Bioethics and Medical Ethics Commons^™

Interdisciplinary, Delphi-Driven Consensus Guidelines On The Use Of Intravenous Ketamine Infusions For Depressive Disorders From The American Society Of Ketamine Physicians, Psychotherapists, And Practitioners (Askp3), David S Mathai, Madeleine Cluck, Amna M Aslam, Erin Amato, Arsalan Azam, Michael Banov, Kathleen A Barrett, Carl J Bonnett, David Feifel, Nicolas Grundmann, H Samuel Ko, Rupert Mcshane, Sandhya Prashad, Tatiana Santini, Lowan H Stewart, Patrick Sullivan, Stefany D Wolfsohn, Jill O Robinson, Amy L Mcguire, L Alison Mcinnes

Center for Medical Ethics and Health Policy Staff Publications

Background: Off-label use of intravenous ketamine (IVK) for depression is a widespread practice with limited regulation in the United States. There is an urgent need for current, evidence-informed treatment guidelines to facilitate patient safety, clinical decision-making, and care quality in real-world contexts.

Methods: The American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3) convened an interdisciplinary working committee tasked with creating guidelines for use of IVK for depression in outpatient settings. Guideline development followed a two-stage process: 1) a hybrid systematic and targeted evidence review and preliminary drafting by the committee, and 2) consensus refinement through a modified Delphi method …

Journal Ida 2023 102 3

Journal IDA

The Journal IDA is a peer-reviewed, scientific periodical owned and published by the Indiana Dental Association, a constituent of the American Dental Association.

Journal IDA concentrates on the clinical aspects of dentistry, including case studies and research; practice management and business aspects of dentistry, from start up to transition; and also includes special and regular feature articles.

Towards Human-Centered Digital Health Interventions, Kristin M Kostick-Quenet, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

This article discusses the potential of digital health interventions (DHIs) in mental health care, emphasizing the importance of designing them to foster genuine humanistic care. It highlights current challenges in measuring engagement and outcomes, advocating for integrating human-centered endpoints such as dignity, autonomy, and therapeutic alliance into evaluation frameworks. The authors call for mechanistic research to identify effective engagement strategies and context-specific implementation approaches. Ultimately, successful DHIs should demonstrate both clinical efficacy and the preservation of humane, person-centered care, ensuring ethical and meaningful mental health support through technology.

Beyond The Binary: Strengthening Nursing Students’ Proficiency Of Equitable Health Promotion, Martha K. Findley

Theses

Background: Sexual and gender diverse (SGD) populations continue to experience significant health inequities, yet prelicensure nursing curricula often lack structured, evidence‑based training to prepare students for equitable care.

Purpose: This study evaluated whether a targeted, transgender‑focused simulation could improve nursing students’ clinical knowledge and preparedness for providing equitable health promotion to SGD populations.

Methods: A pre‑/post‑intervention design was used with senior‑level nursing students who completed a transgender patient simulation emphasizing communication, assessment, and equitable health promotion. Students completed a validated survey measuring knowledge and preparedness in caring for SGD patients.

Results: Significant improvements across most survey items demonstrated that the …

A Language We Built Together: A Physician Assistant’S Reflection On A Renal Transplant, Oviya Mahendran, Sampathkumar Sakthi Selvakumar

Journal of Wellness

This is not just a story of kidney transplantation in a tertiary care hospital in a tier-2 city of South India. It is all about a true clinical journey of resilience, where a young woman with congenital hearing loss, battling chronic kidney disease, discovered hope, understanding, and companionship through a physician assistant's compassionate communication.

