Conferences and Invited Talks
Below are abstracts, links, slides, and handouts from some of the presentations I have given. Please cite appropriately if used. For a full list of presentations, see my CV.
Protecting Disability Rights in a Pandemic
McGill IHSP Disability Working Group | Virtual (2022) Overview: In this talk, Dr. Guidry-Grimes will discuss the theoretical foundations of disability rights during a public health crisis. She will approach this topic as a U.S.-based clinical ethicist and philosopher with a specialization in disability bioethics. She will analyze justice in terms of distribution and recognition, building on the work of Nancy Fraser and disability studies scholars. She will connect conceptual points about justice with the four elements of the IOM vision statement for public health crises, which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. Her analysis will cover both crisis standards of care and contingency standards of care, the latter of which did not receive sufficient normative analysis before the onset of the COVID-19 pandemic. |
The Ethics and Art of Chart Noting
Co-authored with Sara Tariq Center for Practical Bioethics Ethics Committee Consortium | Virtual (2022) (and many more venues) Objectives:
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Ethics and the COVID-19 Pandemic: Everyday Challenges
Covid-19: Ethics Module for Arkansas Providers | Virtual (2021) Objectives:
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Moral Distress in the Pandemic and Beyond
Nursing Grand Rounds | Arkansas Children's Hospital (2021) Objectives:
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Contributions of Ethics Expertise in Clinical Medicine in the U.S.
Co-authored and co-presented with Jamie Carlin Watson UK Clinical Ethics Network | Virtual (2021) European Clinical Ethics Network | Virtual (2021) Center for Practical Bioethics | Virtual (2021) Abstract: Recent research in the United States shows an increase in paid positions in clinical ethics in all sectors (for-profit, not-for-profit, and government health centers), an increase in specialized training for those who conduct ethics consultations, and an increasing number of consultants who provide in situ recommendations as opposed to post hoc case reviews or non-recommendation supports. This suggests a growing acknowledgement of what we call “practical moral expertise”—the competence to speak authoritatively about moral matters. We distinguish the practical moral expertise of clinical ethicists from the academic moral expertise of ethics professors and the performative moral expertise of people we might regard as moral exemplars. We then defend practical moral expertise against three common objections: the uniqueness of morality as a domain of discourse, the problem of bias in moral judgments, and the problem of disagreement among ethicists. We close by highlighting four ways that full-time clinical ethicists can benefit the NHS: moral expertise, increased bandwidth to address moral issues, reducing the amount or intensity of ethical tensions, and reducing moral distress and professional burnout. |
Layers of Vulnerabilities in Mental Health Settings
World Congress of Bioethics | Virtual (2020) Supplemental handout available here This presentation was part of a symposium titled "Peeling Back Layers of Vulnerability" with Florencia Luna, Alison Reiheld, and Elizabeth Victor. The symposium began with Luna's conception of vulnerability as layers and how they can have cascading effects. The panelists applied Luna's theoretical work to particular populations. In this presentation, I focus on persons with psychiatric disabilities in mental health settings (especially hospitals). |
Supporting People with Disabilities in Decision-Making
Arkansas Department of Health Grand Rounds | Little Rock, AR (2019) Objectives:
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Covert Drugging in Food: A Worthwhile Moral Gamble?
