Ethics

Physician-Assisted Suicide: Moral Rights, Constitutional Law and Self-Determination

Death With Dignity movements, efforts to legalize physician-assisted suicide, have gained significant force in recent years. The New York Court of Appeals recently rejected a challenge to a law making it a criminal offense to assist any individual from committing suicide, on the grounds that the state has an overriding state interest in ensuring that patients are not coerced into such choices. In this article with Global Bioethics Initiative, I argue that although individuals may have a moral right to physician-assisted suicide, the court’s decision was nevertheless correct from a legal standpoint. I also suggest that future appeals should focus on flaws in the distinction between actively killing a patient and withdrawing life support, and argue that it will be easier to legalize physician-assisted suicide by passing new laws, given the strong legal precedents against the practice.

Published with Global Bioethics Initiative on September 24th, 2017.

Paolo Macchiarini, Fraud, and Oversight: A Case of Falsified Stem Cell Research

Recent scrutiny by Swedish TV series Experimenten has revealed that stem cell experiments by Paolo Macchiarini were fraudulent and grossly misleading. The experiments, which were lauded as successful attempts to grow new trachea for patients using stem cells, were conducted without sufficient institutional oversight, and likely worsened the condition of Macchiarini’s patients. In fact, most of his patients have died since their procedures, many from complications from the artificial trachea. In this article with Global Bioethics Initiative, I discuss the factors that enabled Macchiarini’s case to occur, and suggest that more oversight is needed when scientists report resounding successes to ensure that ethical regulations continue to be followed.

Published with Global Bioethics Initiative on September 6th, 2017.

 

Track Authorities Are Wrong To Ban Women With Naturally High Testosterone Levels

Athletes with hyperandrogenism have testosterone levels that are naturally higher than what is generally considered the “normal” range for a person to have. The International Association of Athletics Federations will soon debate a rule that forbids female athletes with hyperandrogenism from competing in events against other women, on the assumption that the advantage their elevated testosterone levels confers is unfair because it approaches the lower end of the typical “male range”. In this article for Oxford University’s Uehiro Center for Practical Ethics’s “Practical Ethics, Ethics In the News,” I argue that the IAAF policy overlooks the central principles of sporting ethics in judging these women to have an unfair advantage. Further, I argue that judging naturally high hormone levels unfair is an arbitrary distinction that ignores other naturally occurring advantages without reason. The IAAF policy thus unfairly discriminates against hyperandrogenistic women, and these athletes should be allowed to compete.

Published with Practical Ethics: Ethics In The News (Oxford University’s Uehiro Center for Practical Ethics), August 22nd, 2017.

CRISPR, Pigs, Organs, Ethics: Some Key Considerations

Scientists at eGenesis have used CRISPR to create pigs without genes responsible for producing several viruses that make pig organs unsuitable for transport to humans. While the experiment is certainly a major advance in the effort to design organs from other animals that can be transported into humans, there are many ethical questions to consider with such research. In this article, I discuss some of the contentious claims about the moral status of pigs and other animals used in animal research, and suggest that the ethics of experiments like these aren’t as simple as we might think.

Published on August 13th with Global Bioethics Initiative.

 

Few Americans Plan For End-of-Life Decisions, Even If They Are Sick

A recent study published in Health Affairs suggests that only around one third of Americans plan for end-of-life decisions through measures such as advanced directives or appointing healthcare proxies. Even more surprising, individuals with chronic illnesses were only slightly more likely to take such measures than were generally healthy individuals. In this article, published with Global Bioethics Initiative, I explore the results of the survey and some of the reasons why individuals may not complete advanced directives or appoint healthcare proxies. I also suggest some ways we might attempt to change the culture around end-of-life planning and make such measures better: first, I suggest that clinicians must do more to educate their patients about the way end-of-life plans work; second, I suggest that advanced directives should be as specific as possible in order to accurately reflect the wishes of patients, which can be quite nuanced; and finally, I suggest that media sources should make an effort to accurately represent healthcare proxies advanced directives like Do Not Resuscitate (DNR) orders on television and in movies, rather than to focus solely on dramatic, extreme cases.