Identifying And Addressing Problematic Studies In Allergy And Asthma Research: A Commentary, Alexandro W L Chu, Gordon H Guyatt, Jason W Busse, Romina Brignardello-Petersen, Xiajing Chu, Daniel G Rayner, Paul Oykhman, Vanessa Wong, Yetiani Roldan, Diane R Baker, Leonard B Bacharier, Lisa A Beck, Moshe Ben-Shoshan, Bradley Chipps, Flavia Hoyte, Elliot Israel, David M Lang, Sameer K Mathur, Sharmilee M Nyenhuis, Paul M O'Byrne, Eric T Oliver, John Oppenheimer, Tamara T Perry, Katherine Rivera-Spoljaric, Sarbjit S Saini, Javed Sheikh, Kaharu Sumino, Susan Waserman, Elissa M Abrams, Aikaterini Anagnostou, Jonathan A Bernstein, Anne K Ellis, David B K Golden, Caroline C Horner, Dennis K Ledford, Jay Lieberman, Giselle Mosnaim, Matthew A Rank, Marcus Shaker, Julie Wang, David A Khan, Derek K Chu

Center for Medical Ethics and Health Policy Staff Publications

Randomized controlled trials underpin evidence-based medicine, but a growing proportion of trials contain implausible, inaccurate, or fabricated data. When such studies are incorporated into systematic reviews, they distort effect estimates, inflate evidence certainty, and can mislead the guideline recommendations that the reviews aim to inform. Within 8 recent American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters (JTFPP) systematic reviews, 17% of trials published between 2021 and 2024 were problematic, and in a network meta-analysis of antihistamines for chronic urticaria, 39% of recent trials were excluded because of …

Comparative Analysis Of Artificial Intelligence (Ai) Implications For Active Learning And Assessment At Various Curricular Levels Of Stem And Health Sciences In Developed Versus Underprivileged Countries, Vinay Munlapudi, Santanu De

FDLA Journal

Today’s all-pervasive emergence of artificial intelligence (AI) necessitates a comprehensive evaluation of its role in education, especially for occupational disciplines in health sciences and STEM. AI has reshaped student learning and instructors’ navigation of the evolving, post coronavirus infectious disease (COVID-19) global academic landscape. This study aimed at encapsulating evidence-based AI implications for student-centered, active learning and assessment at various curricular levels of science, technology, engineering, mathematics (STEM) and health sciences education in developed versus underprivileged or less developed countries. An extensive, scoping review of 65 recent, scholarly publications was conducted over six months through diverse search engines (PubMed, Google …

Navigating Undone Science: The Search For Adequate Endometriosis Care, Heather Welty, Melanie Jeske

Center for Medical Ethics and Health Policy Staff Publications

Endometriosis is an estrogen-dependent disease in which tissue similar to the lining of the uterus grows elsewhere in the body leading to a variety of symptoms including heavy and prolonged menstruation, chronic pain, cysts, infertility, and gastrointestinal issues. Despite being one of the most common gynecologic conditions, much remains unknown about potential risk factors for endometriosis, its etiology, and treatment options. First and second-line biomedical treatment options, complementary and alternative medicine, and lifestyle changes are all treatment options that people living with endometriosis (PLE) leverage to manage their symptoms. This article draws on in-depth interviews with 52 people living with …

The Fiduciary Argument Against Conscientious Refusal In Healthcare, Michael Robinson

Philosophy Faculty Articles and Research

The question of when, if ever, healthcare professionals with conscientious objections should be accommodated by permitting them to refuse to provide medical interventions to which they morally object is a heated issue that has received significant attention in the medical ethics literature. While many professional medical associations have long held that such objections may be accommodated in a broad range of cases, a vocal and growing minority has been fervently arguing that the medical profession should cease accommodating conscientious objections and should rarely, if ever, permit clinicians to refrain from providing medical care merely because it conflicts with their conscience. …

Brief Of Public Health And Health Law Scholars As Amici Curiae Urging Affirmance In Support Of Plaintiffs-Appellees, Rachel L. Zacharias, Zeinab Bakhet, Kevin Costello, Maya Manian

Amicus Briefs & Court Filings

INTRODUCTION: Physicians’ use of their judgment and expertise to prescribe drugs and devices for purposes other than those approved by the Food and Drug Administration (“FDA”)—colloquially known as off-label use—is an indispensable feature of modern medicine. The FDA approves drugs as “safe and effective for specific indications.” Christopher M. Wittich, Christopher M. Burkle & William L. Lanier, Ten Common Questions (and Their Answers) About OffLabel Drug Use, 87 Mayo Clinic Procs. 982, 982 (2012). Federal law then generally leaves prescribing decisions, including off-label use of FDA-approved drugs and devices for a patient’s particular indication, to physicians acting under state law …

