Bioethics Publications

  • A Good Death

    Adira Hulkower, Tia Powell – Student

    Hastings Center Report – January 11, 2017

    A good death is hard to find. Family members tell us that loved ones die in the wrong place—the hospital—and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively new and still vulnerable aspect of medical care. For thousands of years, patients and surrogates had no say in medical decision-making. Today, standards support shared decision-making, but these articles both carve out exceptions to those standards, limiting the rights of patients and families in decisions about specific end-of-life treatments. As bioethics consultants in an acute care setting, we frequently confront conflicts similar to those described by Jeffrey Berger and by Ellen Robinson and colleagues. In such cases, our service emphasizes redoubled efforts at communication and mediation. Focusing on goals and values, rather than interventions, produces the best possible collaboration in health care decision-making. Cases in which we would overturn a surrogate's recommendations regarding palliative sedation or do-not-resuscitate orders are rare and require careful processes and clear evidence that the surrogate's choice is contrary to patient values.

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  • Free to Consume? Anti-Paternalism and the Politics of New York City’s Soda Cap Saga

    James Colgrove – Faculty

    Public Health Ethics – January 7, 2017

     2012, New York City Mayor Michael Bloomberg proposed capping the size of sugary beverages that could be sold in the city’s restaurants, sporting and entertainment facilities and food carts. After a lawsuit and multiple appeals, the proposal died in June 2014, deemed an unconstitutional overreach. In dissecting the saga of the proposed soda cap, we highlight both the political perils of certain anti-obesity efforts and, more broadly, the challenges to public health when issues of consumer choice and the threat of paternalism are involved. 

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  • Combating Resistance: Federal Efforts to Reduce Overuse, Curb Misuse, and Incentivize the Development of Antibiotic Drugs

    Donna Hanrahan – Alumni

    Annals of Health Law – January 1, 2017

    This article addresses the public health issue of antibiotic resistance and recommends statutory responses to reduce the overuse, curb misuse, and incentivize the development of novel antibiotic drugs. It then suggests that the Food and Drug Administration (FDA) impose a Risk Evaluation and Mitigation Strategy (REMS) restriction on novel antibiotic drug products to conserve their use and prevent misuse. Further, this article urges Congress to be swift and bold in implementing statutory reform to halt antibiotic resistance by passing the Promise for Antibiotics and Therapeutics for Health (PATH) Act to incentivize innovation in antibiotic development by creating a new regulatory approval pathway for antibiotic drugs. Until a new regulatory regime surrounding antibiotics is established, policymakers should work creatively within existing statutory frameworks to curb resistance by using the Orphan Drug Act (ODA) to spur antibiotic innovation and the Controlled Substance Act (CSA) to promote antibiotic conservation. 

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  • The Imperative for Conceptual Accuracy in Memory Modification

    Carl Erik Fisher, Katrina Hui – Faculty

    AJOB Neuroscience – December 6, 2016

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  • Vaccine Refusal Revisited — The Limits of Public Health Persuasion and Coercion

    James Colgrove – Faculty

    Presidential Politics and Health Policy – October 6, 2016

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  • Your Next Antibiotic Might Be a Virus

    Kira Peikoff – Alumni

    Popular Mechanics – September 15, 2016

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  • Inferior Disagreement

    Maura Priest – Student

    Acta Analytica – September 1, 2016

    Literature in the epistemology of disagreement has focused on peer disagreement: disagreement between those with shared evidence and equal cognitive abilities. Additional literature focuses on the perspective of amateurs who disagree with experts. However, the appropriate epistemic reaction from superiors who disagree with inferiors remains underexplored. Prima facie, this may seem an uninteresting set of affairs. If A is B’s superior, and A has good reason to believe she is B’s superior, A appears free to dismiss B’s disagreement. However, a closer look will show otherwise. I first distinguish competent from incompetent inferiors and then argue that disagreement from the former often gives superiors reason to adjust credence and reevaluate belief. In other words, epistemic inferiority alone is insufficient grounds for dismissing opinion. More nuanced difficulties arise with incompetent inferiors. When superiors disagree with incompetents, this might provide evidence to bolsterbelief credence; however, agreement from incompetents can defeat justification. In either instance, inferior opinion carries epistemic weight. Yet, this fails to cover all ground; at times, superiors learn nothing from inferior disagreement. I finish by exploring these uninformative disagreements, how to distinguish them from the informative cases, and the proper epistemic reactions thereof.

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  • Why Children Should be Allowed to Vote

    Maura Priest – Student

    Public Affairs Quarterly – July 1, 2016

    The United States has an ugly record of unjust disenfranchisement. Initially, only property-owning white males could exercise this essential political right. As time went on, progressive legislation began to rectify these grave wrongs. Property ownership is no longer mandated, poll taxes have been eliminated, and the vote has been expanded to women and minorities. However, there remains a class of the unjustly disenfranchised: those old enough to reason, to make rational and informed decisions, yet denied basic political privileges because of age. This paper argues that the current voting age in the United States conflicts with fundamental liberal principles. It considers a wide range of arguments that attempt to justify youth disenfranchisement and concludes that all such arguments fail. It then briefly argues that youth voting is more likely to help society rather than hurt it. Although arguments in this paper focus on voting in the United States, much of what is said applies to all liberal democracies.

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  • Federal "Right to Try" Bill: Wrong on the Law, and Wrong For Patients

    Lisa Kearns, Beth Roxland – Alumni

    The Hill – June 28, 2016

    On June 16, Jordan McLinn, a seven-year old boy who suffers from Duchenne muscular dystrophy, joined other patients, their advocates, and members of Congress at a rally on the Capitol lawn in support of a federal “right to try” bill. At first blush, the Trickett Wendler Right to Try Act (S. 2912) would grant McLinn and other dying patients an automatic right to pre-approval, or “compassionate,” access to experimental drugs that appear promising in early testing but that have not yet completed clinical trials and been approved by the FDA. Unfortunately, the new federal bill, like similar state laws, is both legally ineffective and ethically troubling.

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  • Ethics of Advances in Human Embryonic Stem Cell Research

    Matthew Dias – Student

    Ampersand – June 16, 2016

    For several decades, scientists have reasoned that stem cells—and human embryonic stem cells (hESC) especially—have the potential to improve human health. In particular, research indicates that the properties unique to hESC (e.g., plasticity, potency) can benefit our understanding of, and approaches to, regenerative medicine and embryology. For instance, understanding how these cells might (i) mitigate or treat diseases such as Alzheimer’s, Parkinson’s, cancer, and diabetes, and (ii) produce vital insights into human development, is a priority within the scientific research enterprise, but one whose methodologies and ethics should be thoroughly monitored and reviewed in accordance with advances in medicine.

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