Published on August 7th, 2017, with Global Bioethics Initiative.

American CRISPR Experiments and the Future of Regulation

CRISPR is a genetic editing technique that is faster and more effective than many techniques that have been used in the past. Recently, Shoulhrat Mitalipov became the first scientist in America to use the technique to modify human embryos using the technique. While the particular experiment was legally permissible and directed toward developing methods for preventing genetically inherited diseases, the experiments raise serious questions about genetic experimentation and how such experiments should be regulated. In this article published with Global Bioethics Initiative, I discuss the experiments and suggest that more specific laws are needed if we are to collectively decide what the future should, and will, look like.

Published on August 7th, 2017, with Global Bioethics Initiative.

Charlie Gard, Compassionate Use, and Single-Payer Health Care

Many critics and analysts have pointed to the Charlie Gard case as an example of the horrors of single-payer health care systems. They claim that Charlie is only in this situation because the hospital will not pay for experimental treatment, and that they won’t pay because of the UK’s single-payer health care system. The reality, however, is that Charlie’s case would be very similar under the laws and policies in America, which does not use a single-payer coverage system. In my article with The Hastings Center Bioethics Forum, I discuss the policies in the U.S. and demonstrate that this case is about quality of life and human suffering, not single-payer health care systems.

Published July 26th, 2017, on The Hastings Center Bioethics Forum.

The Real Problem With Concierge Medicine

Luxury or “concierge” medicine has become increasingly prevalent in the past few years. Concierge practices are private medical services that charge an expensive retainer fee to guarantee more personalized, in-depth care and availability. The proliferation of such practices raises several ethical questions. Do luxury medical practices offer unfair advantages to rich patients? Do concierge practitioners “cheat” the system by cashing out early in their careers and taking spots away from medical school applicants who might have chosen to help many more patients instead? Jon Newlin, C.I.P. and I agree that concierge medical practices are morally problematic in our current healthcare system However, we also believe this is merely a pseudo-problem: the real problem is that we don’t have enough doctors, and the ones we have are not used efficiently.

Published July 14th, 2017 in Becker’s Hospital Review.

 

Why Charlie Gard’s Case Is So Disturbing To Americans

The case of Charlie Gard, an 11-month-old boy with mitochondrial depletion syndrome, captured the attention of healthcare professionals, international heads of state, and citizens throughout the world. The case involved a complicated legal battle between Charlie’s parents, his legal representative, and the hospital where he was being treated. The state ruled that it would be cruel to force Charlie to continue suffering if there was nothing else that could be done to help him, while his parents contended that there were still experimental treatment options open to him. What many Americans might find disturbing about the case is the idea that a court can order the withdrawal of life support from somebody who has family members present to make decisions on his or her behalf. In this article, I argue that the ethical theories at work in the court’s actions are largely uncontroversial. Rather, what is most alarming about the case is the stark difference between British and American bioethics law.

Published July 13th, 2017 on STAT News.

Opinion: House Approves Bill That Defies Basic Standards Of Medical Ethics

“On May 4th, 2017, the Republicans in the U.S. House of Representatives voted to pass the American Health Care Act, an Act that, if enacted into law, would repeal and replace many central elements of the Affordable Care Act, commonly known as Obamacare. The measure has received widespread criticism from many Democrats and from professional medical associations such as the American Medical Association and the American Cancer Society. Many people have questioned various parameters of the bill.” In this article, I argue that the American Health Care Act contradicts several decades of ethical precedent in bioethics and government practice.

Published May 24th, 2017 with The Gittenstein Institute for Health Law and Policy at Hofstra University.

The Ethics of Animal Research and Uncertainty in Human Head Transplantation.