Healthcare Provider's Perceptions Of Family Values When Making End-Of-Life Care Decisions For Their Children: Developing And Implementing A Survey Tool., Nithya Sivakumar, Stephanie Kukora, Cherie Ginwalla, Satyan Lakshminrusimha, Jennifer Rosenthal

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Healthcare providers help families navigate end-of-life care decisions in the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU); however, limited studies exist regarding what values providers perceive families utilize when in these situations.

OBJECTIVE: To evaluate providers' perceptions of values that families considered when making end-of-life care decisions for their child.

DESIGN: Develop a novel survey tool to understand providers' perceptions of values families considered when making end-of-life care decisions for their children and distribute the survey tool to providers in a single quaternary care children's hospital within a university hospital.

METHODS: The novel survey tool …

Perceived Sensitivity Of Sensor-Based Digital Health Data: Qualitative Interview Study, Christine Deeney, Anika Sonig, Meghan E Hurley, Birkan Tunç, Eric A Storch, John D Herrington, Jennifer Blumenthal-Barby, Kristin Kostick-Quenet

Center for Medical Ethics and Health Policy Staff Publications

Background: Digital health tools are increasingly used in mental health care to passively collect patient data and analyze health status outside of clinical settings. While technologies such as digital phenotyping, affective computing, and computational behavioral analysis offer new insights into symptom manifestation in daily life, they generate large volumes of potentially sensitive data that raise significant data privacy concerns, requiring high levels of patient awareness and consent. Empirical research is lacking on stakeholder understandings toward the sensitivity of these data and expectations for data stewardship, perspectives that are critical for developing robust informed consent and data protection policies for digital …

Elective Genomic Sequencing For Adults In Research, Clinical And Commercial Contexts, Michael D Linderman, Sophia M Adelson, Tala M Berro, Jennifer L Anderson, Scott D Crawford, Tshaka J Cunningham, Edward D Esplin, Altovise T Ewing-Crawford, Daiva E Nielsen, Stacey Pereira, Tara Schmidlen, Heather Andrighetti, Steven B Bleyl, George M Church, Eden V Haverfield, Madhuri Hegde, Lazaridis N Konstantinos, Paul Kruszka, Debra Leonard, Thomas May, Molly Mcginniss, Vaibhav Pandya, Eric E Schadt, Bastian Greshake Tzovaras, Bethany Zettler, Amy L Mcguire, Robert C Green

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Elective genomic sequencing (EGS) returns monogenic disease findings in multiple genes, including potentially novel variants, and may also provide participants with carrier status, pharmacogenomic and other health-related information. The PeopleSeq Study assessed participants' motivations for and concerns about EGS and the associated clinical and psychosocial outcomes across diverse EGS providers.

Methods: We administered a shared questionnaire to participants who chose to undergo EGS via 18 academic, clinical, or commercial EGS platforms.

Results: We enrolled 1575 participants, of whom 1147 (72.8%) completed a questionnaire after receiving their EGS results. A majority (60.3%) of the participants who completed a post-result questionnaire …

July 2026 The Back Page — Fighting Burnout By Building A Better Sense Of Community, Tamar Shrikian, Dmd

The Journal of the Michigan Dental Association

Dr. Tamar Shrikian shares a personal commentary on overcoming professional burnout by seeking fulfillment outside the clinical setting. Identifying isolation as a key factor in clinician stress, she discusses her transformative experience joining a community chorus. The article introduces the concept of a "third place"—a social space distinct from home and work—as essential for maintaining a healthy identity beyond being a health care provider. Shrikian encourages her colleagues to actively build social connections, whether through faith communities, hobbies, or organized dentistry, to foster mutual support and overall well-being within the profession.