Co-authored with Megan Dean and Elizabeth Victor American Society for Bioethics and Humanities | Pittsburgh, PA (2019) International Congress on Law and Mental Health | Rome, Italy (2019) Feminist Approaches to Bioethics Congress | Bengaluru, India (2018) Abstract: Covert drugging in food is a relatively common practice in caregiving contexts, including psychiatric and long-term care facilities. Until recently it has received little attention in the bioethical literature and there are few (if any) procedures or rules governing the practice. In this paper, we discuss two ethical issues relating to covert drugging in food, focusing on particular ethical issues that surround the use of food. Drawing on feminist work in food ethics, we begin with the idea that eating is a relational practice, one that entails significant vulnerability to and dependency on others. In cases of covert drugging, relationships between feeders—whether family members, other caregivers, or professionals within medical contexts—and eaters are central. We analyze the ways that these relationships can be undermined and trust eroded through covert drugging of food. Drawing on theories of relational autonomy, we analyze the lost opportunities for agency that already exist in long-term facilities and psychiatric care contexts, as well as how these losses can affect the relational self over time. When patients refuse food they believe to be drugged, they are susceptible to being labeled as “difficult patients” which can lead to further restrictions to their autonomy, eating agency, and ability to form therapeutic alliances. In the final section of the paper, we consider cases in which covert drugging could be ethically permissible, given these concerns. While there may be cases in which covert drugging may be ethically justified, given a lack of suitable alternatives, we argue this practice in any given case should be continually reevaluated in light of the building moral costs to the relational agent over time. |
Ethical Insights for Addressing Conflict between Families and the Medical Team
Co-authored with Jamie Watson Hospice and Palliative Care Conference | Little Rock, AR (2019) Initiative for Pediatric Palliative Care Conference (2019) UAMS/ACH Neonatal ICU Section Meeting | Little Rock, AR (2019) Objectives:
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Impasses and Ethical Challenges at the End of Life: From the NICU to the SICU
Commission for Case Manager Certification | Webinar (2018) Objectives:
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How Hard to Push? The Challenge of Addressing Organizational Ethics
American Society for Bioethics and Humanities | Anaheim, CA (2018) International Conference on Clinical Ethics Consultation | University of Oxford (2018) Abstract: Clinical ethicists generally espouse a commitment to organizational ethics, but what this concretely means can be difficult to discern. Over twenty years ago, Robert Lyman Potter emphasized the important work that bioethicists have to contribute to organizational ethics, which he defines as “the intentional use of values to guide the decisions of a system,” which “implies that members of a cooperative group have articulated and reflected on a set of values and have accepted them as normative for the culture of that organization” (1996, 4). In the course of their work, clinical ethicists in a hospital environment will frequently see preventable ethical conflicts and avoidable moral costs. Clinical ethicists have a unique vantage point in being able to pinpoint troubling patterns and trends that could be emerging, such as those related to resource use, work environment, miscommunication and missing documentation, cultural incompetence, personal biases, and training deficits. When these broader issues arise in a particular case, the clinical ethicist is often stuck in determining the boundaries of their professional role. Clinical ethicists face pressures to be “politic” and not too intervening, leaving certain “messes” to other services who should take responsibility for them. But when the clinical ethicist has identified certain problem areas and communicated them to the proper individuals, and it becomes evident that no one will take responsibility for those problems, then how hard should the clinical ethicist push? What sacrifices and risks are an inherent part of clinical ethicists’ professional obligations? In addition to worries about overstepping our professional boundaries, there are also worries about other services relying too heavily on ethicists taking responsibility for problems that they should learn to address themselves. I analyze these tensions with case examples, and I suggest how clinical ethicists should think about their professional duties regarding organizational ethics. |
A Role for Clinical Ethicists on Ventricular Assist Device Eligibility Committees
Co-authored with Evan DeRenzo International Conference on Clinical Ethics Consultation | University of Oxford (2018) Abstract: Eligibility criteria for ventricular assist devices (VADs) are not as rigid or clear as those for solid-organ transplants, and clinical ethicists may be asked to serve on VAD eligibility committees to help determine whether certain patients should be considered for VAD implantation. Through this role, clinical ethicists can help set precedent for the VAD team in thinking about future cases and also establish the ethos of the team. Clinical ethicists can provide valuable insights during this process, which I will illustrate with an actual case that threatened to set troubling precedent. In this case, Mrs. S was admitted to the hospital after reporting that her husband turned off her medication pump in her sleep. She told the medical team that her husband of the last forty years had always been emotionally abusive, and he enjoyed seeing her ill. At this point of her medical deterioration, Mrs. S needed a VAD to increase her longevity and improve her quality of life. The VAD eligibility committee decided against the implantation because of her unsafe home situation. In the words of her cardiologist, Mrs. S was being “double victimized” by being denied the VAD for this reason. Initially, some members of the medical team were focused on her questionable capacity to report abuse and make decisions, and the patient narrative was reduced and largely dismissed. When the Ethics team was consulted for our recommendation, we broadened the scope of moral concern to include features of the patient’s vulnerability, possibilities for enabling her autonomy, and the moral urgency of responding to her reports of abuse. This case demonstrates the ethical complexity of VAD eligibility and how support from clinical ethicists can make a positive impact in these deliberations. |
