Research: Bioethics

My work in bioethics is focused on the treatment and regulation of addiction, and is informed by my broader views on responsibility. In particular, I am engaged in research on the practice of using opioid treatment agreements, on e-cigarette regulation, and on the ethics of harm reduction.

“Opioid Treatment Agreements and Patient Accountability,” forthcoming, Hastings Center Report

Opioid treatment agreements are written agreements between physicians and patients enumerating the risks associated with opioid medications along with the requirements that patients must meet to receive these medications on an ongoing basis. The choice to use such agreements goes beyond the standard informed consent process, and has a distinctive symbolic significance.  Specifically, it suggests that physicians regard it as important to hold their patients accountable for adhering to various protocols regarding the use of their opioid medications. After laying out a taxonomy of accountability relationships between physicians and patients, I argue that opioid treatment agreements are only justifiable for physicians to use in their provision of care if they improve public health outcomes, which has yet to be demonstrated.

E-cigarettes and the Epistemic Responsibilities of the FDA (with Dana Howard and Micah Berman) (available upon request)

This paper considers the responsibilities of the FDA with regard to evidence about the benefits and harms of e-cigarettes.  Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public the differential risks of e-cigarettes and combustible cigarettes.  We argue, by contrast, that the FDA’s obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountable for informing the public about the health risks and benefits of products it regulates, it also has other roles (and attendant responsibilities) that inform when and how it should disseminate information.  In addition to being a knowledge purveyor, it is also a knowledge producer, an advisor to the public, and a practical agent shaping the material conditions in which people make health-related choices.  In our view, those other roles call for caution in the way the FDA interprets and communicates the available evidence.