Health Care Providers’ Experiences with Implementing Medical Aid-in-Dying in Vermont: a Qualitative Study

Mara Buchbinder, Elizabeth R. Brassfield, Manisha Mishra
Journal of General Internal Medicine

The legal landscape for medical aid-in-dying (AID) in theUSA has shifted dramatically over the past 5 years. Vermont(2013), California (2015), Colorado (2016), the District ofColumbia (2016), and Hawaii (2018) have joined Oregon(1997), Washington (2008), and Montana (2009) in permittingphysicians to … Continued

Advancing Ethics and Policy for Healthy‐Volunteer Research through a Model‐Organism Framework

Jill A. Fisher, Rebecca L. Walker
Ethics & Human Research

Nonhuman animal research and phase I healthy‐volunteer clinical trials are both critical components of testing the safety of investigational drugs as part of the development of new pharmaceuticals. In addition, these types of research share important structural features, as both … Continued

Beyond Our Beginnings: 50 Years of Bioethics

“Beyond Our Beginnings:  50 Years of Bioethics”. We are hosting it at the Mews location at the  Graylyn International Conference Center In recognition of the Hastings Center’s 50th anniversary, this conference surveys the past, present, and future of bioethics scholarship, … Continued

Basic Income, Cash Transfers, and Welfare State Paternalism

Douglas MacKay
The Journal of Political Philosophy

Much of the discussion concerning the permissibility of government paternalism has focused on laws and policies that either (1) ban or mandate the use or purchase of particular products;1 or (2) structure choice contexts to “nudge” people to make one … Continued

Journal of Pain and Symptom Management

Caregivers’ Experiences With Medical Aid-In-Dying in Vermont: A Qualitative Study

Mara Buchbinder, Enioluwafe Ojo, Laila Knio, Elizabeth R. Brassfield
Journal of Pain and Symptom Management

Context Eight jurisdictions in the U.S. currently permit medical aid-in-dying (AID), yet little is known about the direct experience of caregivers in supporting a loved one through the process. Objectives To explore the experiences of lay caregivers involved with AID … Continued

How Biomedical HIV Prevention Trials Incorporate Behavioral and Social Sciences Research: A Typology of Approaches

Amy Corneli, Karen Meagher, Gail Henderson, Holly Peay, Stuart Rennie
AIDS and Behavior

In the field of biomedical HIV prevention, researchers have meaningfully incorporated behavioral and social sciences research (BSSR) into numerous clinical trials, though the timing and degree of integration have been highly variable. The literature offers few frameworks that systematically characterize … Continued

Companion Animal Studies: Slipping Through a Research Oversight Gap

Rebecca L. Walker, Jill A. Fisher
The American Journal of Bioethics

In human subject research ethics, we appeal to principles of respect for persons, beneficence, and justice. In laboratory animal studies, the three Rs (reduce, refine, replace) are key touchstones, along with an overarching principle of promoting animal welfare—when consistent with … Continued

Responding to Requests for Aid-in-Dying: Rethinking the Role of Conscience

Elizabeth R. Brassfield, Manisha Mishra, Mara Buchbinder
Narrative Inquiry in Bioethics

This case study illustrates the complex role that a physician’s conscience can play in end-of-life care. We examine a case from Vermont in which a terminally ill patient requests aid-in-dying from her primary care physician under the state’s “Patient Choice … Continued

Choreographing Death: A Social Phenomenology of Medical Aid-in-dying in the United States

Mara Buchbinder
Medical Anthropology Quarterly

This article draws on ethnographic research on the implementation of Vermont’s 2013 medical aid-in-dying (AID) law to explore a fundamental paradox: While public discourse characterizes AID as a mechanism for achieving an individually controlled autonomous death, the medico–legal framework that … Continued

Sara Stathas for NPR

Anne Drapkin Lyerly interviewed by NPR

Rethinking Bed Rest For Pregnancy “The bottom line is that there’s never been any proven benefit of bed rest,” says Dr. Anne Drapkin Lyerly, an OB-GYN and professor of bioethics at the University of North Carolina at Chapel Hill. Lyerly … Continued

Is Enhancement the Price of Prevention in Human Gene Editing?