Whether or not experimental treatments and surgeries are morally permissible has been a hot topic in bioethics in recent years, especially with the advent of social media campaigns to facilitate compassionate use requests. Head transplant cases present one of the most controversial instances of this issue, pushing us to the very limit of medical ethics. Research in the subject also seems to be somewhat suspect: can we know enough information about a potential human head transplant surgery based on results gleaned through animal testing? Are the procedures done during the animal testing itself morally permissible? On the individual level, is a surgeon who performs a head transplant procedure in breach of the Hippocratic Oath given the current and projected state of our knowledge of the nature and consequences of the surgery? I discuss several crucial topics in this paper. I first address some of the arguments in favor of the technique and some of the medical and social benefits it might create. However, given several other considerations, I do not believe we have enough scientific knowledge to morally justify the human trial. To show this, I will offer several arguments. The first addresses the specific case of the first patient the technique will be tested on, Mr. Sprinidov, and his condition, Werdnig-Hoffmann disease. Although I am not a doctor, I do not believe there is a sufficient, good faith medical basis for believing a head transplant procedure would help him. Second, I analyze the animal testing procedures and results that have gone into researching head transplantation so far. I do not believe the testing itself passes ethical guidelines. Third, I argue that researchers have not gained sufficient information from the limited and flawed animal testing completed thus far, making an actual human head transplant procedure an irrational and unethical risk. Before concluding, I consider a possible contradiction: some clinicians might think physician-assisted suicide is permissible, but not head transplantation. I explore whether or not this presents a contradiction, and ultimately conclude that head transplantation cases are fundamentally different than physician-assisted suicide cases. Although a patient might be within his or her rights to ask a clinician to perform a head transplant operation, it is ethically impermissible for any clinician to actually perform the procedure.

Presented at the Long Island Philosophical Society Spring Conference on April 1st, 2017, and the 12th Annual Graduate Philosophy Conference at West Chester University,  on April 22nd 2017. PDF.

Three-Parent Babies and Social Welfare

Mitochondrial Replacement Techniques (MRTs) are genetic editing procedures that have undergone intense public scrutiny since their legalization in England in 2015. The techniques replace defective maternal mitochondria with healthy mitochondria to prevent several potentially life-threatening disorders. Dr. John Zhang, a physician who has used the technique before, has stated that “[saving] lives is the ethical thing to do.” However, it is not immediately clear that a life has been saved if the technique involves genetic modification of gametes or zygotes: if genetic material is modified during the early stages of development, has a different person been created? If so, has anybody actually been helped? Is it morally permissible to alter personal identity using genetic modification techniques? I argue that replacing the mitochondria leaves personal identity untouched because the genetic codes that determine personal identity reside in the nucleus. I will also argue that traditional objections to genetic modification (i.e. the fear of designer babies, that a technique is “unnatural,” etc.) are not persuasive in this case. However, I also suggest that while the techniques themselves may not be intrinsically wrong, spending resources on creating babies using these techniques might be morally wrong. I suggest that if we have a moral responsibility to help people who already exist that lack the objects of basic human rights, it is morally wrong to spend excessive amounts on creating additional people.

Presented at Albany Medical College, April 7th, 2017.

What’s So Bad About Robot Revolution?

Many philosophers take it as a given that it would be intrinsically bad if the human species ceased to exist. They believe there is something particularly morally undesirable about such an outcome. This is often expressed in terms of there no longer being “creatures like us,” though that tends to refer specifically to human beings. This assumption has largely gone unchallenged in bioethical literature, specifically in regard to the possibility that either alien species visit Earth, or artificially intelligent entities (robots!) took over society. I explore some of the biases at play in such assumptions. Specifically, we have three biases: we are speciesist, organicist, and and naturalist in our preference for our own species’ survival. 

Presented at Fordham University, February 2017. Presentation Flyer PDF.

