•  58
    Principles versus procedures in making health care coverage decisions: Addressing inevitable conflicts
    with Lindsay M. Sabik
    Theoretical Medicine and Bioethics 29 (2): 73-85. 2008.
    It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is “accountability for reasonableness.” We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patient…Read more
  •  52
    Response to Poullier
    Journal of Medicine and Philosophy 18 (5): 475-476. 1993.
  •  39
    The importance of epistemology for clinical practice
    with Paola Cuzzani
    Theoretical Medicine and Bioethics 12 (1): 87-90. 1991.
  •  38
    Evidence-Based Medicine as an Instrument for Rational Health Policy
    with Nikola Biller-Andorno and Ruud Ter Meulen
    Health Care Analysis 10 (3): 261-275. 2002.
    This article tries to present a broad view on the values and ethicalissues that are at stake in efforts to rationalize health policy on thebasis of economic evaluations (like cost-effectiveness analysis) andrandomly controlled clinical trials. Though such a rationalization isgenerally seen as an objective and `value free' process, moral valuesoften play a hidden role, not only in the production of `evidence', butalso in the way this evidence is used in policy making. For example, thedefinition o…Read more
  •  37
  •  36
    The 'borderzone zone' controversy a study of theory structure in biomedicine
    Theoretical Medicine and Bioethics 7 (3). 1986.
    This paper gives an account of theory structure in the biomedical sciences with particular emphasis on cardiology. Rather than regarding theories as axiomatizable sets of statements (the so-called received view), theories are regarded as answers to questions which are accepted as legitimate and interesting by scientists within a field of investigation at a given time. This account of theory structure is used to distinguish between theories which are quite liable to be revised during the course o…Read more
  •  36
    This article presents a case study from the history of cardiology, namely, the development towards the acceptance of the coronary theory of angina pectoris. I show that the arguments which were considered decisive against the theory were not answered at the time the theory was accepted. I also point out that the experimental and practical success of the theory cannot be used to support the initial choice because, in the subsequent development, the field researchers became preoccupied with new qu…Read more
  •  36
    The Fair Benefits Approach Revisited
    Hastings Center Report 40 (4): 3-3. 2010.
    In this issue, Alex London and Kevin Zollman provide an analysis of an influential approach to the ethics of international research, known as the “fair benefits” approach. According to them, the fair benefits approach suffers from a fatal flaw: it is either too vague to be useful, or worse, is internally inconsistent. The fair benefits approach was developed based on a presentation I gave at a workshop organized in Malawi in March 2001 by the National Institutes of Health Clinical Center’s Depar…Read more
  •  35
    No ethical divide between China and the West in human embryo research
    with Xiaomei Zhai and Vincent Ng
    Developing World Bioethics 16 (2): 116-120. 2016.
    This is a discussion of the reaction to the recent research article publication in the journal Protein & Cell by a group of scientists at Sun Yat-sen University using the CRISPR/Cas9 technique on editing non-viable human zygotes. Many commentators condemned the Chinese scientists for overstepping ethical boundaries long accepted in Western countries and accused China of having lax regulations on genomic research in general. We argue that not only did this research follow strict ethical standards…Read more
  •  34
    The use of interval estimators as a basis for decision-making in medicine
    Theoretical Medicine and Bioethics 5 (3). 1984.
    Decision analysts sometimes use the results of clinical trials in order to evaluate treatment alternatives. I discuss some problems associated with this, and in particular I point out that it is not valid to use the estimates from clinical trials as the probabilities of events which are needed for decision analysis. I also attempt to show that an approach based on objective statistical theory may have advantages over commonly used methods based on decision theory. These advantages include the re…Read more
  •  33
    Book reviews (review)
    with John Root Stone
    Theoretical Medicine and Bioethics 10 (3). 1989.
  •  29
    The World Medical Association’s revised Declaration of Helsinki endorses the view that all trial participants in every country are entitled to the worldwide best standard of care. In this paper the authors show that this requirement has been rejected by every national and international committee that has examined this issue. They argue that the consensus view now holds that it is ethically permissible, in some circumstances, to provide research participants less than the worldwide best care. Fin…Read more
  •  28
    Attitudes towards transfers of human tissue samples across borders: An international survey of researchers and policy makers in five countries
    with Xinqing Zhang, Kenji Matsui, Benjamin Krohmal, Alaa Zeid, Vasantha Muthuswamy, Young Koo, and Yoshikuni Kita
    BMC Medical Ethics 11 (1): 16-. 2010.
    Background: Sharing of tissue samples for research and disease surveillance purposes has become increasingly important. While it is clear that this is an area of intense, international controversy, there is an absence of data about what researchers themselves and those involved in the transfer of samples think about these issues, particularly in developing countries. Methods: A survey was carried out in a number of Asian countries and in Egypt to explore what researchers and others involved in r…Read more
  •  27
    Obligations of low income countries in ensuring equity in global health financing
    with John Barugahare
    BMC Medical Ethics 16 (1): 1-11. 2015.
    BackgroundDespite common recognition of joint responsibility for global health by all countries particularly to ensure justice in global health, current discussions of countries’ obligations for global health largely ignore obligations of developing countries. This is especially the case with regards to obligations relating to health financing. Bearing in mind that it is not possible to achieve justice in global health without achieving equity in health financing at both domestic and global leve…Read more
  •  27
    There is a growing interest in comparison of international health care data with the hope that such studies will enable individual systems to learn from other systems. Such comparisons, however, presuppose that there exist common criteria for evaluating health care systems. The main thesis of this paper is that these comparative studies are misleading because they employ inappropriate operationalizations of these criteria because the operarionalizations are based upon mistaken global conceptuali…Read more
  •  26
    Aiming at a moving target: research ethics in the context of evolving standards of care and prevention
    with S. Shah
    Journal of Medical Ethics 39 (11): 699-702. 2013.