Eric T. Juengst, Gail E. Henderson, Rebecca L. Walker, John M. Conley, Karen M. Meagher, Katherine Saylor, Margaret Waltz, Kristine J. Kuczynski, R. Jean Cadigan
The CRISPR Journal

New gene-editing tools challenge conventional policy proscriptions of research aimed at either human germline gene editing or human enhancement by potentially lowering technical barriers to both kinds of intervention. Some recent gene-editing reports have begun to take up the prospect … Continued

The American Journal of Bioethics

Health Research Priority Setting: A Duty to Maximize Social Value?

Doug MacKay
The American Journal of Bioethics

Leah Pierson and Joseph Millum’s article “Health Research Priority Setting: The Duties of Individual Funders” (2018) tackles an important question that has not received the attention it deserves from bioethics scholars: How should funders of research set priorities among competing … Continued

Healthy volunteers’ perceptions of risk in US Phase I clinical trials: A mixed-methods study

Jill A. Fisher, Lisa McManus, Marci D. Cottingham, Julianne M. Kalbaugh, Megan M. Wood, Torin Monahan, Rebecca L. Walker
PLoS Medicine

There is limited research on healthy volunteers’ perceptions of the risks of Phase I clinical trials. In order to contribute empirically to long-standing ethical concerns about healthy volunteers’ involvement in drug development, it is crucial to assess how these participants … Continued

HEC Members participated in the 1st Annual UNC Story Slam

HEC Members Rimma Osipov, Sara Scarlet, and Gary Winzelberg participated in the 1st Annual UNC Story Slam. Story Slam began as a wellness event sponsored by the Annals of Internal Medicine at the annual meeting for the American College of Physicians. … Continued

MS4 clinical ethics student

MS4 Clinical Ethics Student Presentations

On October 16th our 4 students taking the Clinical Ethics MS4 Elective presented their final projects. These projects are intended to become resources for the HEC and reflect the students’ interests as they prepare for residency next year. The Presentation … Continued

Journal of Ethics & Social Philosophy

Immigrant Selection, Health Requirements, and Disability Discrimination

Doug MacKay
Journal of Ethics & Social Philosophy

Australia, Canada, and New Zealand currently apply health requirements to prospective immigrants, denying residency to those with health conditions that are likely to impose an “excessive demand” on their publicly funded health and social service programs. In this paper, I … Continued

AIDS Research and Human Retroviruses

Indirect Benefits in HIV Cure Clinical Research: A Qualitative Analysis.

Adam Gilbertson, Elizabeth Poole Kelly , Stuart Rennie, Gail Henderson, JoAnn Kuruc, Joseph D. Tucker
AIDS Research and Human Retroviruses

.Currently, much of early phase HIV cure research involves unknown and potentially serious risks, with little or no chance of direct health benefits. During informed consent, researchers emphasize this lack of personal medical benefit to minimize misconceptions that undermine genuine … Continued

Hastings center special report

Are Parents Really Obligated to Learn as Much as Possible about Their Children’s Genomes?

Josephine Johnston, Eric Juengst
Hastings Center Special Report

As new parents quickly learn, parenting always involves choosing your battles. Ideally, parents have the freedom to make those moral choices without the prejudice of an unreasonable or premature inflicted ought. Resolving the predictive uncertainties of genomic information is the … Continued

Ethics Consult Workshop June 2019

Registration for the workshop will open in early 2019.

CEDG and HEC Welcome Mark Baumgarten and Tyler Clay

Mark Baumgarten and Tyler Clay will join the Clinical Ethics Discussion Group as student leaders, and the Hospital Ethics Committee as student members, in January 2019. Center for Bioethics faculty members Arlene Davis and Eric Juengst are advisors to the student … Continued

Doug MacKay

Public Issues and Public Reason Conference selected Douglas MacKay as the Keynote Speaker

“Government Policy Experiments and the Ethics of Randomization” November 8–9, 2018 A Conference of Applied Ethics and Critical Social Sciences Carleton University Ottawa, Canada The Public Issues and Public Reason (PIPR) conference is a multidisciplinary conference at which graduate students from … Continued

Stakeholder engagement to inform HIV clinical trials: a systematic review of the evidence

Suzanne Day, Meredith Blumberg, Thi Vu, Yang Zhao, Stuart Rennie, Joseph D. Tucker
Journal of the International AIDS Society