Facts as Determinants of Morality: How Human Action, Reason, Cognition, and Social Activity Determine What We Ought To Do

It is a central axiom of moral philosophy that “ought implies can.” We think that if someone can’t do something, they ought not to be held morally responsible if they don’t do it, and if someone can do something, they’ve done something morally wrong if they have not. Studies in neuroscience and social dynamics have shown and suggested that human beings do not always have the degree of control we think we do. We may not have free will or make moral judgments as we have traditionally believed.  The results of these studies and experiments suggest that we may not always be in control and that we may not always be rational, but that we can control and account for our biases and emotions with training and careful deliberation. I argue that studying philosophy, religion, literature, and the other humanities can enable us to make better decisions in the face of what recent developments in science have taught us.

Presented at  the International Conference on Morality, Moral Philosophy and the Humanities in the Age of Neuroscience, November 2016. PDF.

Principlism: Arguing the Inclusion of dignity and Vulnerability in Clinical Ethics Consultation

Clinicial Ethics consultation has largely been dominated by principlism, the theory that conflicts in medical ethics can be resolved by balancing four ethical principles: beneficence, non-maleficence, justice, and autonomy. Autumn Fiester has criticized this model, claiming that, when put into practice, principlism becomes a mere check-list that often overlooks many issues and obligations clinicians have toward patients. Dr. Renee McLeod-Sordjan, Dr. Lauren Sparber and I proposed The Expanded Principles Model in a presentation at the American Society for Bioethics and the Humanities National Meeting in Washington, DC. The model includes dignity and vulnerability as distinct principles in order to provide clinicians with a more effective heuristic for discerning ethical issues and obligations.

Presented for the Philosophy of Medicine Affinity Group at the American Society for Bioethics and the Humanities National Meeting in Washington, DC, October 2016. Article forthcoming.

Do Professional Codes Give Us An Obligation To Enhance Ourselves?

We think it is wrong for athletes to take performance enhancing drugs to boost their athletic abilities because it violates the principles of sport. If it’s true that a profession can limit what we can use, can it also be true that a professional code can permit or even require us to take certain enhancements? Biomedical enhancement has been a topic of both popular and academic discussion for decades, with the possibility of dramatic enhancements growing ever closer as our scientific knowledge develops. In some cases, cognitive and physical enhancements already exist, and it is important to settle how we ought to best make use of them, as well as when they should be restricted. I argue that the principles manifested in professional codes (the Hippocratic Oath, Sir Robert Peel’s Principles of Policing, etc.) would permit professionals to take cognitive or physical enhancements as they become available. In some cases, taking enhancements might even be required.

Presented at Fordham University, March 2016, and The Long Island Philosophical Society’s Spring 2016 Conference, April 2016.

 Criminology and Research Ethics

A recent study involved shooting several pigs in the head to research blood-spatter patterns. I examine what I believe to be the central principles of research ethics and whether or not the study was morally permissible. I argue that there were other ways to conduct the study that would have involved fewer deaths, and that the positive information gained from the study was not enough to justify killing the pigs.

Published on Ethics and Society, Social Justice Solutions, and The Bioethics Research Library at Georgetown University.

The Ethics of Mitochondrial Replacement Techniques: Three-Parent Babies and the Non-Identity Problem

In 2015, Britain legalized Mitochondrial Replacement Technique, a genetic IVF procedure that replaces defective maternal mitochondria with healthy donor mitochondria. The procedure ensures that the subsequent child will not develop with a mitochondrial disorder that could lead to epilepsy or other problems that lead to an early death. However, there are several eugenic concerns about the technology, as well as the worry that we create new persons by editing oocytes. The paper examines these worries and concludes that, based on a genetic account of biological and personal identity, Mitochondrial Replacement Technique, as it currently stands, does not raise eugenic concerns and does not fall subject to the Non-Identity Problem.

Presented at the Bowling Green State University Conference on the Ethics of Emerging Technologies, November 2016. PDF.

