Works by Arthur R. Derse
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- Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose.Kenneth D. Marshall,Arthur R. Derse,Scott G. Weiner &Joshua W. Joseph -2024 -American Journal of Bioethics 24 (5):11-24.Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)
- Quality Attestation for Clinical Ethics Consultants: A Two‐Step Model from the American Society for Bioethics and Humanities.Eric Kodish,Joseph J. Fins,Clarence Braddock,Felicia Cohn,Nancy Neveloff Dubler,Marion Danis,Arthur R. Derse,Robert A. Pearlman,Martin Smith,Anita Tarzian,Stuart Youngner &Mark G. Kuczewski -2013 -Hastings Center Report 43 (5):26-36.Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)
- A Pilot Evaluation of Portfolios for Quality Attestation of Clinical Ethics Consultants.Joseph J. Fins,Eric Kodish,Felicia Cohn,Marion Danis,Arthur R. Derse,Nancy Neveloff Dubler,Barbara Goulden,Mark Kuczewski,Mary Beth Mercer,Robert A. Pearlman,Martin L. Smith,Anita Tarzian &Stuart J. Youngner -2016 -American Journal of Bioethics 16 (3):15-24.Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)
- An Ethics Committee’s Evaluation of Normothermic Regional Perfusion (NRP) in 2018–Unsatisfactory Answers Then—and Now.Arthur R. Derse -2024 -American Journal of Bioethics 24 (6):34-37.An adult university hospital ethics committee evaluated a proposed TA-NRP protocol in the fall of 2018. The protocol raised ethical concerns about violation of the Uniform Determination of Death Act and the prohibition known as the Dead Donor Rule, with potential resultant legal consequences. An additional concern was the potential for increased mistrust by the community of organ donation and transplantation. The ethics committee evaluated the responses to these concerns as unable to surmount the ethical and legal boundaries and the (...) ethics committee declined to endorse the procedure. These concerns endure. (shrink)
- Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion.Adam Omelianchuk,Alexander Morgan Capron,Lainie Friedman Ross,Arthur R. Derse,James L. Bernat &David Magnus -2024 -Hastings Center Report 54 (4):14-23.In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's—more and higher‐quality organs and more efficient allocation—can be achieved by removing organs from deceased donors (...) and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call “ethical parsimony,” which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy‐makers should favor NMP over NRP. (shrink)
- Promoting Equity in Health Care through Human Flourishing, Justice, and Solidarity.Fabrice Jotterand,Ryan Spellecy,Mary Homan &Arthur R. Derse -2023 -Journal of Medicine and Philosophy 48 (1):98-109.In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, we provide a (...) definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity. (shrink)
- What Is the Minimal Competency for a Clinical Ethics Consult Simulation? Setting a Standard for Use of the Assessing Clinical Ethics Skills (ACES) Tool.Katherine Wasson,William H. Adams,Kenneth Berkowitz,Marion Danis,Arthur R. Derse,Mark G. Kuczewski,Michael McCarthy,Kayhan Parsi &Anita J. Tarzian -2019 -AJOB Empirical Bioethics 10 (3):164-172.Background: The field of clinical ethics is examining ways of determining competency. The Assessing Clinical Ethics Skills (ACES) tool offers a new approach that identifies a range of skills necessary in the conduct of clinical ethics consultation and provides a consistent framework for evaluating these skills. Through a training website, users learn to apply the ACES tool to clinical ethics consultants (CECs) in simulated ethics consultation videos. The aim is to recognize competent and incompetent clinical ethics consultation skills by watching (...) and evaluating a videotaped CEC performance. We report how we set a criterion cut score (i.e., minimally acceptable score) for judging the ability of users of the ACES tool to evaluate simulated CEC performances.Methods: A modified Angoff standard-setting procedure was used to establish the cut score for an end-of-life case included on the ACES training website. The standard-setting committee viewed the Futility Case and estimated the probability that a minimally competent CEC would correctly answer each item on the ACES tool. The committee further adjusted these estimates by reviewing data from 31 pilot users of the Futility Case before determining the cut score.Results: Averaging over all 31 items, the proposed proportion correct score for minimal competency was 80%, corresponding to a cut score that is between 24 and 25 points out of 31 possible points. The standard-setting committee subsequently set the minimal competency cut score to 24 points.Conclusions: The cut score for the ACES tool identifies the number of correct responses a user of the ACES tool training website must attain to “pass” and reach minimal competency in recognizing competent and incompetent skills of the CECs in the simulated ethics consultation videos. The application of the cut score to live training of CECs and other areas of practice requires further investigation. (shrink)No categories
- Issues of “Cost, Capabilities, and Scope” in Characterizing Adoptees' Lack of “Genetic-Relative Family Health History” as an Avoidable Health Disparity: Response to Open Peer Commentaries on “Does Lack of ‘Genetic-Relative Family Health History’ Represent a Potentially Avoidable Health Disparity for Adoptees?”.Thomas May,James P. Evans,Kimberly A. Strong,Kaija L. Zusevics,Arthur R. Derse,Jessica Jeruzal,Alison LaPean Kirschner,Michael H. Farrell &Harold D. Grotevant -2016 -American Journal of Bioethics 16 (12):4-8.Many adoptees face a number of challenges relating to separation from biological parents during the adoption process, including issues concerning identity, intimacy, attachment, and trust, as well as language and other cultural challenges. One common health challenge faced by adoptees involves lack of access to genetic-relative family health history. Lack of GRFHx represents a disadvantage due to a reduced capacity to identify diseases and recommend appropriate screening for conditions for which the adopted person may be at increased risk. In this (...) article, we draw out common features of traditionally understood “health disparities” in order to identify analogous features in the context of adoptees’ lack of GRFHx. (shrink)
- “Erring on the Side of Life” Is Sometimes an Error: Physicians Have the Primary Responsibility to Correct This.Arthur R. Derse -2017 -American Journal of Bioethics 17 (2):39-41.