Stakeholder engagement is an essential component of HIV clinical trials. We define stakeholder engagement as an input by individuals or groups with an interest in HIV clinical trials to inform the design or conduct of said trials. Despite its value, … Continued

“I think the parent should be there because no one was born alone”: Kenyan adolescents’ perspectives on parental involvement in HIV research

Allison K Groves, Denise D Hallfors, Bonita J Iritani, Stuart Rennie, Fredrick S Odongo, Daniel Kwaro, Nyaguara Amek, Winnie K Luseno
African Journal of AIDS Research
October, 2018

Despite a pressing need for adolescent HIV research in sub-Saharan Africa, ethical guidance for conducting research among minor adolescents is lacking. One ethical issue is the degree to which parents should be involved in the research process. The existing discourse … Continued

Disadvantaged, outnumbered, and discouraged: women’s experiences as healthy volunteers in U.S. Phase I trials

Nupur Jain, Marci D. Cottingham , Jill A. Fisher
Critical Public Health

While enormous strides have been made in the representation of women in clinical trials, the percentage of women enrolling in Phase I trials still remains low, which both raises public health concerns about the safety of new drugs and social … Continued

Healthy Volunteers’ Perceptions of the Benefits of Their Participation in Phase I Clinical Trials

Jill A. Fisher, Lisa McManus, Megan M. Wood, Marci D. Cottingham, Julianne M. Kalbaugh, Torin Monahan, Rebecca L. Walker
Journal of Empirical Research on Human Research Ethics

Other than the financial motivations for enrolling in Phase I trials, research on how healthy volunteers perceive the benefits of their trial participation is scant. Using qualitative interviews conducted with 178 U.S. healthy volunteers enrolled in Phase I trials, we … Continued

Pregnant women’s attitudes toward Zika virus vaccine trial participation

Ilona Telefus Goldfarb, Elana Jaffe, Kaitlyn James, Anne Drapkin Lyerly

As Zika virus infection during pregnancy can cause a range of congenital anomalies, pregnant women may be a target population for vaccination in future outbreaks. Their inclusion in vaccine trials is critical to ensure safe and effective vaccines in pregnancy. … Continued

Why Does the Shift from “Personalized Medicine” to “Precision Health” and “Wellness Genomics” Matter?

Eric T. Juengst, PhD, Michelle L. McGowan, PhD
AMA Journal of Ethics

Efforts to conceptualize the application of human genomics to health care have displayed an evolving set of translational research goals. Under personalized genomic medicine, the aim was to individualize treatment and empower patients to take more responsibility for their own … Continued

Rawlsian Justice and the Social Determinants of Health

Jayna Fishman, Douglas MacKay
Journal Applied Philosophy

In this article, we suggest that the evidence regarding the social determinants of health calls for a deep re‐thinking of our understanding of distributive justice. Focusing on John Rawls’s theory of distributive justice in particular, we argue that a full … Continued

Formation à la bioéthique en République Démocratique du Congo : expériences et défis

S. Rennie, L. Ravez, D. Makindu, A. Fox, B. Grauls, R. Yemesi, P. Kayembe, J. L. Chalachala, M. Kashamuka, F. Behets
Éthique & Santé

In regions marked by socio-economic turmoil, the task of teaching bioethics to health professionals and researchers can be more challenging than elsewhere. To demonstrate this, in this article we describe some of our teaching experiences in the Democratic Republic of … Continued

Medical Aid In Dying In Hawaii: Appropriate Safeguards Or Unmanageable Obstacles?

Mara Buchbinder, Thaddeus M. Pope
Health Affairs Blog

On April 5, 2018, Hawaii became the eighth jurisdiction in the United States to affirmatively authorize medical aid in dying (MAID). The Our Care, Our Choice Act (OCOCA), which takes effect on January 1, 2019, permits Hawaii physicians to write … Continued

Government Policy Experiments and Informed Consent

Douglas MacKay, Averi Chakrabarti
Public Health Ethics

Governments are increasingly making use of field experiments to evaluate policy interventions in the spheres of education, public health and welfare. However, the research ethics literature is largely focused on the clinical context, leaving investigators, institutional review boards and government … Continued