Ethical Complexities in Assessing Patients' Insight
Clinical Ethics Grand Rounds | University of Kentucky (2018) Bioethics Grand Rounds | University of Washington (2018) Abstract: The question of whether a patient has insight is among the first to be considered in psychiatric contexts, but also elsewhere in the hospital. There are several competing conceptions of 'insight,' which broadly refers to a patient's awareness of their psychiatric condition. In the literature, current accounts of insight generally have more demanding criteria than clinicians had in years past. Data on which groups of psychiatric patients tend to lack insight have changed dramatically over the years. Studies also give contradictory evidence regarding the frequency and consequences of poor insight. A number of crucial questions remain unanswered or fiercely debated. Given the conceptual ambiguities associated with the meaning of insight, there are significant ethical concerns about how patients' decisions are weighed and evaluated. After outlining some of the key disagreements in the literature about what insight means, I will demonstrate how insight assessments can impact attempts at shared decision-making. |
Meaningfulness within Voice-Hearing Communities
Benjamin Rabinowitz Symposium in Medical Ethics | University of Washington (2018) Abstract: The dominant epistemic community within a society has the power, seemingly, to establish constraints on what should count as meaningful living. What counts as meaningful to a voice-hearer (that is, someone who hears voices for reasons of psychiatric disability), for example, might seem idiosyncratic and simply false to those external to the voice-hearing community though completely sensible to those within this community. Support networks for voice-hearers can legitimate claims of meaningfulness in a reasons-giving process with others, and traditional support networks (such as family members and healthcare institutions) might undermine the epistemic confidence that certain voice-hearers have in asserting the meaningfulness of their voices. I give an overview of voice-hearing communities within the psychiatric user/survivor movement, and I philosophically unpack claims of meaningful living in virtue of voice-hearing. I conclude by providing preliminary recommendations for the clinician-patient relationship in these situations. |
"But It's a Gift!" Adherence Pressures Post-Transplant
William Paterson University Ethics Colloquium | Wayne, NJ (2018) Abstract: “Gift” language is rampant in public campaigns, scholarly studies and analyses, and even in the hallways of hospitals when referring to transplantable organs. The organ-as-a-gift notion brings with it a number of social and moral implications, not only for motivating potential donors and their families but also for motivating recipients. The “gift ethic” in transplant contexts needs further analysis, especially given how “gift” language can structure moral relationships among donors, donors’ families, healthcare professionals (HCPs), organ procurement coordinators, prospective and past transplant recipients, and recipients’ support system. Although substantial literature explores the gift ethic as it relates to encouraging donation, there are far fewer studies and discussions on how this ethic impacts recipients. This issue merits investigation because transplant recipients are frequently subjected to moral remonstrations and various other pressures to respect their “gift,” but to what extent these pressures are justified is not always evident or obvious. My aim is two-fold. First, I will briefly analyze how organs could be a certain type of gift. Second, I will investigate the general moral obligations and justifiable expectations of organ recipients as implied by the gift ethic, and I will outline the limitations of those obligations and expectations. |
"But Is That Possible?" Achieving Shared Decision-Making in Cases of Psychiatric Disability
Association for Practical and Professional Ethics | Chicago, IL (2018)* * Winner of the Best Formal Paper by an Early Career Scholar Award Abstract: I argue that health care professionals should try to achieve shared decision-making with patients who have psychiatric disabilities, but clearer normative guidance is needed for this model of the therapeutic relationship to attain its ethical aims. The normative implications of shared decision-making become especially tricky to discern in cases where there are various barriers to genuine collaboration with the patient. Health care professionals and patients might be too quick to give up on the possibility of shared decision-making because of these barriers. While health care professionals might not realize the agential possibilities and deeply held values of these patients, patients might not trust that they can participate in decision-making and disclose what matters most to them. I focus on those difficult cases where shared decision-making seems unreachable with this patient population. There are a couple of distinctive challenges in mental health contexts: a) when the health care professional does not trust the patient’s knowledge claims and b) when the patient and health care professional have different conceptions of psychiatric recovery. Regarding the first challenge, I analyze how clinical assessments of insight can affect how the clinician perceives the patient’s epistemic standing in the decision-making process, which can undermine attempts at shared decision-making before they even begin. In response to the second challenge, I show how mental health professionals and patients can come to an impasse if they do not have the same recovery orientation. Their disagreements will persist if the patient and health care professionals cannot share their expertise and values with one another. |