Clinical Ethics Training Needs Among Pediatricians And Pediatric Residents In Ethiopia: Conference-Based Cross-Sectional Survey., Betelehem Kassa, Addishiwot Melesse, Eyob Kebede Etissa, Bitseat W. Haile, Atnafu Mekonnen Tekleab, Stephanie Kukora

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Pediatricians encounter ethically challenging cases in clinical practice throughout the world. In Ethiopia, ethically distressing pediatric cases are heightened by limited resources, lack of ethical frameworks to guide clinical care and withdrawal of supportive therapies, absence of child protection laws, and dearth of trained ethics consultants or institutional ethics committees providing clinical ethics consultation. Ethics training remains limited in undergraduate medical programs and absent in the resident curriculum at most institutions.

METHODS: A survey of Pediatric Residents and Pediatricians attending the Ethiopian Pediatric Society's 24th Annual Conference on March 2023 was conducted using a self-administered, clinical ethics needs assessment. …

Assessing Clinician Preference For Redirection Of Care In Neonatal Tracheostomies, Gabriella Destefano, Alla Kushnir, Perri Donenfeld

Cooper Rowan Medical Journal

A spectrum of indications exists for the implementation of neonatal tracheostomies, ranging from short-term airway control to congenital airway anomalies. The decision to initiate long-term mechanical ventilation is multifaceted and can be influenced by factors such as physician preferences, caregivers’ attitudes, and comorbidities. It is important to have an ethical framework in place to guide the treatment of preterm neonates who may require long term mechanical ventilation. This study examines physician perspectives on the ethics of neonatal tracheostomy, focusing on the treatment of infants with bronchopulmonary dysplasia. A mixed methods study, consisting of demographic information and 5 clinical vignettes centering …

Dimensional Welfare Beyond Pain: Extending The Precautionary Principle In Birch’S “The Edge Of Sentience”, Willa M. Lane, Nicola S. Clayton

Animal Sentience

Birch's (2024) The Edge of Sentience identifies sentience candidates primarily through the pain-focused LSE Criteria. Yet, as Birch himself notes in Proposal 17, sentience is not pain. We argue that statutory welfare protections must therefore reach beyond pain, and that the right tool for doing so is Birch et al.’s (2020) dimensionality framework, which characterises conscious experience across five domains. Used together, the LSE Criteria establish that welfare is at stake, while the dimensionality framework maps what is at stake beyond pain to provide a taxon-specific profile of where captivity impoverishes experience. We apply this approach to invertebrate welfare and …

Advocating For A Care-Based Ethic: Stories Of Pregnancy And Birth From Caregivers Of Children With Down Syndrome, Lydia Ocasio-Stoutenburg, Nayma Sultana Mim

Developmental Disabilities Network Journal

Down syndrome (DS) impacts about 1 in every 640 childbirths in the United States. While quality of life has improved for people with DS, systemic inequities and deficit-based perceptions have persisted throughout history, with material impacts on people with DS and their caregivers. Researchers have documented how caregivers of children with DS have had negative experiences with healthcare providers and genetic counselors, whose biased views about DS translate into subtle and overt pressures. Few studies explicitly focus on the experiences of Caregivers of Color, multilingual families, as well as families with varying economic experiences who have children with DS. This …

Explaining Variation In Medical Aid In Dying Policy Across U.S. States, Abigail Hopper

Undergraduate Theses, Capstones, and Recitals

This paper asks why Medical Aid in Dying (MAiD) policy in the United States does not follow a simple partisan pattern between states. Existing scholarship on morality policy emphasizes ideological conflict and partisan alignment, but this framework cannot fully explain why states with similar political compositions have adopted different MAiD policy outcomes, indicating that some key mechanisms shaping the variation have been overlooked. To address this, this paper combines a national dataset of MAiD policies across all fifty states with a comparative case study of Montana, Colorado, and West Virginia, focusing on differences in institutional venues, framing strategies, and coalition …

Emotional Intelligence Documentary - The Art Of Compassion: Learning From Spain, Poetry, And Medicine, Emily E. Morin

