Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency (...) legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients. (shrink)

The National Institute of Mental Health reports that approximately 5.2 million Americans experience post-traumatic stress disorder 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 drugs raises important ethical concerns, including some futuristic dystopias put forth by the President's (...) Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)

With more countries implementing Open Notes, the practice of providing patients with unhindered access to their clinical visit notes, research on this practice is finally increasing. Many studies report positive findings, especially around self-reported outcomes, such as feeling more in control of one’s care, increased medication adherence and a strengthened patient–doctor relationship. 1 However, comparatively less research has been done on the potential ramifications that may also arise from Open Notes. Blease’s recent article underscores this and demonstrates why (...) Open Notes must also be considered in terms of nocebo effects, negative side effects that arise from negative expectations. 2 The article presents a compelling and well-thought-out argument for how nocebo effects may vary across different populations by linking patient–clinician communication inequalities with and by presenting preliminary evidence of nocebo effects. Blease’s argument does not detract from Open Notes, but rather takes a balanced approach by imploring us... (shrink)

In their open peer commentary: “Making It Count: Extracting Real World Data from Compassionate Use and Expanded Access Programs”, Rozenberg and Greenbaum discuss impo...

In our target article (Sabatello et al. 2021), we proposed the use of community engagement and the establishment of a Truth and Reconciliation Commission (TRC) as pathways for promoting social just...

Alexandre Gajevic Sayegh presents an intriguing interdisciplinary exploration of climate justice policy issues. He argues the important point that justice must be a key element of any climate regim...

(2010). Response to Open Peer Commentaries on “How to Do Research Fairly in an Unjust World”. The American Journal of Bioethics: Vol. 10, No. 6, pp. W4-W6.

I greatly appreciate the open peer commentary authors’ thoughtful engagement with my proposal to include a Citizens’ Jury (CJ) at the level of the International Commission when exploring ethical re...

Many of the commentaries have made similar points regarding the nature of full moral status, so I shall begin by addressing these together. They argue that my representation of the Claim is stronger than many proponents of full moral status would accept (Ord 2008). Robert Card (2008) says that I assume that it is equally bad to lose human life at all stages. Russell DiSilvestro (2008) says that I assume a flawed principle that he calls (M). Marianne Burda (2008) (...) says that I assume that life must be saved or prolonged at all costs. Christopher Dodsworth and colleagues (2008) say that I assume embryos have as much to lose as adults. I assume none of these things. The argument I put forward works just as well for more subdued claims about the moral status of the embryo. All that is required is to find the badness of embryo death to be at least roughly comparable to the badness of adult death, so that when a proponent of full moral status hears that 30 times more of our moral equals die of spontaneous abortion than die of cancer, their views would require urgent action if such action is possible. The comparison between the badness of adult death and of fetal or embryonic death is made routinely in the literature in support of restrictions upon abortion, in vitro fertilization (IVF) and stem cell research, and it appears to be a mainstream view worthy of serious attention.1 If a large proportion of those who claim that the embryo has full moral status are none-the-less quite sure that each embryo death is much less bad than an adult death, then they owe it to their readers to be more clear about this. Let us now consider the other points of each commentary in turn. (shrink)

Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self. After the ethicist (...) appreciates how these concepts influence the invocator's worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle. (shrink)

(2010). Response to Open Peer Commentaries on “The Pitfalls of Deducing Ethics from Economics: Why the Association of American Medical Colleges is Wrong About Pharmaceutical Detailing”. The American Journal of Bioethics: Vol. 10, No. 1, pp. W1-W3.

We’re grateful for the thoughtful and incisive commentaries on our article, “Ethical Responsibilities for Companies that Process Personal Data” (McCoy et al. 2023). In the article, we propose the E...

The convergence of increasingly efficient high throughput sequencing technology and ubiquitous Internet use by the public has fueled the proliferation of companies that provide personal genetic information direct-to-consumers. Companies such as 23andme and Navigenics are emblematic of a growing market for PGI that some argue represents a paradigm shift in how the public values this information and incorporates it into how they behave and plan for their futures. This new class of social networking business ventures that market the science of (...) the personal genome illustrates the new trend in collaborative science. In addition to fostering a consumer empowerment movement, it promotes the trend of democratizing information—openly sharing of data with all interested parties, not just the biomedical researcher—for the purposes of pooling data and escalating the innovation process. This target article discusses the need for new approaches to studying DTC genomics using social network analysis to identify the impact of obtaining, sharing, and using PGI. As a locus of biosociality, DTC personal genomics forges social relationships based on beliefs of common genetic susceptibility that links risk, disease, and group identity. Ethical issues related to the reframing of DTC personal genomic consumers as advocates and research subjects and the creation of new social formations around health research may be identified through social network analysis. (shrink)

A growing body of evidence has linked consumption of trans fatty acids to cardiovascular disease. To promote public health, numerous state and local governments in the United States have banned the use of artificial trans fats in restaurant foods, and additional bans may follow. Although these policies may have a positive impact on human health, they open the door to excessive government control over food, which could restrict dietary choices, interfere with cultural, ethnic, and religious traditions, and exacerbate socioeconomic (...) inequalities. These slippery slope concerns cannot be dismissed as far-fetched, because the social and political pressures are place to induce additional food regulations. To protect human freedom and other values, policies that significantly restrict food choices, such as bans on types of food, should be adopted only when they are supported by substantial scientific evidence, and when policies that impose fewer restrictions on freedom, such as educational campaigns and product labeling, are likely to be ineffective. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page W4-W6, August 2011.