Women’s Views About a Paternal Consent Requirement for Biomedical Research in Pregnancy

Kristen A. Sullivan, Maggie Little, Nora E. Rosenberg, Tiwonge Mtande, Chifundo Zimba, Elana Jaffe, Jean Anderson, Jenell S. Coleman, Sappho Gilbert, Marielle S. Gross Wolf, Irving Hoffman, Lisa Rahangdale, Ruth Faden, Anne Drapkin Lyerly
Journal of Empirical Research on Human Research Ethics

Clinical research to inform the evidence base to guide nonobstetrical care during pregnancy is critically important for the well-being of women and their future offspring. Conversations about regulations for such research, including whether paternal consent should ever be required, should … Continued

Returning Incidental Findings in Low‐Resource Settings: A Case of Rescue?

Douglas Mackay
The Hastings Center Report

In a carefully argued article, Haley K. Sullivan and Benjamin E. Berkman address the important question of whether investigators have a duty to report incidental findings to research participants in low‐resource settings. They suggest that the duty to rescue offers … Continued

Returning negative results to individuals in a genomic screening program: lessons learned

Butterfield, Rita M., Evans, James P., Rini, Christine, Kuczynski, Kristine J., Waltz, Margaret, Cadigan, R. Jean, Goddard, Katrina A. B., Muessig, Kristin R., Henderson, Gail E.
Genetics in Medicine

In genomics, the return of negative screening results for rare, medically actionable conditions in large unselected populations with low prior risk of disease is novel and may involve important and nuanced concerns for communicating their meaning. Recruitment may result in … Continued

Virtue, Vice, and “Voracious” Science: How should we approach the ethics of primate research?

Rebecca L. Walker
Perspectives in Biology and Medicine,

Philosophical approaches to animal research have typically asked whether nonhuman animals have rights that would prohibit such research or whether the benefit of such research on the whole balances out the harms to animals. The professional ethics approach instead promotes … Continued

To report or not to report: Exploring healthy volunteers’ rationales for disclosing adverse events in Phase I drug trials

Lisa McManus, Jill A. Fisher
AJOB Empirical Bioethics

Background: Phase I trials test the safety and tolerability of investigational drugs and often use healthy volunteers as research participants. Adverse events (AEs) are collected in part through participants’ self-reports of any symptoms they experience during the trial. In some … Continued

Access to Aid-in-Dying in the United States: Shifting the Debate From Rights to Justice

Mara Buchbinder
American Journal of Public Health

Much of the literature on aid-in-dying (AID) has drawn heavily on rights-based ethical and legal frameworks that emphasize patients’ rights of self-determination in end-of-life decision-making. Less attention has focused on how terminally ill people actually experience such putative rights once … Continued

New Visiting Scholar:  Pablo Garcia Barranquero

The UNC Center for Bioethics would like to welcome our new Visiting Scholar from the University of Malaga, Pablo Garcia Barranquero. He will be with us from May 3 – July 31, 2018, working with Eric Juengst on conceptual issues in longevity … Continued

Captive to the Clinic: Phase I Clinical Trials as Temporal Total Institutions

Quintin Williams, Jill A. Fisher
Sociological Inquiry

This article develops the concept of temporal total institutions to describe how and why individuals voluntarily submit to highly controlled and often dehumanizing environments. We focus empirically on Phase I clinical trials, which offer compensation to healthy people in exchange … Continued

Navigating Ethics Review of Human Infection Trials With Zika

Franklin G. Miller, Anne Drapkin Lyerly
The Hastings Center

Human infection challenge studies, which deliberately expose healthy volunteers to disease-causing infectious agents under carefully controlled conditions, offer a valuable method of biomedical research aimed at efficient initial efficacy testing of vaccine candidates, among other possible uses. They can be … Continued

Grudging Trust and the Limits of Trustworthy Biorepository Curation

Karen M Meagher, Eric T Juengst, Gail E. Henderson
The American Journal of Bioethics

Kraft and colleagues (2018) present an analysis of focus groups assembled to provide guidance on governance practices for biorepository-based research initiatives like the National Institutes of Health (NIH) All of Us Research Program of the Precision Medicine Initiative. They emphasize respondents’ … Continued