Cultivating Emotional Intelligence through the Humanities in Spain

The Art of Compassion: Learning from Spain, Poetry, and Medicine explores how art, literature, and cultural experiences can deepen compassion and inform more human-centered healthcare. Drawing on works encountered during a Medical Humanities study abroad program in Spain, the documentary examines compassion as a skill that can be cultivated through self-reflection, recognition of shared vulnerability, and appreciation of multiple perspectives. Through analysis of poetry by Lope de Vega, Jaime Sabines, and Yehuda Halevi, alongside artworks by Diego Velázquez, Francisco Goya, and Pablo Picasso, the film connects themes of empathy, suffering, identity, and healing to contemporary clinical practice. The documentary also …

Moving Beyond Traditional Cost Containment For Glp-1 Coverage Within Oregon's Proposed Universal Health Plan, Manoj Rajesh

University Honors Theses

In 2022, Oregon voters passed Measure 111, constitutionally mandating access to affordable health care. As the Universal Health Plan Governance Board (UHPGB) designs the state's proposed single-payer system, it faces an unprecedented financial vulnerability: the clinical demand for GLP-1 receptor agonists. These high-cost, indefinite-use medications for obesity and metabolic syndrome threaten to overwhelm fixed public budgets. Historically, both the Oregon Health Plan's Medicaid framework and commercial private insurers have relied on static cost-containment models—categorical exclusions, step therapy, and aggressive utilization management—that achieve short-term fiscal solvency at the expense of comprehensive preventative care. This thesis argues that to fulfill the mandate …

Better Questions Make Better Dentists: Why Values-Based Conversations Lead To Better Outcomes, Anish Gupta Dds

The Journal of the Michigan Dental Association

Dr. Anish Gupta argues that technical proficiency in dentistry must be guided by values-based communication to ensure optimal patient outcomes. He critiques traditional informed consent that merely lists procedural options, suggesting it can lead to confusion if a patient's primary motivations—such as dignity or quality of life—are not addressed. By slowing down to uncover what truly matters to the patient, dentists can provide better guidance and clinical judgment. Gupta emphasizes that alignment with patient values removes obstacles to treatment acceptance.

Parent Perspectives On Neonatal Research Without Prior Consent: A Mixed-Methods Interview Study., Stephanie A. Kraft, Abigail Brickler, Abril Beretta, Rishabh Jain, Andrea Kelsh, Kaashif A. Ahmad, Justin T. Clapp, Neal W. Dickert, Rebecca A. Dorner, Katherine F. Guttmann, Anup C. Katheria, Stephanie Kukora, Benjamin A. Mooso, Elliott Mark Weiss, Fam-Connect Collaborative

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Recruitment for clinical research in the neonatal intensive care unit (NICU) is difficult, which may lead to low enrollment rates, systematically skewed samples, and nongeneralizable results. Research without prior consent (RWPC), defined as obtaining consent only after infants have been randomized to a treatment arm, may improve enrollment but raises ethical challenges. There is a need to better understand how parents with lived experience of having an infant in the NICU consider RWPC’s impact on critical ethical values related to informed consent, including decision-making, respect, and trust. This mixed-methods study aimed to describe parental perceptions of the acceptability and …

Dementia, Advance Directives, And Second-Order Volitions, Rand Hirmiz

Research Collection School of Social Sciences

This paper contributes to the ongoing debate over the authority of advance directives in cases where patients with dementia express desires that conflict with their earlier wishes. Drawing on Harry Frankfurt’s concept of second-order volitions, I argue that the preferences of the pre-dementia self (the “then-self”) should, in most cases, take precedence over those of the post-dementia self (the “now-self”) –  particularly in instances where the now-self has lost the capacity to form second-order volitions and is no longer able to meaningfully repudiate prior values and commitments.

Public Attitudes Toward Cascade Genetic Screening In The United States, Hadley Stevens Smith, Emilie S Zoltick, Madison R Hickingbotham, Emily S Bonkowski, Stacey Pereira, Tara A Lavelle, David L Veenstra, Amy L Mcguire, Katherine E Bonini, Leila Jamal

Center for Medical Ethics and Health Policy Staff Publications

Introduction: After a patient receives genetic test results that indicate an actionable health condition, cascade genetic screening (CGS) is the process of evaluating the patient's relatives for a potentially elevated genetic risk of disease. The United States primarily relies on patients to communicate with their relatives, resulting in suboptimal rates of risk communication, familial genetic testing uptake, and risk-reducing interventions. There is ongoing debate about whether and how best to inform relatives of a potentially increased genetic risk.