- Emergency research and consent: Keeping the exception from undermining the rule.Arthur R. Derse -2006 -American Journal of Bioethics 6 (3):36 – 37.
- Adam Omelianchuk, Alexander Morgan Capron, Lainie Friedman Ross, Arthur R. Derse, James L. Bernat, and David Magnus reply.Adam Omelianchuk,Alexander Morgan Capron,Lainie Friedman Ross,Arthur R. Derse,James L. Bernat &David Magnus -2024 -Hastings Center Report 54 (5):37-38.This letter responds to letters by Garson Leder and by Harrison Lee in the same issue, September‐October 2024, of the Hastings Center Report.
- The Brutal but Utile Truth of "Futile".Arthur R. Derse -2018 -Perspectives in Biology and Medicine 60 (3):340-344.What term is most appropriate in describing the limits of medicine? That depends on who determines the limits and the bases on which those limits are delineated and communicated. Schneiderman, Jecker, and Jonsen critique two recent policy statements by critical care providers—Bosslet et al. and Nates et al. —for their rejection of the use of the term futile for treatment. Both statements recommend using the adjective inappropriate for the problematic treatment, rather than futile, based on the lack of consensus of (...) just what constitutes futility. Schneiderman, Jecker, and Jonsen also assert that, despite a lack of consensus about the determination of futility, the definitions they have... (shrink)
- Duty to Family: Ethical Considerations in the Resuscitation Bay.Ashley Pavlic,Arthur R. Derse,Nancy Jacobson,Christopher Calciano &Colin Liphart -2024 -Journal of Clinical Ethics 35 (1):54-58.To examine the ethical duty to patients and families in the setting of the resuscitation bay, we address a case with a focus on providing optimal care and communication to family members. We present a case of nonsurvivable traumatic injury in a minor, focusing on how allowing family more time at the bedside impacts the quality of death and what duty exists to maintain an emotionally optimal environment for family grieving and acceptance. Our analysis proposes tenets for patient and family-centric (...) care that, in alignment with trauma-informed care principles, optimize the long-term well-being of the family, namely valuing family desires and sensitivity to location. (shrink)No categories
- Flying Too Close to the Sun: Lessons Learned from the Judicial Expansion of the Objective Patient Standard for Informed Consent in Wisconsin.Arthur R. Derse -2017 -Journal of Law, Medicine and Ethics 45 (1):51-59.The Wisconsin Supreme Court, after adopting the doctrine of the objective patient standard, expanded it in bold and innovative ways over nearly four decades, until the Wisconsin legislative and executive branches drastically reversed this course. The saga has implications for other jurisdictions considering adoption or expansion of the objective patient standard doctrine.No categories
- Civility in Health Care: A Moral Imperative.Joel M. Geiderman,John C. Moskop,Catherine A. Marco,Raquel M. Schears &Arthur R. Derse -2024 -HEC Forum 36 (2):245-257.Civility is an essential feature of health care, as it is in so many other areas of human interaction. The article examines the meaning of civility, reviews its origins, and provides reasons for its moral significance in health care. It describes common types of uncivil behavior by health care professionals, patients, and visitors in hospitals and other health care settings, and it suggests strategies to prevent and respond to uncivil behavior, including institutional codes of conduct and disciplinary procedures. The article (...) concludes that uncivil behavior toward health care professionals, patients, and others subverts the moral goals of health care and is therefore unacceptable. Civility is a basic professional duty that health care professionals should embrace, model, and teach. (shrink)
- Adolescent Boarding in the ED: Issues of Autonomy, Nonmaleficence, and Distributive Justice.John C. Moskop &Arthur R. Derse -2024 -American Journal of Bioethics 24 (7):139-143.An Emergency Department (ED) nurse caring for seventeen-year-old Bethany requests ethics consultation in a situation, ED boarding of a minor patient, that has become more and more common in recent...
