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344Should individuals choose their definition of death?Journal of Medical Ethics 34 (9): 688-689. 2008.Alireza Bagheri supports a policy on organ procurement where individuals could choose their own definition of death between two or more socially accepted alternatives. First, we claim that such a policy, without any criterion to distinguish accepted from acceptable definitions, easily leads to the slippery slope that Bagheri tries to avoid. Second, we suggest that a public discussion about the circumstances under which the dead donor rule could be violated is more productive of social trust than…Read more
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100Intrinsic Conflicts of Interest in Clinical Research: A Need for DisclosureKennedy Institute of Ethics Journal 13 (2): 83-91. 2003.: Protection of human subjects from investigators' conflicts of interest is critical to the integrity of clinical investigation. Personal financial conflicts of interest are addressed by university policies, professional society guidelines, publication standards, and government regulation, but "intrinsic conflicts of interest"—conflicts of interest inherent in all clinical research—have received relatively less attention. Such conflicts arise in all clinical research endeavors as a result of the…Read more
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90Philosophical debates about the definition of death: Who cares?Journal of Medicine and Philosophy 26 (5). 2001.Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics w…Read more
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85Propranolol and the prevention of post-traumatic stress disorder: Is it wrong to erase the “sting” of bad memories?American Journal of Bioethics 7 (9). 2007.The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering dru…Read more
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82Death and organ procurement: Public beliefs and attitudesKennedy Institute of Ethics Journal 14 (3): 217-234. 2004.: Although "brain death" and the dead donor rule—i.e., patients must not be killed by organ retrieval—have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents ≥18 years were randomly selected and surveyed using random digit dialing (RDD) samp…Read more
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71Clinical Ethics Consultation: Examining how American and Japanese experts analyze an Alzheimeras caseBMC Medical Ethics 9 (1): 2-. 2008.BackgroundFew comparative studies of clinical ethics consultation practices have been reported. The objective of this study was to explore how American and Japanese experts analyze an Alzheimer's case regarding ethics consultation.MethodsWe presented the case to physicians and ethicists from the US and Japan (one expert from each field from both countries; total = 4) and obtained their responses through a questionnaire and in-depth interviews.ResultsEstablishing a consensus was a common goal amo…Read more
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69One or two types of death? Attitudes of health professionals towards brain death and donation after circulatory death in three countriesMedicine, Health Care and Philosophy 16 (3): 457-467. 2013.This study examined health professionals’ (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual…Read more
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67For Experts Only? Access to Hospital Ethics CommitteesHastings Center Report 21 (5): 17-24. 1991.How closely involved with hospital ethics committees should patients and their families become? Should they routinely have access to committees, or be empowered to initiate consultations? To what extent should they be informed of the content or outcome of committee deliberations? Seeing ethics committees as the locus of competing responsibilities allows us to respond to the questions posed by a patient rights model and to acknowledge more fully the complex moral dynamics of clinical medicine.
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66Quality Attestation for Clinical Ethics Consultants: A Two‐Step Model from the American Society for Bioethics and HumanitiesHastings Center Report 43 (5): 26-36. 2013.Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perfor…Read more
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60A Pilot Evaluation of Portfolios for Quality Attestation of Clinical Ethics ConsultantsAmerican Journal of Bioethics 16 (3): 15-24. 2016.Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and sugge…Read more
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59The Dead Donor Rule: Should We Stretch It, Bend It, or Abandon It?Kennedy Institute of Ethics Journal 3 (2): 263-278. 1993.The dead donor rule—that persons must be dead before their organs are taken—is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbol…Read more
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55Ethics consultation: from theory to practice (edited book)Johns Hopkins University Press. 2003.In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns -- w…Read more
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53Some Must DieZygon 38 (3): 705-724. 2003.The transplantation and procurement of human organs has become almost routine in American society. Yet, organ transplantation raises difficult ethical and psychosocial issues in the context of “controlled” death, including the blurring of boundaries between life and death, self and other, healing and harming, and killing and letting die. These issues are explored in the context of the actual experiences of organ donors and recipients, brain death, the introduction of non‐heartbeating donor proto…Read more
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50"Allow natural death" is not equivalent to "do not resuscitate": a responseJournal of Medical Ethics 34 (12): 887-888. 2008.Venneman and colleagues argue that “do not resuscitate” (DNR) is problematic and should be replaced by “allow natural death” (AND). Their argument is flawed. First, while end-of-life discussions should be as positive as possible, they cannot and should not sidestep painful but necessary confrontations with morality. Second, while DNR can indeed be nonspecific and confusing, AND merely replaces one problematic term with another. Finally, the study’s results are not generalisable to the population…Read more
