Some infants are in the NICU for a long time. Often, they experience many medical ups and downs. ... more Some infants are in the NICU for a long time. Often, they experience many medical ups and downs. These take an emotional toll on parents. Parents respond in different ways. Some get angry. Some get depressed. Marriages break up. Some parents stop visiting the NICU. If the infant eventually recovers, many of the problems go away. If the infant remains chronically ill, the emotional problems can be exacerbated by worries about the future. They can also be made worse if the parents and health professionals don't trust each other. In this ethics rounds, we present a case in which parents and doctors seem unsure of each other's values and motives.
Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with con... more Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with conversations about her treatment, was offered genetic testing for the BRCA1 and BRCA2 mutations. It was revealed that she carried a harmful BRCA1 mutation that is known to increase the lifetime risk of breast and ovarian cancer significantly. Once the results came back, her oncologist brought up the option of a prophylactic mastectomy and advised her to inform her living relatives of the results of the test. Mrs. Durham's primary care physician, Dr. Bartlett, expected she would do so, too. At her first appointment after the diagnosis, Dr. Bartlett asked Mrs. Durham how she was holding up and how her sister, Mrs. Weir-her only living family member and also one of Dr. Bartlett's patients-had taken the news. "Oh. Well, I haven't told her." "Are you going to?" asked Dr. Bartlett. Mrs. Durham responded, "You know we haven't spoken in quite some time, and I can't imagine making this the topic of our first conversation." "Yes, I know…but I think this is important information that may affect her health." Mrs. Durham sighed. "We're estranged, for one thing, and for another, I want to keep my cancer private. I don't want people knowing I'm sick and pitying me." Dr. Bartlett felt pulled in two directions-his obligation to respect Mrs. Durham's wishes and protect her privacy conflicted with his obligation to promote Mrs. Weir's health. BRCA1 mutations are not "reportable" illnesses like HIV and tuberculosis, so he was not compelled by law to break Mrs. Durham's confidentiality. Dr. Bartlett considered how he might be able to encourage Mrs. Durham's sister to be tested for the BRCA mutations while preserving Mrs. Durham's confidentiality.
Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with con... more Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with conversations about her treatment, was offered genetic testing for the BRCA1 and BRCA2 mutations. It was revealed that she carried a harmful BRCA1 mutation that is known to increase the lifetime risk of breast and ovarian cancer significantly. Once the results came back, her oncologist brought up the option of a prophylactic mastectomy and advised her to inform her living relatives of the results of the test. Mrs. Durham's primary care physician, Dr. Bartlett, expected she would do so, too. At her first appointment after the diagnosis, Dr. Bartlett asked Mrs. Durham how she was holding up and how her sister, Mrs. Weir-her only living family member and also one of Dr. Bartlett's patients-had taken the news. "Oh. Well, I haven't told her." "Are you going to?" asked Dr. Bartlett. Mrs. Durham responded, "You know we haven't spoken in quite some time, and I can't imagine making this the topic of our first conversation." "Yes, I know…but I think this is important information that may affect her health." Mrs. Durham sighed. "We're estranged, for one thing, and for another, I want to keep my cancer private. I don't want people knowing I'm sick and pitying me." Dr. Bartlett felt pulled in two directions-his obligation to respect Mrs. Durham's wishes and protect her privacy conflicted with his obligation to promote Mrs. Weir's health. BRCA1 mutations are not "reportable" illnesses like HIV and tuberculosis, so he was not compelled by law to break Mrs. Durham's confidentiality. Dr. Bartlett considered how he might be able to encourage Mrs. Durham's sister to be tested for the BRCA mutations while preserving Mrs. Durham's confidentiality.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2021
This issue of The Journal of Medicine and Philosophy is dedicated to topics in clinical ethics wi... more This issue of The Journal of Medicine and Philosophy is dedicated to topics in clinical ethics with essays addressing clinician participation in state sponsored execution, duties to decrease ecological footprints in medicine, the concept of caring and its relationship to conscientious refusal, the dilemmas involved in dual use research, a philosophical and practical critique of principlism, conundrums that arise when applying surrogate decision-making models to patients with moderate intellectual disabilities, the phenomenology of chronic disease, and ethical concerns surrounding the use of artificial intelligence in medicine. Throughout the issue, the themes of conceptual and moral boundaries in bioethics, critiques of current clinical ethics paradigms, and the importance of transparency are prominent.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine
Often lurking below the surface of many clinical ethical issues are questions regarding backgroun... more Often lurking below the surface of many clinical ethical issues are questions regarding background metaphysical, epistemological, meta-ethical, and political beliefs. In this issue, authors critically examine the effects of background beliefs on conscientious objection, explore ethical issues through the lenses of particular theoretical approaches like pragmatism and intersectional theory, rigorously explore the basic concepts at play within the patient safety movement, offer new theoretical approaches to old problems involving decision making for patients with dementia, explicate and explore the problems and promises of machine learning in medicine, and offer us a non-rights-based argument for the just distribution of healthcare resources.