    In rapidly evolving medical fields where the standard of care or prevention changes frequently, guidelines are increasingly likely to conflict with what participants receive in research. Although guidelines typically set the standard of care, there are some cases in which research can justifiably deviate from guidelines. When guidelines conflict with research, an ethical issue only arises if guidelines are rigorous and should be followed. Next, it is important that the cumulative evidence and th…Read more
  •  25
    Reassessing Diagrams of Cardiac Mechanics: From Otto Frank and Ernest Starling to Hiroyuki Suga
    with Johann-Peter Kuhtz-Buschbeck, Jochen Schaefer, and Nicolaus Wilder
    Perspectives in Biology and Medicine 59 (4): 471-490. 2016.
    The main topic of this article is Otto Frank's forgotten notion of the pressure-volume diagram of the cardiac ventricle as a means to assess the external mechanical work of the heart. Developed by Frank at the end of the 19th century, this idea was reenvisioned as pressure-volume area about 70 to 80 years later by Hiroyuki Suga. This notion now serves as a perspective for defining cardiac contractility and thus enabling the controlled clinical application of cardiac assist devices. We begin our …Read more
  •  24
    Reviews (review)
    with Wolfgang U. Eckart, Marion Weber, and Reidar K. Lie
    Theoretical Medicine and Bioethics 9 (3). 1988.
  •  20
    All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities. We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the Unit…Read more
  •  19
    Review (review)
    Theoretical Medicine and Bioethics 2 (2). 1987.
  •  18
    Background: Although health is a right of all individuals without any distinction, the realisation of this right has remained very difficult for the marginalised populations of poor countries. Inequitable distribution of health opportunities globally is a major factor in explaining why this is the case. Whereas the Protection, Promotion and Fulfilment of the health rights of poor country citizens are a joint responsibility of both domestic and external governments, most governments flout their o…Read more
  •  15
    Moral Standards for Research in Developing Countries from "Reasonable Availability" to "Fair Benefits"
    with Maged El Setouhy, Tsiri Agbenyega, Francis Anto, Christine Alexandra Clerk, Kwadwo A. Koram, Michael English, Rashid Juma, Catherine Molyneux, Norbert Peshu, Newton Kumwenda, Joseph Mfutso-Bengu, Malcolm Molyneux, Terrie Taylor, Doumbia Aissata Diarra, Saibou Maiga, Mamadou Sylla, Dione Youssouf, Catherine Olufunke Falade, Segun Gbadegesin, Ferdinand Mugusi, David Ngassapa, Julius Ecuru, Ambrose Talisuna, Ezekiel Emanuel, Christine Grady, Elizabeth Higgs, Christopher Plowe, Jeremy Sugarman, and David Wendler
    Hastings Center Report 34 (3): 17. 2004.
  •  15
    The Ethics of the Physician-Patient Relationship
    Ethical Perspectives 4 (4): 263-270. 1997.
    It is a remarkable fact about the development of medical ethics from the 1960s until today that there has been a dramatic shift from a position where it was taken for granted that the physician knows best, to a position where much greater emphasis is put on the patient’s treatment preferences. This shift is evident with regard to physician attitudes towards disclosing a cancer diagnosis. For example, in 1961, a survey of cancer physicians showed that almost 90% of the physicians reported that th…Read more
  •  15
    Bioethical Implications of Globalization: An International Consortium Project of the European Commission
    with Thomas E. Novotny, Emilio Mordini, Ruth Chadwick, J. Martin Pedersen, Fabrizio Fabbri, Natapong Thanachaiboot, Elias Mossialos, and Govin Permanand
    PLoS Med 3 (2). 2006.
    The term “globalization” was popularized by Marshall McLuhan in War and Peace in the Global Village. In the book, McLuhan described how the global media shaped current events surrounding the Vietnam War [1] and also predicted how modern information and communication technologies would accelerate world progress through trade and knowledge development. Globalization now refers to a broad range of issues regarding the movement of goods and services through trade liberalization, and the movement of …Read more
  •  14
    A Survey of Scientist and Policy Makers' Attitudes Toward Research on Stored Human Biological Materials in Sri Lanka
    with Vajira H. W. Dissanayake, Dulika S. Sumathipala, U. G. A. C. Kariyawasam, J. M. D. N. M. M. Jayamanne, and P. K. D. S. Nisansala
    Developing World Bioethics 15 (3): 226-232. 2015.
    Introduction Stored human samples and the establishment of biobanks are increasing in the world. Along with this there are the questions of ethics that arise such as the correct method of obtaining informed consent for research on stored samples and the policies involved in collaborative research using collected samples. This study is an attempt to evaluate the researchers, academics and policy makers' views on these ethical aspects. Methods This was an anonymised study involving a Sri Lankan po…Read more
  •  13
    Obligations of poor countries in ensuring global justice: The case of uganda
    with John Barugahare
    Etikk I Praksis - Nordic Journal of Applied Ethics 8 (2). 2014.
    Obligations of global justice rest mainly on the global rich but also to a lesser extent on the global poor. The governments of poor countries are obliged to fulfill requirements of non-aggression, good governance and decency, along with all other requirements which facilitate the achievement of global justice. So far, obligations of poor countries seem to be taken as given yet the behavior of governments in poor countries and occurrences therein attest to the contrary;this suggests a need to ma…Read more
  •  12
    This book, edited by a team of leading European bioethicists, is in all respects an innovative publication.
  •  11