Rationality, Autonomy, and Capacity: Their Use and Abuse in Clinical Judgments
Co-authored with Jamie Watson American Society for Bioethics and Humanities | Kansas City, MO (2017) Abstract: Rationality, autonomy, and capacity conceptually diverge. A patient could make a rational decision that nevertheless fails to be sufficiently capacitated or autonomous. A patient could reach the bar of decisional capacity, even if there are autonomy-undermining influences affecting what decisions the patient makes. We clarify these conceptual distinctions and argue that overlooking them can lead to morally inappropriate conclusions about patients and their decisions. We argue that, while capacity is the minimal standard for consent and refusal, patients who are capacitated, autonomous, and rational are in the best moral position to understand and use information about their own care, and patients lacking any one of these might need different forms of decisional support or empowerment. These distinctions can be helpful for understanding providers’ obligations when a patient wants to be left alone. We root our analysis in a clinical case where a patient refused a relatively safe diagnostic procedure. The result of the patient’s refusal was going to be his likely death from a preventable and treatable complication. The medical team disagreed with his reasoning, and the patient was held in the hospital for hours against his will and subjected to numerous capacity assessments. We suggest that the patient’s decision could have been capacitated without being substantively rational or autonomous. Keeping these notions distinct could have made a difference for how the involved clinicians and clinical ethicists viewed the nature of their obligations in this case. |
Ethical Treatment of LGBTQ+ Patients (International Panel)
International Academy of Law and Mental Health | Prague, Czech Republic (2017) Abstract: Research illustrates that the LGBTQ+ patient population has been rendered vulnerable in many spheres of life, including clinical settings. While some of forms of discrimination and mistreatment are overt, subtler and insidious forms affect these patients’ experiences as well. Health care spaces and providers often convey unintentional microaggressions against this population, which can damage the therapeutic relationship and discourage patients from seeking treatment at all. In order to protect these patients and ensure equitable care and access to services, concrete steps need to be taken. I will discuss the ethics education that my hospital currently has, which consists of scheduled programming for nurses and ad hoc talks as needed for specific cases. Providing education on this topic in clinical settings will face challenges: a) push back from some health care providers (HCPs) based on their cultural or religious background, b) problematic conceptions of conscientious objection, and c) lack of institutional support in trying to overcome heteronormativity and cisnormativity. Nursing directors might struggle to respond to nurses who do not understand or respect a patient’s self-identified gender. Some HCPs might even attempt to invoke conscientious objection (CO) in providing care to these patients. Unless there is a clear policy on the meaning and constraints of CO, these refusals by HCPs can pose significant obstacles to excellent patient care. Moreover, sensitivity or diversity training will prove to be insufficient. This training can result in a backlash, increasing tensions in clinical relationships and providers’ avoidance of these patients. Despite efforts to eliminate discriminatory practices and homophobic behavior, heteronormative ideals remain concretized in multiple ways, including small talk, healthcare forms, posters, brochures, and intake procedures. These institutional issues have to be addressed for a hospital to achieve its aims of equitable care for all patients, regardless of sexual orientation or gender identity. |
Differing Ethical Perspectives on Assisted Suicide (International Panel)
International Conference on Clinical Ethics Consultation | Washington, DC (2016) Abstract: This panel presents multiple perspectives on assisted suicide (AS) in different countries. The first panelist will emphasize that choice is not intrinsically valuable, so we should consider how adding AS to end-of-life options may or may not support autonomous decision making. In the U.S., we are still striving to improve end-of-life care, so offering AS should be analyzed against the backdrop of an imperfect health care system. The second panelist will discuss the passage of the new law in California, exploring concerns about our professional obligations to patients and our professions. She will analyze the concept of control that often seems to be the crux of the arguments in the U.S. and what is lost when that becomes the focus. The next panelist will provide reflections on the recent U.K. parliamentary debate on AS, focusing on the arguments on both sides with respect to the concept of vulnerability. She will discuss the ambivalent position of UK law with discretion ultimately left to the Crowne Prosecution Service, which has a potential discriminatory effect. Our last panelist will share perspectives from Central Europe. Lay organizations offer AS with little public control in Switzerland; Germany’s liberal legislation has recently been changed to prohibit Swiss-style AS; Austria has instituted restrictive legislation. The role of clinical ethics support will be illustrated by recent university hospital guidelines on responding to patients’ questions regarding AS. |
Futile Treatment: Is It Ever Ethically Permissible to Provide It?