- The ECMO Bridge and 5 Paths.Arthur R. Derse -2023 -American Journal of Bioethics 23 (6):1-4.Childress and coauthors present a case considering ECMO withdrawal over the objection of the conscious patient who is no longer a candidate for transplantation or other definitive therapeutic inter...
- Alzheimer’s Disease and the Invisible Person: The Missing Patient Voice.Garson Leder &Arthur R. Derse -2022 -American Journal of Bioethics 22 (7):87-90.There are at least three related issues that need to be resolved in this case: Who should be the patient’s medical decision-maker?, Should the patient be treated and possibly admitted?, and...
- Net Effect: Professional and Ethical Challenges of Medicine Online.Arthur R. Derse &Tracy E. Miller -2008 -Cambridge Quarterly of Healthcare Ethics 17 (4):453-464.From computerized medical records to databases of pharmacological interactions and automated provisional EKG readings, the emergence of information technology has significantly altered the practice of medicine. Information technology has been widely used to enhance diagnosis and treatment and to improve communication between providers. The advent of the Internet also brings far-reaching implications for patient–physician communication, challenging physicians, patients, and policymakers to consider its impact on the delivery of medical care and the therapeutic relationship. A new set of practices by patients (...) and physicians is unfolding in cyberspace, ranging from the use of e-mail to communicate between physicians and patients in an existing relationship to one-to-one consultations with an anonymous physician and ongoing online treatment, such as psychotherapy. These practices are emerging in both the for-profit and not-for-profit spheres. (shrink)
- Decision-making capacity.Arthur R. Derse -2012 - In D. Micah Hester & Toby Schonfeld,Guidance for healthcare ethics committees. Cambridge, UK: Cambridge University Press. pp. 55.
- Ethical and Regulatory Considerations Regarding Enrollment of Incompetent Adults in More Than Minimal Risk Research as Compared With Children.Arthur R. Derse &Ryan Spellecy -2015 -American Journal of Bioethics 15 (10):68-69.In this case, the investigator should be allowed to enroll incompetent adults into this study, with certain safeguards. If an incompetent adult has an agent or a legally authorized representative (...
- Is patients' time too valuable for informed consent?Arthur R. Derse -2007 -American Journal of Bioethics 7 (12):45 – 46.
- Is There a Lingua Franca for Bioethics at the End of Life?Arthur R. Derse -2000 -Journal of Law, Medicine and Ethics 28 (3):279-284.In this issue, Raphael Cohen-Almagor reviews some of the terms used in the discussion of bioethical issues at the end of a patient's life; he argues that they are “valueladen” and serve “primarily the physicians, at times at the expense of the patients’ best interest.” Each of the following terms comes under scrutiny: “death with dignity,” “persistent vegetative state,” “futility,” “double effect,” and “brain death.” He argues that these concepts, developed in recent decades, “have generated an unhealthy atmosphere for patients, (...) which might lead to undesirable actions at the end of patients’ lives.” He issues a plea to discontinue the use of the term “persistent vegetative state” because it is dehumanizing, to explain “double effect” and “futility” in detail and with sincerity, and to clarify the motivation for using these terms and others. He warns physicians not to use terminology that is offensive to patients and loved ones or that weakens their patients’ will to live. (shrink)
- Making decisions about life-sustaining medical treatment in patients with dementia.Arthur R. Derse -1999 -Theoretical Medicine and Bioethics 20 (1):55-67.The problem of decision-making capacity in patients with dementia, such as those with early stage Alzheimer's, can be vexing, especially when these patients refuse life-sustaining medical treatments. However, these patients should not be presumed to lack decision-making capacity. Instead, an analysis of the patient's decision-making capacity should be made. Patients who have some degree of decision-making capacity may be able to make a choice about life-sustaining medical treatment and may, in many cases, choose to forgo treatment.
- The seven-year itch.Arthur R. Derse -2005 -American Journal of Bioethics 5 (5):1 – 5.
