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.

Papers:

“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.

Clinician Discretion, Opioid Treatment Agreements, and Health Disparities (with Adrienne Beck and Dana Howard) (under review)

The increasing use of opioid treatment agreements (OTAs) has prompted debate within the medical community about ethical challenges with respect to their implementation. The literature on this topic discusses concerns such as the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients, and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. However, few publications have explored the potential for racial bias in the current way that OTAs are incorporated into clinical practice and the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are incorporated into clinical practice and what mechanisms should be in place for drug testing, changes in prescription, termination of the patient-physician relationship, and contacting law enforcement. This paper uses the guidelines provided for OTA implementation by the state of Indiana as a case study in order to argue that giving physicians too much discretion is likely to exacerbate racial health disparities.

E-cigarettes and the Multiple Responsibilities of the FDA (with Dana Howard and Micah Berman) (under review)

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.