American Association of Critical Care Nurses | Washington, DC (2015) Abstract: I begin by giving a brief overview of what ethics is and what falls within the purview of a bioethics department within a hospital. Next I explore how ‘futility’ as a term could be used differently by clinicians, families, patients, ethicists, and I distinguish between biomedical and normative futility. I highlight the distress that healthcare providers can feel in being asked to provide care they deem futile or in being prevented from providing care that they do not believe to be futile. I mention existing professional standards related to the meaning of futility and correlated professional obligations that have ethical import. I demonstrate the moral uncertainties that can arise when there are different conceptions of futile care and related professional obligations by applying them to an actual clinical case that occurred in our Neonatal ICU. |
Ethical Bargaining and Parental Exclusion: A Clinical Case Analysis
Co-authored presentation with Elizabeth Victor Canadian Bioethics Society | Winnipeg, Manitoba (2015) International Conference on Clinical Ethics Consultation | New York, NY (2015) Abstract: We present an actual clinical case where the long-term health of a child was at stake, and the medical team handled their dispute with the father by making an ethically impermissible compromise. This case reveals the limits of ethical bargaining, which occurs when the involved parties choose not to pursue a morally preferable option for the sake of coming to a resolution. We argue that the bargain struck in this case was not within the range of morally permissible options, as it led to the denial of the mother’s parental standing and risking the future health of a child. Moreover, based on how the case was settled and later analyzed by an ethics committee, we contend that there is an obligation to acknowledge and confront potentially damaging family dynamics. In these instances, it can be morally urgent to enable the autonomy of all relevant caregivers, especially since the dominating decision-maker might not be fairly characterizing the role of other caregivers or representing the best interests of the patient and family. |
Problems of Clinical Insight When Listening to the Voices of Psychiatric Patients
American Society for Bioethics & Humanities | San Diego, CA (2014)* International Conference on Clinical Ethics Consultation | Paris, France (2014) *Winner of the 2014 ASBH Student Paper Award Abstract: The question of whether a patient has insight is among the first to be considered in psychiatric contexts. There are several competing conceptions of ‘clinical insight,’ which broadly refers to a patient’s awareness of his/her medical condition. Current accounts generally have more demanding criteria than clinicians used in years past. Insight used to be considered all-or-nothing and unidimensional. Insight is now viewed more as a multidimensional and continuous construct. The precise specifications of the dimensions appear inadequate for providing clear guidance, though. Data on which groups of psychiatric patients tend to lack insight have changed dramatically over the years. Studies also give contradictory evidence regarding the frequency and consequences of poor insight. For example, some researchers claim that all psychiatric conditions compromise insight; others suggest that poor insight is only present in psychosis. Several studies find no correlation between level of insight and severity of psychopathology, but others come to the opposite conclusion. A number of crucial questions remain unanswered or fiercely debated. Given the conceptual ambiguities associated with insight determinations, there are significant ethical concerns about how patients’ decisions are weighed and evaluated in psychiatric care. Patients’ concerns about having their status as knowers denigrated can result in their distrust of clinicians, which in turn can hurt treatment compliance. After outlining some of the key disagreements in the literature about what clinical insight means, I will suggest ways in which clinical ethics services can contribute to therapeutic alliance building for patients whose insight level is uncertain. |
Inhospitable Healthcare Spaces: Why Training on LGBTQIA Issues Is Not Enough
Co-authored presentation with Megan Dean and Elizabeth Victor Canadian Bioethics Society | Winnipeg, Manitoba (2015) American Society for Bioethics & Humanities | San Diego, CA (2014) Supplemental handout available here Abstract: In this paper, we highlight the ways in which heteronormativity marginalizes Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual populations (LGBTQIA) in clinical contexts. Recent research reveals that healthcare spaces and providers often convey micromessages that make this population feel anxious, unwelcome, or ashamed. Despite efforts to eliminate discriminatory practices and homophobic behavior, heteronormative ideals remain concretized in multiple ways, including small talk, healthcare forms, posters, brochures, intake procedures, and pronoun usage. LGBTQIA patients have reported fear of hostility, isolation, or refusal of service if they come out to their healthcare providers. Yet, if healthcare providers are to adequately