The Significance of Philosophical Ethics in a Scientific World

I examine the significance of studying Ethics in a world increasingly focused on the value of scientific research and technology. Science may explain the physics of how we live, but it does nothing to tell us what choices to make beyond those that involve our biological survival.

Published on Ethics and Society and Social Justice Solutions.

Human Nature

The Meaning of Life

The meaning of life is perhaps the most frequently debated philosophical topic. In a chapter from Ruminations, a book I’m writing, I examine some of the previous accounts given and propose a new answer based on whether or not one considers one’s life worth living. This does not refer to the traditional idea that some lives are so unpleasant that one would wish to be dead, rather than alive; rather, it is a view that one’s previous actions in life were worth the trouble it took to do them.

Presented for The Philosophers’ Society at Fordham University, October 2015.

Our Time: Existentialism in the Age of Fear

A colleague recently quipped that Existentialism was more of a historical period now, rather than an actual philosophy. In essence, all the work that could be done in Existentialism has been done, and the philosophy is complete and outdated. I examine this claim and show that Existential issues are even more prevalent now than ever before, given the constant threat of terrorism in the West and pressure to surpass the accomplishments of previous generations, a feat that may not be possible for every individual. Now more than ever, we must choose to live with courage and to decide our lives for ourselves.

Published in Akadimia Filosofia, May 2015. PDF.

Book Reviews

Cells Are The New Cure by Robin Smith, MD, and Max Gomez, PhD (BenBella Books, Inc., 2017). ISBN 9781944648800.

I review “Cells Are The New Cure: The Cutting-Edge Medical Breakthroughs That Are Transforming Our Health” (BenBella Books) by Robin Smith, MD, and Max Gomez, PhD. The book provides a wide survey of the innovative developments in stem cell therapies and genetic editing techniques that have occurred in recent years, as well as an excellent account of how clinical trials and other research studies are conducted and funded, pointing the way toward the cutting-edge cell-based therapies of the future.

Published with Global Bioethics Initiative, August 25th, 2017.

The Last Launch: Messages in the Bottle by Yi-Fu Taun (George F. Thompson Publishing, 2016)

I review Yi’Fu Taun’s book The Last Launch: Messages in the Bottle, a personal memoir and series of short essays on life, love, human goodness, and human society. The book covers topics like “Human Value and Equality,” the effects of chance and accidents, “Shamelessness and Trust,” “Encounters with Goodness,” and the nature of Christian forgiveness, and offers heartwarming wisdom for future generations.

Published in Dialogue, forthcoming October 2016.

One Child: Do We Have A Right To More? by Sarah Conly (Oxford University Press, 2016)

I review Sarah Conly’s book One Child: Do We Have A Right To More?, which considers arguments for and against limitations on the number of children we can have, both legally and ethically. While many people believe we have an inviolable right to have as many children we want, Conly argues that we are not within our rights when we commit actions that put others in danger. Reducing the global population will drastically reduce the continued damage we do to our planet and make human life more sustainable. Further, Conly believes that we can overcome concerns over sex-selection and other practical worries.

Published in Dialogue,  April 2016.

Seeing Things As They Are by John R. Searle (Oxford University Press, 2015)

I review John Searle’s book Seeing Things as they Are, which analyzes the claim that when we perceive the world, we are seeing the world itself, not “sense data,” as many philosophers have argued. He calls such claims “The Bad Argument.”

Published in Akadimia Filosofia, May 2015. PDF.

The Most Good You Can Do by Peter Singer (New Haven: Yale University Press, 215)

I review what amounts to the sequel to the New York Times bestseller The Life You Can Save (2010). The Most Good You Can Do explores how to implement the argument Singer made in The Life You Can Save and presents real-life examples of people who have become “effective altruists,” people who have figured out how to live in such a way that they can donate between one third and one half of their personal income to charity.

Published on Ethics and Society and Social Justice Solutions.