We are pleased to resubmit a revised version of our manuscript entitled "Pain as a Global Public ... more We are pleased to resubmit a revised version of our manuscript entitled "Pain as a Global Public Health Priority." We found the Reviewers' suggestions inordinately helpful, and have endeavored to incorporate them into the revised manuscript. Pursuant to the author instructions for revision and resubmission, we have included in this cover letter a point-by-point response to the Reviewers' concerns. Please do not hesitate to contact us if we may be of any assistance during this stage of the review process.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2021
Head transplantation fits within the broader conceptual space occupied by transhumanists and othe... more Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstances, and in what ways human immortality would be good. In this paper, I disambiguate the ways in which immortality might be considered a human good and then argue that immortality is neither necessary nor sufficient condition for objective meaning in life. I also argue that mortality is not a necessary condition for objective meaning in life.
Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with con... more Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with conversations about her treatment, was offered genetic testing for the BRCA1 and BRCA2 mutations. It was revealed that she carried a harmful BRCA1 mutation that is known to increase the lifetime risk of breast and ovarian cancer significantly. Once the results came back, her oncologist brought up the option of a prophylactic mastectomy and advised her to inform her living relatives of the results of the test. Mrs. Durham's primary care physician, Dr. Bartlett, expected she would do so, too. At her first appointment after the diagnosis, Dr. Bartlett asked Mrs. Durham how she was holding up and how her sister, Mrs. Weir-her only living family member and also one of Dr. Bartlett's patients-had taken the news. "Oh. Well, I haven't told her." "Are you going to?" asked Dr. Bartlett. Mrs. Durham responded, "You know we haven't spoken in quite some time, and I can't imagine making this the topic of our first conversation." "Yes, I know…but I think this is important information that may affect her health." Mrs. Durham sighed. "We're estranged, for one thing, and for another, I want to keep my cancer private. I don't want people knowing I'm sick and pitying me." Dr. Bartlett felt pulled in two directions-his obligation to respect Mrs. Durham's wishes and protect her privacy conflicted with his obligation to promote Mrs. Weir's health. BRCA1 mutations are not "reportable" illnesses like HIV and tuberculosis, so he was not compelled by law to break Mrs. Durham's confidentiality. Dr. Bartlett considered how he might be able to encourage Mrs. Durham's sister to be tested for the BRCA mutations while preserving Mrs. Durham's confidentiality.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2021
Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult eth... more Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult ethical question faced by clinicians, patients, and families. In this issue of The Journal of Medicine and Philosophy devoted to issues in clinical ethics, the authors engage in this enterprise by reflecting on morally good medical decision making, conscientious objection, presumed consent in organ donation, the permissibility of surrogate decision making, and the failure of legislative limits on the scope of euthanasia in Belgium.
A clinical ethics consultant (CEC) may, at times, be called upon to make independent substantive ... more A clinical ethics consultant (CEC) may, at times, be called upon to make independent substantive moral judgments and then offer justifications for those judgments. A CEC does not act unprofessionally by utilizing background beliefs that are religious in nature to justify those judgments. It is important, however, for a CEC to make such judgments authentically and, when asked, to offer up one’s reasons for why one believes the judgment is true in a transparent fashion.
Religions often operate as comprehensive worldviews, attempting to answer the deepest existential... more Religions often operate as comprehensive worldviews, attempting to answer the deepest existential questions that human beings can ask: Who am I? Where do I come from? Where am I going after I die? How should I live? Often ethical systems are embedded and justified within these broader narratives. Inevitably, the clinical ethics consultant will encounter and engage with religiously based ethical systems. In this issue, the authors reflect seriously and deeply on the implications of such engagement.