enable patient autonomy and administer the standard of care for all patients, they need access to information related to sexual history and lifestyle. LGBTQIA individuals’ understandable avoidance of clinical encounters and hospitals’ general lack of initiative to reform healthcare spaces perpetuate one another. We analyze this perpetuating cycle and the double bind that results. Additionally, we discuss how and why consciousness raising and professional training on LGBTQIA issues will hit a number of obstacles and prove insufficient. For example, certain attempts to eradicate heteronormativity can result in a backlash, increasing tensions in waiting rooms or clumsiness in pronoun/patient reference on intake forms. We address the extent to which healthcare professionals have responsibilities to address heteronormativity as it arises interpersonally and institutionally, and we offer some considerations for concrete problem-solving. |
Dementia, Sexual Autonomy, and Gatekeeper Responsibility
Co-authored presentation with Elizabeth Victor International Conference on Clinical Ethics Consultation | Paris, France (2014) "Enabling Autonomy: Sexual Rights and Cognitive Disability" (earlier version) Eastern Division of the Society for Women in Philosophy | Little Rock, Arkansas (2013) Canadian Bioethics Society Conference | Banff, Alberta (2013) Abstract: We begin by discussing the role of gatekeepers in relation to sexual autonomy and sexual rights, particularly in cases of cognitively disabled individuals who still retain sufficient decisional capacity for sexual activity and sexual expression. Recognizing that ‘the cognitively disabled’ are not one homogenous category, we will focus on individuals with early to moderate dementia who are in states of dependency on others (e.g., in a nursing home). Our aims are to 1) outline some systematic paternalistic efforts to suppress these individuals’ sexual experimentation and expression, 2) offer a choice-specific capacity framework as it relates to sexual decision-making, and 3) argue for ways in which institutions (especially medical) should respond to the particular vulnerabilities and interests of this population in relation to sexual identity. Shifting from an independence model of autonomy to a relational framework, we argue that sexual rights are positive as well as negative, and policies should provide supports and mechanisms for different forms of sexual expression. These provisions can ameliorate coercion concerns without leading to the extreme and unjust conclusion that all non-ideal agents should be prevented from pursuing sexual relationships or lifestyles. Individuals with early to moderate dementia could potentially develop or maintain their decisional capacity for sexual activity if (for instance) nursing home staff enabled autonomy by assisting these individuals to be active inquirers into sexual possibilities and by providing the conditions necessary for non-harmful sexual activity. The interdependence needs of the cognitively disabled should be recognized and accommodated; these needs do not, in themselves, justify exclusion or neglect. A precautionary principle that stifles their sexuality is unfair to this population, considering the importance sexuality generally has for identity and well-being. |
End of Life Decisions for People with Significant Intellectual Disabilities
Co-authored presentation with Marisa Brown, Carol Taylor, and Erin Leveton International Conference on Clinical Ethics Consultation | Paris, France (2014) Regional Clinical Ethics Symposium | Washington Hospital Center (2014) Abstract: Our study analyzes and evaluates how guardians make end-of-life decisions for individuals with profound intellectual disability (PID) who have never had decisional capacity. This project explores two unique features of the moral problems associated with these decisions. The first is the complexity in identifying the best interests of the ward when, due to the PID, he or she has never had the ability to describe his/her wishes. In these instances, family members, lawyers, or other social service professionals are given the status of guardian and may be vested in making decisions that can either hasten or prolong the end-of-life process. We discuss some common questions and concerns associated with this “gold standard” of surrogate decision-making when applied to these individuals. For example, there are worries about surrogates completely de-personalizing the best interest standard, not making a concerted effort to determine the ward’s preferences (to the extent they might exist), or simply deferring to medical judgment without critical reflection. The second unique feature to be explored is developing an understanding of how these decisions are made and should be made within a patient-centered framework. In response to these challenges, we have surveyed local guardians about their experiences making end-of-life decisions for this population, and we solicited their thoughtful responses to case vignettes. This research was done with assistance from scholars, lawyers, and disability advocates. Additionally, we have constructed a web-based toolkit to assist guardians tasked with making decisions for wards with PID. |
Demands for Recognition and the Psychiatric User/Survivor Movement