Caring for the Wounded—the Ethics of Trauma Surgery

Sara Scarlet
AMA Journal of Ethics

In a fraction of a second, trauma changes us. Trauma injures organs, fractures bones, and makes us bleed, but it also leads to suffering, demoralization, and fear. While physical injuries can often be neatly classified, emotional and spiritual injuries cannot. … Continued

Lack of Information on Surgical Care for Incarcerated Persons


Sara Scarlet, Anthony A. Meyer, Elizabeth B. Dressen

With 2.2 million incarcerated people, the United States imprisons more people than any other country in the world.1 This mass incarceration is recent, arising from the war on drugs and punitive sentencing policies that began in the 1970s.1 Ethnic minorities … Continued

Bystander risk, social value, and ethics of human research

Contentious risks demand a new approach

S. K. Shah, J. Kimmelman, A. D. Lyerly, H. F. Lynch, F. G. Miller, R. Palacios, C. A. Pardo, C. Zorrilla
April, 2018

Two critical, recurring questions can arise in many areas of research with human subjects but are poorly addressed in much existing research regulation and ethics oversight: How should research risks to “bystanders” be addressed? And how should research be evaluated … Continued

Mara Buchbinder to present at Hettleman Lecture

Congratulation to  Mara Buchbinder on winning the UNC Hettleman prize! Please join us for Mara’s presentation of her Hettleman Lecture at 1:00pm on Tuesday, May 1st in the Tate Turner Kuralt auditorium, with reception following. We hope to see you there! Hettleman … Continued

Recrutement-engagement dans des essais cliniques en prévention Contextes, logiques sociales et médiations

Exceptional Risk: Healthy Volunteers’ Perceptions of HIV/AIDS Clinical Trials

Marci D. Cottingham, Julianne M. Kalbaugh, Teresa Swezey, Jill A. Fisher

Exceptional Risk: Healthy Volunteers’ Perceptions of HIV/AIDS Clinical Trials. As with all early-stage testing of investigational drugs, clinical trials targeting HIV/AIDS can pose unknown risks to research subjects. Unlike sick participants seeking a therapeutic benefit, the motivations and barriers for healthy volunteers … Continued

Harm Reduction Protocols for Early Abortion: A Middle Way?

Anne Drapkin Lyerly , Margaret Olivia Little
Obstetrics & Gynecology
April, 2018

Excerpt One late evening in the 1990s when I (Dr. Lyerly) was a resident, our gynecology team was called to evaluate a young woman in shock. According to her husband, she had not been herself for a couple of days, … Continued

Including All Voices in International Data-Sharing Governance

Jane Kaye, Sharon F. Terry, Eric Juengst, Sarah Coy, Jennifer R. Harris, Don Chalmers, Edward S. Dove, Isabelle Budin-Ljøsne, Clement Adebamowo, Emilomo Ogbe, Louise Bezuidenhout, Michael Morrison, Joel T. Minion, Madeleine J. Murtagh, Jusaku Minari, Harriet Teare, Rosario Isasi, Kazuto Kato, Emmanuelle Rial-Sebbag, Patricia Marshall, Barbara Koenig, Anne Cambon-Thomsen
Human Genomics
March 7, 2018

Governments, funding bodies, institutions, and publishers have developed a number of strategies to encourage researchers to facilitate access to datasets. The rationale behind this approach is that this will bring a number of benefits and enable advances in healthcare and … Continued

Disparate Compensation Policies for Research Related Injury in an Era of Multinational Trials

A Case Study of Brazil, Russia, India, China and South Africa

George Rugare Chingarande, Keymanthri Moodley
BMC Medical Ethics
February 17, 2018

Compensation for research related injuries is a subject that is increasingly gaining traction in developing countries which are burgeoning destinations of multi center research. However, the existence of disparate compensation rules violates the ethical principle of fairness. The current paper … Continued

Mara Buchbinder to speak at the National Academies of Medicine Workshop on Physician-Assisted Death

Physician-Assisted Death: Scanning the Landscape and Potential Approaches– A Workshop February 12–13, 2018 National Academy of Sciences Building 2101 Constitution Avenue NW, Washington, DC This National Academies of Sciences, Engineering, and Medicine workshop will explore the evidence base and research … Continued