Recent Publications
“Artificial Kidneys and the Emergence of Bioethics: The History of the ‘Outsiders’ in the Allocation of Hemodialysis,” forthcoming in Social History of Medicine.

“Ethics Consultation and Facilitated Consensus,” The Journal of Clinical Ethics 20 (1) 2009: 44-55.

Review of Meyers, A Practical Guide to Clinical Ethics Consulting (Lanham, MD: Rowman & Littlefield Publishers; 2007) in Cambridge Quarterly of Healthcare Ethics 17 (3) 2008: 347-350.

“The Role of the Clinical Ethics Consultant in Unsettled Cases,” forthcoming, Journal of Clinical Ethics.

“Final Comments,” (with William J. Winslade) forthcoming, Journal of Clinical Ethics.

“Consensus, Clinical Decision Making, and Unsettled Cases,” (with William J. Winslade) (target article) forthcoming, Journal of Clinical Ethics.

Philosophical Problems in the Law, Fifth Edition (Boston: Wadsworth/Cengage.; 2012), forthcoming.

Work in Progress
I am currently completing a draft of a paper on an aspect of the Supreme Court's death-penalty jurisprudence that raises a number of difficult conceptual and normative problems. The Court has long required that inmates who develop mental illness on death row must be "competent for execution" before the death sentence may be carried out. The competence for execution (CFE) requirement generates wrenching moral dilemmas for prisoners, health care professionals, and the legal system. The prisoner must choose between foregoing anti-psychotic and other medications that would otherwise palliate the devastating symptoms of severe mental illness, thereby rendering him "incompetent" and "unexecutable," or taking medication that will provide relief but bring it about that he is "competent" and thus is killed. The prisoner's psychiatrist must decide whether she should continue to write a prescription where doing so is tantamount to an authorization to kill the patient, or to refuse such a course and deliberately exacerbate mental disease in the prisoner. My draft piece argues that the "competence" requirement is an unworkable conceptual muddle. But I want to expand this argument to consider the problems posed by "synthetically" creating competence by medicating death-row inmates. Do anti-psychotic medications actually effect a "cure," such that inmates who were formerly disordered now no longer are? Or does drug therapy merely "mask" the offender's psychoses? Is the resulting "competence" genuine or "artificial"? And what would such competing descriptions mean?

I am also working on a paper addressing the following set of problems in medical and research ethics. Persons with serious illnesses often benefit from access to investigational treatments and therapies—e.g., pharmaceuticals—through enrollment in research trials designed to produce evidence of efficacy in treating the diseases from which they suffer. Often, however, it takes years and multiple phases of randomized, controlled trials to generate a body of statistically significant and scientifically sound data on which to establish standards of practice for the treatment of life-threatening disorders, such as various forms of cancer or AIDS. Some terminally ill patients have argued that they should not be made to wait until a promising drug or therapy has been proven efficacious by the epistemic standards adhered to by researchers; rather, they insist upon a right to immediate access experimental therapies outside of and prior to the completion of controlled trials. Critically ill individuals who have exhausted conventional therapies and who are expected to die soon have a right, they claim, to access “last chance” therapies without having to enroll in clinical trials. It is wrong to force such persons, as a condition of obtaining a chance at a possibly therapeutic, new treatment, to participate in a randomized trial in which they have a 50% chance of receiving a standard treatment which has already proven ineffective in their case or, worse, a placebo.

Must we meet the demands of such persons? Do they have a right to direct, off-trial access to experimental therapies? Do we have a duty to provide such to them? These questions give rise to a host of others: Do desperate patients with a life-threatening illness have a right to determine whether to shoulder the risk of treatments of uncertain safety and effectiveness? Do they have a claim on any investigational drug or therapy from which they come to believe a possibility of benefit might derive?

What is the justification for denying terminally ill persons access to therapies for which there is (currently) insufficient evidence of efficacy? Will giving the terminally ill access to unproven remedies undermine the scientific integrity and validity of clinical studies, causing undue harm to future patient populations? Would allowing direct, off trial access to unproven remedies mistreat the desperately ill by encouraging them to entertain “false hopes” of a cure? Should the government prevent such individuals from assuming too great a level of risk with regard to untested drugs or therapies?