National Endowment for the Humanities Colloquium | Hood College, honorarium provided (2014) Abstract: By and large, philosophical scholarship has not taken much notice of the psychiatric user/survivor movement, even though it began in the 1970s and even though the activists believe that they are pushing an important civil rights and human rights agenda. Especially after the movement branched into groups that have more nuanced positions than those proposed by those within the anti-psychiatry camp, it is philosophically and morally important to analyze what these groups aim to accomplish and what their underlying concerns are. It is not my intention to critique or defend all of their claims. Rather, I will focus on how their demand for recognition parallels a similar demand among disability rights advocates. Recognition, as a moral and political aim, involves more than mere acknowledgement of difference; rather, it involves positive accommodations and reevaluating what the group identities mean for individuals. For disability activists and psychiatric user/survivors, the call for recognition is tied to having their varied modes of being (i.e., those that are not able-bodied and able-minded) respected, accepted, and accommodated. A Strawsonian framework will help unpack what this duty means interpersonally. I will argue that a wholly objective attitude toward psychiatrically disabled individuals will strip them of their ability to have variant modes of being identified and respected, and this type of attitude further disempowers an already vulnerable population. If an objective attitude toward them is ever justified, it should be reserved only for those rare and extreme disorders that have significantly deteriorated the individual’s agential capacities. The duty of recognition, therefore, will come into conflict with the duty of beneficence when the individual’s fundamental capacities are compromised or suspected of being compromised. Keeping this tension in mind is important for having a clear and precise account of what recognition does and does not require for this population. |
Vulnerabilities and Institutional Barriers in Clinical and Public Health Contexts
Co-authored presentation with Elizabeth Victor Human Development and Capabilities Association | Managua, Nicaragua (2013) This presentation builds off of our paper "Vulnerabilities Compounded by Social Institutions" and our invited talk at the Pan American Health Organization in 2013 (see below). This presentation also incorporates a policy tool for identifying and mitigating compounded vulnerabilities. |
Hallucinations in the Emergency Room: Respectful Responses to Signs of Mental Illness and Treatment Refusals
International Conference on Clinical Ethics Consultation | Munich, Germany (2013) Supplemental handout available here Abstract: In the case of a patient with significant medical needs and signs of mental illness, at what point does the suspected psychiatric condition compromise the patient's capacity to refuse medically recommended and time-sensitive treatment? Determining the appropriate response to this question is a relevant topic to clinical ethics consultation, thought it can cause significant consternation and moral distress. I will begin by describing actual cases where patients refused treatment for pressing medical conditions while exhibiting possible signs of mental illness. In order to unpack the ethical complexities embedded in these cases and others of a similar nature, I will analyze and evaluate competing models of capacity, giving preference to a version of the sliding scale model. In each of these approaches, clinicians have to weigh patient well-being against respect for patient autonomy. What constitutes the authentic or "true" self of a mentally ill patient can be questionable, though, and their symptoms can raise further doubts about their ability to make autonomous decisions. I argue for a revised sliding scale model that avoids over-idealization and admits flexibility can protect mentally ill individuals from hard paternalist interventions without pointlessly tying the hands of medical professionals who want to promote patients' well-being. |
Understanding Vulnerabilities and Institutional Barriers in the Americas
Pan American Health Organization | Washington, DC (2013) This presentation was part of the monographic series hosted by the Office of Gender, Diversity, and Human Rights. I was invited to discuss different conceptions of 'vulnerability' in the bioethics literature and to provide my own preferred understanding of it (drawing on my co-authored paper on the topic). This presentation also incorporated some of PAHO's projects and general public health concerns, such as those related to poverty and indigenous populations. Furthermore, I show how, in countries where abortion is illegal, medical and legal institutions compound vulnerabilities when they obligate healthcare providers to report cases of self-induced abortion when women seek medical attention afterwards. |
Medical Privacy and Confidentiality: Bioethical Perspectives and Regional Challenges