- When I Lay My Burden Down: Commentary on Berger.Arthur R. Derse -2009 -Journal of Clinical Ethics 20 (2):172-174.No categories
- When Not to Rescue: An Ethical Analysis of Best Practices for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Arthur R. Derse &Nancy S. Jecker -2017 -Journal of Clinical Ethics 28 (1):44-56.It is now a default obligation to provide cardiopulmonary resuscitation (CPR), in the absence of knowledge of a patient’s or surrogate’s wishes to the contrary. We submit that it is time to reevaluate this position. Attempting CPR should be subject to the same scrutiny demanded of other medical interventions that involve balancing a great benefit against grievous harms.No categories
- Universal Emergency Access under Managed Care: Universal Doubt or Mission Impossible?Gregory Luke Larkin,James E. Weber &Arthur R. Derse -1999 -Cambridge Quarterly of Healthcare Ethics 8 (2):213-225.Appropriate concerns about cost and unequal access to healthcare have resulted in the creation of powerful managed networks seeking to share the risks of high healthcare costs among plans, providers, and patients. Much to their credit, these managed networks have slowed the rise in healthcare spending by as much as 44% in markets with high HMO penetration. However, whether these savings will materially improve access and quality remains to be seen.
- Case Study: Retiring the Pacemaker.Paul J. Reitemeier,Arthur R. Derse &Jeffrey Spike -1997 -Hastings Center Report 27 (1):24.
- Managed Care, Doctors, and Patients: Focusing on Relationships, Not Rights.Robyn S. Shapiro,Kristen A. Tym,Dan Eastwood,Arthur R. Derse &John P. Klein -2003 -Cambridge Quarterly of Healthcare Ethics 12 (3):300-307.For over a decade, managed care has profoundly altered how healthcare is delivered in the United States. There have been concerns that the patient-physician relationship may be undermined by various aspects of managed care, such as restrictions on physician choice, productivity requirements that limit the time physicians may spend with patients, and the use of compensation formulas that reward physicians for healthcare dollars not spent. We have previously published data on the effects of managed care on the physician-patient relationship from (...) the physician's perspective. In 1999, we collected data on the impact of managed care arrangements on the physician-patient relationship from the patient's perspective. This article discusses our collective findings. (shrink)
- Managed Care: Effects on the Physician-Patient Relationship.Robyn S. Shapiro,Kristen A. Tym,Jeffrey L. Gudmundson,Arthur R. Derse &John P. Klein -2000 -Cambridge Quarterly of Healthcare Ethics 9 (1):71-81.Over the past several years, healthcare has been profoundly altered by the growth of managed care. Because managed care integrates the financing and delivery of healthcare services, it dramatically alters the roles and relationships among providers, payers, and patients. While analysis of this change has focused on whether and how managed care can control costs, an increasingly important concern among healthcare providers and recipients is the impact of managed care on the physicianpatient relationship, but little data have been collected and (...) analyzed. We designed a survey for distribution to Wisconsin physicians to analyze the prevalence and types of managed care arrangements in the state, and the impact of these arrangements on physicians and their relationships with patients. (shrink)
- In the Absence of Evidentiary Harm, Existing Societal Norms Regarding Parental Authority Should Prevail.Kimberly A. Strong,Arthur R. Derse,David P. Dimmock,Kaija L. Zusevics,Jessica Jeruzal,Elizabeth Worthey,David Bick,Gunter Scharer,Alison La Pean Kirschner,Ryan Spellecy,Michael H. Farrell,Jennifer Geurts,Regan Veith &Thomas May -2014 -American Journal of Bioethics 14 (3):24-26.
- Akira Akabayashi, MD, Ph. D., is Professor in the Department of Biomedical Ethics at the School of Health Science and Nursing at the University of Tokyo Graduate School of Medicine, Tokyo, Japan, and Professor at the School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan. [REVIEW]Rachel A. Ankeny,M. L. S. Bette Anton,Alister Browne,Nuket Buken,Murat Civaner,Arthur R. Derse,Brent Dickson,Dan Eastwood,Todd Gilmer &Michael L. Gross -2003 -Cambridge Quarterly of Healthcare Ethics 12:229-231.
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David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Area Editors:
David Bourget
Gwen Bradford
Berit Brogaard
Margaret Cameron
David Chalmers
James Chase
Rafael De Clercq
Ezio Di Nucci
Esa Diaz-Leon
Barry Hallen
Hans Halvorson
Jonathan Ichikawa
Monte Johnson
Michelle Kosch
Øystein Linnebo
Paul Livingston
Brandon Look
Manolo Martínez
Matthew McGrath
Michiru Nagatsu
Susana Nuccetelli
Giuseppe Primiero
Jack Alan Reynolds
Darrell P. Rowbottom
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