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should (...) be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page W1-W3, June 2011.

We discuss some of the relationships between the notion of "mutual stationarity" of Foreman and Magidor and measurability in inner models. The general thrust of these is that very general mutual stationarity properties on small cardinals, such as the ℵns, is a large cardinal property. A number of open problems, theorems, and conjectures are stated.

We respond to open peer commentaries on our target article, "Health Research Priority Setting: The Duties of Individual Funders".

Volume 20, Issue 8, August 2020, Page W14-W16.

The American Journal of Bioethics, Volume 11, Issue 10, Page W1-W3, October 2011.

Precision medicine relies on data and biospecimens from participants who willingly offer their personal information on the promise that this act will ultimately result in knowledge that will improv...

The allocation of scarce health care resources such as flu treatment or organs for transplant presents stark problems of distributive justice. Persad, Wertheimer, and Emanuel have recently proposed a novel system for such allocation. Their “complete lives system” incorporates several principles, including ones that prescribe saving the most lives, preserving the most life-years, and giving priority to persons between 15 and 40 years old. This paper argues that the system lacks adequate moral foundations. Persad and colleagues' defense of giving priority (...) to those between 15 and 40 leaves them open to the charge that they discriminate unfairly against children. Second, the paper contends that the complete lives system fails to provide meaningful practical guidance in central cases, since it contains no method for balancing its principles when they conflict. Finally, the paper proposes a new method for balancing principles of saving the most lives and maximizing life-years. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page W1-W3, August 2011.

The global landscape in which we wrote this essay has fundamentally changed. Given how these changes have altered the rhythm of life, particularly the added responsibilities that many of you have a...

In “Developing a Reflexive, Anticipatory, and Deliberative Approach to Unanticipated Discoveries: Ethical Lessons from iBlastoids,” we proposed a RAD approach to meet the challenging issues...

Purpose: To determine the relative value that patients place on consent for procedures in the emergency department and to define a set of procedures that fall in the realm of implied consent. Methods: A questionnaire was administered to a convenience sample 134 of 174 patients who were seen in the ED of a Midwestern teaching hospital. The questionnaire asked how much time they believed was necessary to give consent for various procedures. Procedures ranged from simple to complex. Results: Participants valued (...) a simple blood draw at a low mean of 1.02 minutes of extra time and a lumbar puncture at a high mean of 7.78 minutes. Of all participants 52% and 48% noted a time-value of “0” time on blood draw and intravenous line starts, respectively, indicating that they desire no additional consent for these procedures. Conclusion: Defining a set of ED procedures covered under implied consent will be difficult because many patients value formal consent for even the simplest procedure. (shrink)

Volume 19, Issue 5, May 2019, Page W3-W4.

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. (...) To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation by prospective parents before deciding whether or how to use NIPW. (shrink)

This target article considers the ethical implications of providing prenatal diagnosis and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion for (...) these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

Background: This study investigated the factors affecting the acceptability in France of abortions. Method: 80 study participants from Toulouse and 124 from Metz judged the acceptability of abortion in 64 vignettes composed of five factors: 1) the adolescent's age (15 or 17.5 years), 2) the adolescent's plans to continue schooling or not, 3) the fetus' age (1, 2, 3, or 4 months), 4) the adolescent's parents' agreement or not, and 5) the agreement or not of baby's father. Results: Three clusters (...) were noted: 1) abortion is never acceptable (8% of participants), 2) abortion is always acceptable (23%), and 3) acceptability of abortion depends on the circumstances (63%). In the majority cluster (3), all five factors had significant effects, but the fetus's age accounted for most of the variance (78%). Conclusion: Most subjects in this study judged, in accordance with French law, that the acceptability of induced abortion in minors depends on the circumstances and, in particular, on the fetus' age. (shrink)

Articulating the public's widespread unease about animal biotechnology has not been easy, and the first attempts have not been able to provide an effective tool for navigating the moral permissibility of this research. Because these moral intuitions have been difficult to cash out, they have been belittled as representing nothing more than fear or confusion. But there are sound philosophical reasons supporting the public's opposition to animal biotechnology and these arguments justify a default position of resistance I call the Presumption (...) of Restraint. The Presumption of Restraint constitutes a justificatory process that sets out the criteria for permitting or rejecting individual biotechnology projects. This Presumption of Restraint can be overridden by compelling arguments that speak to a project's moral and scientific merit. This strategy creates a middle-of-the-road stance that can embrace particular projects, while rejecting others. The Presumption of Restraint can also serve as a model for assessing moral permissibility in other areas of technological innovation. (shrink)

Clinical ethics consultations are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering (...) sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient “closure” for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as “bioethics mediation.”. (shrink)