Methods: We conducted a nationally representative survey of US adults to assess attitudes toward informing at-risk relatives, acceptability of system-mediated communication, and …

Rethinking Ethics For An Era Of Trusted Computational Tools, Kristin M Kostick-Quenet, Meghan Hurley, John Herrington, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Computer perception (CP) technologies are poised to deliver near real-time behavioral insights with high precision. As technical barriers recede, our field's ethical focus must shift from "Can we trust the data?" to "Should we use it here, and how?" We propose a contextual ethics framework that: (1) defines the appropriate scope of CP integration; (2) advocates codesigned roadmaps to manage expectations and epistemic conflict; (3) expands evaluation beyond performance metrics to humanistic outcomes; and (4) anticipates future high performance systems to safeguard dignity, empathy, and shared decision-making in clinical care.

Artificial Intelligence In Healthcare: Ethical Frameworks, Challenges, And Global Approaches To Responsible Implementation: A Perspective, Vikas Vaibhav, Arwinder Singh, Yashpal S, Raviprakash Meshram, Varun Chandran A, Kshitiza Sharma

Graduate Medical Education Research Journal

Major advancements in domains like diagnosis and personalised treatment will be seen because of the rapid growth of artificial intelligence (AI) in healthcare. But this shift additionally presents significant ethical concerns that need to be carefully considered at every stage of AI's research, use, and impact on society in medical settings.

This review summarises the findings of multiple systematic and scoping reviews, as well as studies of specific AI applications published between 2013 and 2025. Additionally, it examines ethical norms from different countries and international organisations objectively. Consistent ethical challenges identified include the "black box" problem (lack of transparency and …

"First, Do No Harm": Ethical Failures And Preventive Solutions In The United States Pharmaceutical System - A Narrative Review, Rebekah R. Bailey

Honors Theses

The United States pharmaceutical system is highly advanced but faces growing ethical concerns related to drug development and marketing, overprescription, and high drug costs. This thesis examines how pharmaceutical marketing, regulatory practices, and prescribing behaviors may conflict with the ethical principle of “first, do no harm.”

Using a narrative review of interdisciplinary literature in public health, medical ethics, and applied ethics, this thesis analyzes patterns in drug development, marketing strategies, and regulatory oversight. The findings suggest that ethical issues are systemic, driven by commercial incentives, inconsistent regulatory standards, and an increasing reliance on pharmaceutical solutions. These factors contribute to overmedicalization, …

Expanding Expanded Access: A Case Of Onc201 And The Ethical Limitations Of Compassionate Use, Ava C. Hutchings

Honors Theses

This study examines the ethical and structural limitations of the Expanded Access program in the United States, with particular focus on its application to terminal pediatric illness. Although the program is intended to provide patients with life-threatening conditions access to investigational therapies outside of clinical trials, its effectiveness in serving critically ill children remains uncertain. This program is analyzed through careful consideration of regulatory review and ethical theory. Key policies governing Expanded Access are examined alongside scholarly discussions of pediatric autonomy and parental authority.

A case study of ONC201, a now-approved investigational drug, is used to illustrate how Expanded Access …

Values-Based Clinical Ethics: A New Model Of Health And Ethics Consultation For Patients Suffering In Extremis, Adam Trainer

Electronic Theses and Dissertations

This dissertation argues that contemporary clinical ethics is inadequately equipped to support patients suffering in extremis because it relies on an insufficiently discriminating account of health and a constrained model of moral reasoning. Drawing on Bernard Lonergan, it reconceives health as an emergent, multi-layered, heuristic notion shaped by biological, psychological, social, and existential goods. On that basis, it critiques principlism’s global applicability thesis and the undergirding claim that its principles form part of the common morality, arguing that this justificatory structure is philosophically insufficient and practically limited for clinical ethics in cases marked by profound suffering, moral plurality, and normative …