In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the b... more In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God’s-eye perspective. In this paper, I focus on the implications of Engelhardt’s views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants (CECs) should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt’s views for this question. Finally, I discuss some of Engelhardt’s foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation.
... Brody emphasizes a different sense of integrityfidelity to values. In particular, Brody is i... more ... Brody emphasizes a different sense of integrityfidelity to values. In particular, Brody is interested in fidelity to personal values. ... In this section, I will analyze two important objections to Brody's account of integrity. Brody argues that fidelity to core personal values is virtuous. ...
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, Jan 18, 2015
The central claim of this paper is that American states' use of so-called "triggering co... more The central claim of this paper is that American states' use of so-called "triggering conditions" to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate deci...
Recent debates have led some to question the legitimacy of physicians refusing to provide legally... more Recent debates have led some to question the legitimacy of physicians refusing to provide legally permissible services for reasons of conscience. In this paper, I will explore the question of whether medical professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all medical services. I will argue that they do not. I will also argue for an approach to dealing with intractable moral disagreements between patients and physicians that gives both parties veto power with regards to participation. Finally, I will respond to three objections to allowing physicians broad freedom to act on their consciences: such allowances would violate the conscience of the patient, would lead to unfairness, and would thwart important societal goals.
In poorly designed pay-for-performance schemes in which case mix adjustments are not adequate, se... more In poorly designed pay-for-performance schemes in which case mix adjustments are not adequate, self-interest could lead nephrologists toward cherry picking dialysis patients. Cherry picking, however, is morally problematic. First, it may manifest itself as a subtle form of covert rationing which threatens to undermine patient trust. Second, it involves shifting the burden of caring for sicker (and less financially attractive) patients to other nephrologists and dialysis units that do not practice cherry picking, creating injustices in the health care system. Finally, it treats patients as mere means through which nephrologists achieve reimbursement instead of as persons possessing dignity and deserving of respect.
Some infants are in the NICU for a long time. Often, they experience many medical ups and downs. ... more Some infants are in the NICU for a long time. Often, they experience many medical ups and downs. These take an emotional toll on parents. Parents respond in different ways. Some get angry. Some get depressed. Marriages break up. Some parents stop visiting the NICU. If the infant eventually recovers, many of the problems go away. If the infant remains chronically ill, the emotional problems can be exacerbated by worries about the future. They can also be made worse if the parents and health professionals don't trust each other. In this ethics rounds, we present a case in which parents and doctors seem unsure of each other's values and motives.
Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with con... more Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with conversations about her treatment, was offered genetic testing for the BRCA1 and BRCA2 mutations. It was revealed that she carried a harmful BRCA1 mutation that is known to increase the lifetime risk of breast and ovarian cancer significantly. Once the results came back, her oncologist brought up the option of a prophylactic mastectomy and advised her to inform her living relatives of the results of the test. Mrs. Durham's primary care physician, Dr. Bartlett, expected she would do so, too. At her first appointment after the diagnosis, Dr. Bartlett asked Mrs. Durham how she was holding up and how her sister, Mrs. Weir-her only living family member and also one of Dr. Bartlett's patients-had taken the news. "Oh. Well, I haven't told her." "Are you going to?" asked Dr. Bartlett. Mrs. Durham responded, "You know we haven't spoken in quite some time, and I can't imagine making this the topic of our first conversation." "Yes, I know…but I think this is important information that may affect her health." Mrs. Durham sighed. "We're estranged, for one thing, and for another, I want to keep my cancer private. I don't want people knowing I'm sick and pitying me." Dr. Bartlett felt pulled in two directions-his obligation to respect Mrs. Durham's wishes and protect her privacy conflicted with his obligation to promote Mrs. Weir's health. BRCA1 mutations are not "reportable" illnesses like HIV and tuberculosis, so he was not compelled by law to break Mrs. Durham's confidentiality. Dr. Bartlett considered how he might be able to encourage Mrs. Durham's sister to be tested for the BRCA mutations while preserving Mrs. Durham's confidentiality.
Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with con... more Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with conversations about her treatment, was offered genetic testing for the BRCA1 and BRCA2 mutations. It was revealed that she carried a harmful BRCA1 mutation that is known to increase the lifetime risk of breast and ovarian cancer significantly. Once the results came back, her oncologist brought up the option of a prophylactic mastectomy and advised her to inform her living relatives of the results of the test. Mrs. Durham's primary care physician, Dr. Bartlett, expected she would do so, too. At her first appointment after the diagnosis, Dr. Bartlett asked Mrs. Durham how she was holding up and how her sister, Mrs. Weir-her only living family member and also one of Dr. Bartlett's patients-had taken the news. "Oh. Well, I haven't told her." "Are you going to?" asked Dr. Bartlett. Mrs. Durham responded, "You know we haven't spoken in quite some time, and I can't imagine making this the topic of our first conversation." "Yes, I know…but I think this is important information that may affect her health." Mrs. Durham sighed. "We're estranged, for one thing, and for another, I want to keep my cancer private. I don't want people knowing I'm sick and pitying me." Dr. Bartlett felt pulled in two directions-his obligation to respect Mrs. Durham's wishes and protect her privacy conflicted with his obligation to promote Mrs. Weir's health. BRCA1 mutations are not "reportable" illnesses like HIV and tuberculosis, so he was not compelled by law to break Mrs. Durham's confidentiality. Dr. Bartlett considered how he might be able to encourage Mrs. Durham's sister to be tested for the BRCA mutations while preserving Mrs. Durham's confidentiality.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2021
This issue of The Journal of Medicine and Philosophy is dedicated to topics in clinical ethics wi... more This issue of The Journal of Medicine and Philosophy is dedicated to topics in clinical ethics with essays addressing clinician participation in state sponsored execution, duties to decrease ecological footprints in medicine, the concept of caring and its relationship to conscientious refusal, the dilemmas involved in dual use research, a philosophical and practical critique of principlism, conundrums that arise when applying surrogate decision-making models to patients with moderate intellectual disabilities, the phenomenology of chronic disease, and ethical concerns surrounding the use of artificial intelligence in medicine. Throughout the issue, the themes of conceptual and moral boundaries in bioethics, critiques of current clinical ethics paradigms, and the importance of transparency are prominent.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine
Often lurking below the surface of many clinical ethical issues are questions regarding backgroun... more Often lurking below the surface of many clinical ethical issues are questions regarding background metaphysical, epistemological, meta-ethical, and political beliefs. In this issue, authors critically examine the effects of background beliefs on conscientious objection, explore ethical issues through the lenses of particular theoretical approaches like pragmatism and intersectional theory, rigorously explore the basic concepts at play within the patient safety movement, offer new theoretical approaches to old problems involving decision making for patients with dementia, explicate and explore the problems and promises of machine learning in medicine, and offer us a non-rights-based argument for the just distribution of healthcare resources.
We are pleased to resubmit a revised version of our manuscript entitled "Pain as a Global Public ... more We are pleased to resubmit a revised version of our manuscript entitled "Pain as a Global Public Health Priority." We found the Reviewers' suggestions inordinately helpful, and have endeavored to incorporate them into the revised manuscript. Pursuant to the author instructions for revision and resubmission, we have included in this cover letter a point-by-point response to the Reviewers' concerns. Please do not hesitate to contact us if we may be of any assistance during this stage of the review process.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2021
Head transplantation fits within the broader conceptual space occupied by transhumanists and othe... more Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstances, and in what ways human immortality would be good. In this paper, I disambiguate the ways in which immortality might be considered a human good and then argue that immortality is neither necessary nor sufficient condition for objective meaning in life. I also argue that mortality is not a necessary condition for objective meaning in life.
Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with con... more Mrs. Durham was diagnosed with an invasive epithelial ovarian cancer and, in conjunction with conversations about her treatment, was offered genetic testing for the BRCA1 and BRCA2 mutations. It was revealed that she carried a harmful BRCA1 mutation that is known to increase the lifetime risk of breast and ovarian cancer significantly. Once the results came back, her oncologist brought up the option of a prophylactic mastectomy and advised her to inform her living relatives of the results of the test. Mrs. Durham's primary care physician, Dr. Bartlett, expected she would do so, too. At her first appointment after the diagnosis, Dr. Bartlett asked Mrs. Durham how she was holding up and how her sister, Mrs. Weir-her only living family member and also one of Dr. Bartlett's patients-had taken the news. "Oh. Well, I haven't told her." "Are you going to?" asked Dr. Bartlett. Mrs. Durham responded, "You know we haven't spoken in quite some time, and I can't imagine making this the topic of our first conversation." "Yes, I know…but I think this is important information that may affect her health." Mrs. Durham sighed. "We're estranged, for one thing, and for another, I want to keep my cancer private. I don't want people knowing I'm sick and pitying me." Dr. Bartlett felt pulled in two directions-his obligation to respect Mrs. Durham's wishes and protect her privacy conflicted with his obligation to promote Mrs. Weir's health. BRCA1 mutations are not "reportable" illnesses like HIV and tuberculosis, so he was not compelled by law to break Mrs. Durham's confidentiality. Dr. Bartlett considered how he might be able to encourage Mrs. Durham's sister to be tested for the BRCA mutations while preserving Mrs. Durham's confidentiality.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2021
Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult eth... more Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult ethical question faced by clinicians, patients, and families. In this issue of The Journal of Medicine and Philosophy devoted to issues in clinical ethics, the authors engage in this enterprise by reflecting on morally good medical decision making, conscientious objection, presumed consent in organ donation, the permissibility of surrogate decision making, and the failure of legislative limits on the scope of euthanasia in Belgium.
A clinical ethics consultant (CEC) may, at times, be called upon to make independent substantive ... more A clinical ethics consultant (CEC) may, at times, be called upon to make independent substantive moral judgments and then offer justifications for those judgments. A CEC does not act unprofessionally by utilizing background beliefs that are religious in nature to justify those judgments. It is important, however, for a CEC to make such judgments authentically and, when asked, to offer up one’s reasons for why one believes the judgment is true in a transparent fashion.
Religions often operate as comprehensive worldviews, attempting to answer the deepest existential... more Religions often operate as comprehensive worldviews, attempting to answer the deepest existential questions that human beings can ask: Who am I? Where do I come from? Where am I going after I die? How should I live? Often ethical systems are embedded and justified within these broader narratives. Inevitably, the clinical ethics consultant will encounter and engage with religiously based ethical systems. In this issue, the authors reflect seriously and deeply on the implications of such engagement.
In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the b... more In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God’s-eye perspective. In this paper, I focus on the implications of Engelhardt’s views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants (CECs) should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt’s views for this question. Finally, I discuss some of Engelhardt’s foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation.
... Brody emphasizes a different sense of integrityfidelity to values. In particular, Brody is i... more ... Brody emphasizes a different sense of integrityfidelity to values. In particular, Brody is interested in fidelity to personal values. ... In this section, I will analyze two important objections to Brody's account of integrity. Brody argues that fidelity to core personal values is virtuous. ...
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, Jan 18, 2015
The central claim of this paper is that American states' use of so-called "triggering co... more The central claim of this paper is that American states' use of so-called "triggering conditions" to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate deci...
Recent debates have led some to question the legitimacy of physicians refusing to provide legally... more Recent debates have led some to question the legitimacy of physicians refusing to provide legally permissible services for reasons of conscience. In this paper, I will explore the question of whether medical professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all medical services. I will argue that they do not. I will also argue for an approach to dealing with intractable moral disagreements between patients and physicians that gives both parties veto power with regards to participation. Finally, I will respond to three objections to allowing physicians broad freedom to act on their consciences: such allowances would violate the conscience of the patient, would lead to unfairness, and would thwart important societal goals.
In poorly designed pay-for-performance schemes in which case mix adjustments are not adequate, se... more In poorly designed pay-for-performance schemes in which case mix adjustments are not adequate, self-interest could lead nephrologists toward cherry picking dialysis patients. Cherry picking, however, is morally problematic. First, it may manifest itself as a subtle form of covert rationing which threatens to undermine patient trust. Second, it involves shifting the burden of caring for sicker (and less financially attractive) patients to other nephrologists and dialysis units that do not practice cherry picking, creating injustices in the health care system. Finally, it treats patients as mere means through which nephrologists achieve reimbursement instead of as persons possessing dignity and deserving of respect.
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Papers by Clint Parker