Center for Bioethics Papers

The Department serves as the hub for interdisciplinary research and collaboration on topics across four research areas in biomedical ethics: neuro- and mental healthcare ethics, health policy, behavioral economics, research ethics, global bioethics, and the ethics of healthcare allocation. Our health policy research follows three tracks: reducing low-value services; economic and health impacts of policies, such as smoking cessation and workplace wellness; and implementation sciences, with specific effort towards replicating effective programs in the healthcare delivery system.




Search results

Now showing 1 - 10 of 85
  • Publication
    Research Issues in Genetic Testing of Adolescents for Obesity
    (2004-08-01) Segal, Mary E; Sankar, Pamela; Reed, Danielle R
    Obesity is often established in adolescence, and advances are being made in identifying its genetic underpinnings. We examine issues related to the eventual likelihood of genetic tests for obesity targeted to adolescents: family involvement; comprehension of the test’s meaning; how knowledge of genetic status may affect psychological adaptation; minors’ ability to control events; parental/child autonomy; ability to make informed medical decisions; self-esteem; unclear distinctions between early/late onset for this condition; and social stigmatization. The public health arena will be important in educating families about possible future genetic tests for obesity.
  • Publication
    Successes and Failures of Hospital Ethics Committees: A National Survey of Ethics Committee Chairs
    (2002-01-01) McGee, Glenn E; Caplan, Arthur L.; Spanogle, Joshua P; Asch, David A.; Penny, Dina
    In 1992, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) passed a mandate that all its approved hospitals put in place a means for addressing ethical concerns. Although the particular process the hospital uses to address such concerns—ethics consultant, ethics forum, ethics committee—may vary, the hospital or healthcare ethics committee (HEC) is used most often. In a companion study to that reported here, we found that in 1998 over 90% of U.S. hospitals had ethics committees, compared to just 1% in 1983, and that many have some and a few have sweeping clinical powers in hospitals.
  • Publication
    Desktop Medicine
    (2010-11-10) Karlawish, Jason
  • Publication
    A Pilot Survey on the Licensing of DNA Inventions
    (2003-09-01) Henry, Michelle R; Cho, Mildred K; Weaver, Meredith A; Merz, Jon F
    Despite ethical concerns about gene patents, virtually no empirical evidence exists to support claims about either positive or negative effects, and extremely little is known about the intellectual property protection strategies of firms and universities. This article discusses the results of a pilot study to examine patenting and licensing philosophies, policies, and practices of different types of institutions and to describe the contractual conditions for licensing DNA sequence inventions.
  • Publication
    Open Label Extension Studies and the Ethical Design of Clinical Trials
    (2001-08-01) Cassarett, David; Karlawish, Jason; Sankar, Pamela; Hirschman, Karen; Asch, David A.
  • Publication
    The Triumph of Autonomy in Bioethics and Commercialism in American Healthcare
    (2007-01-01) Moreno, Jonathan
    Justifying his proposal for "health savings accounts," which would allow individuals to set aside tax-free dollars against future healthcare needs, President Bush has said that "Health savings accounts all aim at empowering people to make decisions for themselves." Who could disagree with such a sentiment? Although bioethicists may be among those who express skepticism that personal health savings accounts will be part of the needed "fix" of our healthcare financing system, self determination has long been part of their mantra. Indeed, the field of bioethics played an important role in advancing this idea in the medical world when physician paternalism was regnant. Has its popularity caused it to become so vapid as to be ripe for misuse?
  • Publication
    Pilot Study: Does the White Coat Influence Research Participation?
    (2002-07-01) Merz, Jon F; Rebbeck, Timothy R; Sankar, Pamela; Meagher, Emma A
    In health care, the white coat symbolizes professionalism, trustworthiness, and competence; it also represents power. This suggests that the wearing of a white coat could influence the decisions of potential subjects who are asked to participate in clinic-based research.
  • Publication
    Bioethics Consultation in the Private Sector
    (2002-06-01) Brody, Baruch; Dubbler, Nancy; Caplan, Arthur L.; Blustein, Jeff; Kahn, Jeffrey P; Kass, Nancy; Moreno, Jonathan; Lo, Bernard; Sugarman, Jeremy; Zoloth, Laurie
    The members of a task force on bioethics consultation report their conclusions. The task force was convened by the American Society for Bioethics and Humanities and the American Society of Law, Medicine, and Ethics, although these groups do not endorse the group's conclusions. Two commentaries follow, and an essay by science reporter Nell Boyce sets the scene.
  • Publication
    Ethical Considerations in Treating the Horse with Laminitis
    (2004-03-01) Fiester, Autumn; Mann, Lori
    The nature of laminitis - its unpredictable course, the severe pain and disability it causes, the lengthy convalescence it requires even when cured - poses challenging ethical quandaries for the clinicians who treat it and the owners whose horses suffer from it. Unique among equine ailments, this disease places owners and clinicians in the untenable position of trying to balance considerations that are very difficult to weigh against each other: the animal's pain, the unknown disease trajectory, the questionable possibility of full recovery, the limited usefulness of the animal post-laminitis, the financial drain of treatment, the financial loss of a formerly productive horse, the expense of maintaining a "pasture potato," the animal's frustration or distress during convalescence, etc. The pressing question in every case of laminitis is: where should we draw the line? The answer to this question will not only be different in every individual case of laminitis, but different owners and clinicians will often have divergent views even regarding the same case. In an ethical terrain that is so clearly "gray," absolutes are unlikely to be found. Instead, our essay hopes to clarify the ethical considerations involved in treating a horse with laminitis to facilitate the decision-making process regarding the specific cases encountered by clinicians in the field.
  • Publication
    Older Adults’ Attitudes Toward Enrollment of Noncompetent Subjects Participating in Alzheimer’s Research
    (2009-02-01) Karlawish, Jason; Rubright, Jonathan; Casarett, David; Cary, Mark; Ten Have, Thomas; Sankar, Pamela
    OBJECTIVE: Research that seeks to enroll noncompetent patients with Alzheimer’s disease without presenting any potential benefit to participants is the source of substantial ethical controversy. The authors used hypothetical Alzheimer’s disease studies that included either a blood draw or a blood draw and lumbar puncture to explore older persons’ attitudes on this question. METHOD: Face-to-face interviews were conducted with 538 persons age 65 and older. Questions explored participants’ understanding of research concepts, their views on enrolling persons with Alzheimer’s disease in research, and their preferences regarding having a proxy decision maker, granting advance consent, and granting their proxy leeway to override the participant’s decision. Additional questions assessed altruism, trust, value for research, and perceptions of Alzheimer’s disease. RESULTS: The majority (83%) were willing to grant advance consent to a blood draw study, and nearly half (48%) to a blood draw plus lumbar puncture study. Most (96%) were willing to identify a proxy for research decision making, and most were willing to grant their proxy leeway over their advance consent: 81% for the blood draw study and 70% for the blood draw plus lumbar puncture study. Combining the preferences for advance consent and leeway, the proportion who would permit being enrolled in the blood draw and lumbar puncture studies, respectively, were 92% and 75%. Multivariate models showed that willingness to be enrolled in research was most strongly associated with a favorable attitude toward biomedical research. CONCLUSIONS: Older adults generally support enrolling noncompetent persons with Alzheimer’s disease into research that does not present a benefit to subjects. Willingness to grant their proxy leeway over advance consent and a favorable attitude about biomedical research substantially explain this willingness.