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44Back to the Future: Obtaining Organs from Non-Heart-Beating CadaversKennedy Institute of Ethics Journal 3 (2): 103-111. 1993.In lieu of an abstract, here is a brief excerpt of the content:Back to the Future:Obtaining Organs from Non-Heart-Beating CadaversRobert M. Arnold (bio) and Stuart J. Youngner (bio)Organ Transplantation requires viable donor organs. This simple fact has become the Achilles' heel of transplantation programs. Progress in immunology and transplant surgery has outstripped the supply of available organs. Between 1988 and 1991, for example, the number of transplant candidates on waiting lists increase…Read more
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41A Conceptual Model for the Translation of Bioethics Research and ScholarshipHastings Center Report 46 (5): 34-39. 2016.While the bioethics literature demonstrates that the field has spent substantial time and thought over the last four decades on the goals, methods, and desired outcomes for service and training in bioethics, there has been less progress defining the nature and goals of bioethics research and scholarship. This gap makes it difficult both to describe the breadth and depth of these areas of bioethics and, importantly, to gauge their success. However, the gap also presents us with an opportunity to …Read more
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39The Texas Advanced Directive Law: Unfinished BusinessAmerican Journal of Bioethics 15 (8): 34-38. 2015.The Texas Advance Directive Act allows physicians and hospitals to overrule patient or family requests for futile care. Purposefully not defining futility, the law leaves its determination in specific cases to an institutional process. While the law has received several criticisms, it does seem to work constructively in the cases that come to the review process. We introduce a new criticism: While the law has been justified by an appeal to professional values such as avoiding harm to patients, a…Read more
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39Resolving problems at the intensive care unit/oncology unit interfacePerspectives in Biology and Medicine 31 (2): 299. 1988.
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36Task Force on Standards for Ethics Consultation: Response to “Ethics Consultation: The Least Dangerous Profession?” (review)Cambridge Quarterly of Healthcare Ethics 5 (2): 284. 1996.
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36When slippery slope arguments miss the mark: a lesson from one against physician-assisted deathJournal of Medical Ethics 44 (10): 657-660. 2018.In 1989, Susan Wolf convincingly warned of a troublesome consequence that should discourage any movement in American society towards physician-assisted death—a legal backlash against the gains made for limiting life-sustaining treatment. The authors demonstrate that this dire consequence did not come to pass. As physician-assisted suicide gains a foothold in USA and elsewhere, many other slippery slope arguments are being put forward. Although many of these speculations should be taken seriously…Read more
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34Thoughts of Hastening Death among Hospice PatientsJournal of Clinical Ethics 11 (1): 56-65. 2000.
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33Poverty: Not a Justification for Banning Physician‐Assisted DeathHastings Center Report 48 (6): 38-46. 2018.Many critics of the legalization of physician‐assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. We will provide empirical evidence suggesting that concerns about money influence medical decisions throughout the full course of illness, but at the end of life…Read more
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33The Definition of DeathIn Bonnie Steinbock (ed.), The Oxford handbook of bioethics, Oxford University Press. 2007.Two factors, medical science's growing control over the timing of death and the increasingly desperate need for organs, have led to a reopening of the debate about the definition of death and have forced a consideration of aspects of the determination of death that had never been addressed before. Without the pressing need for organs, the definition of death would have remained on the back shelf, the conversation of a few interested philosophers or theologians. This article examines some new que…Read more
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33Do Formal Advance Directives Affect Resuscitation Decisions and the Use of Resources for Seriously Ill Patients?Journal of Clinical Ethics 5 (1): 23-30. 1994.
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33How Can You Be Transparent About Labeling the Living as Dead?American Journal of Bioethics 17 (5): 24-25. 2017.
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32Should Psychiatrists Serve as Gatekeepers for Physician‐Assisted Suicide?Hastings Center Report 28 (4): 24-31. 1998.Mandating psychiatric evaluation for patients who request physician‐assisted suicide may not offer the clearcut protection from possible coercion or other abuse that proponents assert. Competence itself is a complex concept and determinations of decisionmaking capacity are not straightforward, nor is the relationship between mental illness and decisionmaking capacity in dying patients clearly understood. And casting psychiatrists as gatekeepers in end‐of‐life decisions poses risks to the profess…Read more
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32Talking about death is not the same as communicating about deathJournal of Medical Ethics 41 (4): 303-303. 2015.
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30Patients?Attitudes Toward Hospital Ethics CommitteesJournal of Law, Medicine and Ethics 12 (1): 21-25. 1984.
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30Response to Open Peer Commentaries on “The Texas Advanced Directive Law: Unfinished Business”American Journal of Bioethics 15 (9): 6-7. 2015.
Cleveland, Ohio, United States of America