the costs and benefits that individuals experience from immunization and community protection. Modeling vaccine refusers as free riders also likely distorts the ethical…Read more
  •  27
    Vaccine Refusal Is Still Not Free Riding
    Erasmus Journal for Philosophy and Economics 14 (2). 2022.
    In a recent article, "Can One Both Contribute to and Benefit from Herd Immunity?", Lucie White argues that vaccine refusal is more like free riding than we have claimed that it is. Here, we critically reply to White’s arguments.
  •  26
    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...
  •  25
    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
  •  32
    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
  •  353
    Reasons to Accept Vaccine Refusers in Primary Care
    with Jason Adam Wasserman and Douglas Opel
    Pediatrics 146 (6). 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
  •  19
    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
  •  19
    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
  •  28
    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
  •  32
    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
  •  26
    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
  •  11
    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
  •  31
    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
  •  6
    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
  •  189
    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
  •  29
    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.
  •  8
    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
  •  8
    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