Pan American Health Organization | Washington, DC (2012) The purpose of this brown bag lunch is to a) clarify what privacy and confidentiality are and why they matter, b) highlight some representative laws from the region on this issue, c) explain and implement some of the distinctive tools of bioethics, and d) provide some concrete recommendations for ameliorating this situation so as to better advocate for and protect the patient. Following the presentation, you are invited to an open discussion addressing, among others, the following questions:
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Ethical Considerations for Consent Procedures for Electroconvulsive Therapy
American Society for Bioethics and Humanities | Washington, DC (2012) Supplemental handout available here Abstract: The Food and Drug Administration has recently reviewed studies on ECT’s efficacy and safety, and they have yet to devote a concerted effort to discussing the ethical issues surrounding consent procedures for ECT. I aim to outline some of the core concerns, given that 1) many facts about the therapeutic mechanisms and side effects of ECT are still less than certain; 2) ECT often affects patients’ short-term and long-term memory; and 3) ECT is frequently used for vulnerable populations. Studies show that many patients who consent to ECT often do not believe that their choice was truly voluntary. Informed consent procedures are complicated even further given how ECT can dramatically change the patient's sense of self. If we adopt a psychological continuity view of personal identity, and if ECT causes dramatic alterations in memory, personality, and narrative, then this therapy can significantly disrupt a patient’s identity. This possibility has ramifications for proxy decision-making as well. I outline core ethical considerations for consent procedures for ECT and provide some recommendations. |
Courage in the Everyday and in Extremis: Civilian and Combatant Virtue in Harry Potter
Ethics Across the Curriculum | Young Harris College, honorarium (2014) Ethics and Children's Literature: A Symposium | DePauw University (2012) Abstract: Especially since children are vulnerable in many contexts and often view themselves as powerless, they face numerous situations that inspire fear. The Harry Potter series takes place within the context of an overarching war, and Harry Potter, Neville Longbottom, and Severus Snape each experience the civilian-combatant shift. Their courage both in everyday life and in warfare distinguish them as moral heroes. Aristotle defines ‘courage’ as “a mean with respect to things that inspire confidence or fear” (NE III.7, 1116a10). Through the characters of Harry, Neville, and Severus, I will analyze how this virtue develops along different tracks, given the particularities of the person and the situation. Their moral perception, moral imagination, and moral sense are all colored by the losses they have endured and in what ways that are connected to the war. Aristotle describes how the attainment of virtue requires a gradual calibration process that takes account of who we are and how we stand toward our emotions and desires. Someone can be courageous in battle and not in everyday life and vice versa. Harry, Neville, and Severus demonstrate how the roles of civilian and soldier present their own challenges when it comes to attaining the virtue of courage. |
The Persistence of Agency through Social Institutions and Caring for Future Generations
Co-authored presentation with Elizabeth Victor Ideals and Reality in Social Ethics | University of South Wales (2013) Congress of the International Network on Feminist Approaches to Bioethics | Rotterdam, Netherlands (2012) These presentations are based on our paper with the same title. |
Compounded Vulnerabilities in Social Institutions: Vulnerabilities as Kinds
Co-authored presentation with Elizabeth Victor Feminist Epistemologies, Methodologies, Metaphysics & Science Studies | Pennsylvania State Univ. (2012) Diotima Conference: A Graduate Conference for Feminist Philosophy | Univ. of Western Ontario (2011) Supplemental handout available here This presentation is based on our paper "Vulnerabilities Compounded by Social Institutions." |
Ethics Case Work-Up: Psychiatry
Sibley Hospital, Ethics Advisory Committee | Washington, DC (2012) Supplemental handout available here This was an invited lecture on capacity determinations among psychiatric populations. I discuss a case that was brought to Georgetown Hospital in which a patient refused medically indicated surgery and allegedly had Bipolar Disorder. Working through the moral dimensions of the case, I use the sliding scale framework to assess the patient's capacity (based on available facts given in her medical records) to make this refusal. |
Taking Responsibility for Complicity in Moral Wrongs
Thomas Jefferson High School for Science and Technology, EthicsAware Event | Alexandria, VA (2012) EthicsAware is a program created by a high school student to raise awareness about ethical issues and moral behavior. I was invited to discuss a topic within applied ethics and engage the students in a friendly debate. My presentation focused on the notion of complicity in the political and private spheres. If I buy clothing manufactured in a sweatshop, am I complicitous for financially supporting an unjust institution? If I stand by while a student is being bullied, am I responsible for my silence? |