26 found
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  1. Prioritizing Parental Liberty in Non-medical Vaccine Exemption Policies: A Response to Giubilini, Douglas and Savulescu.Mark Christopher Navin & Mark Aaron Largent - 2017 - Public Health Ethics 10 (3).
    In a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Giubilini, Douglas and Savulescu give insufficient (...)
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  2.  17
    Three Kinds of Decision-Making Capacity for Refusing Medical Interventions.Mark Christopher Navin, Abram L. Brummett & Jason Adam Wasserman - 2021 - American Journal of Bioethics 22 (11):73-83.
    According to a standard account of patient decision-making capacity, patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical c...
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  3.  14
    Capacity for Preferences: Respecting Patients with Compromised Decision‐Making.Jason Adam Wasserman & Mark Christopher Navin - 2018 - Hastings Center Report 48 (3):31-39.
    When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient’s best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional (...)
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  4.  20
    Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices.Heidi Malm & Mark Christopher Navin - 2020 - American Journal of Bioethics 20 (9):45-57.
    Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person’s ability to keep VZV suppressed can be ‘boosted’ through exposure to active chickenpox infections. (...)
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  5.  12
    Reasons to Amplify the Role of Parental Permission in Pediatric Treatment.Mark Christopher Navin & Jason Adam Wasserman - 2017 - American Journal of Bioethics 17 (11):6-14.
    Two new documents from the Committee on Bioethics of the American Academy of Pediatrics expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the importance of informed and (...)
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  6.  10
    Capacity for Preferences and Pediatric Assent: Implications for Pediatric Practice.Mark Christopher Navin & Jason Adam Wasserman - 2019 - Hastings Center Report 49 (1):43-51.
    Children’s preferences about medical treatment—like the preferences of other patients—hold moral weight in decision-making that is independent of considerations of autonomy or best interests. In light of this understanding of the moral value of patient preferences, the American Academy of Pediatrics could strengthen the ethical foundation for its formal guidance on pediatric assent.
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  7.  9
    It’s Worth What You Can Sell It for: A Survey of Employment and Compensation Models for Clinical Ethicists.Jason Adam Wasserman, Abram Brummett & Mark Christopher Navin - forthcoming - HEC Forum:1-16.
    This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized salary of respondents with a clinical doctorate is $188,310.08 (SD=$88,556.67), $146,134.85 (SD=$55,485.63) for those with a non-clinical doctorate, and $113,625.00 (SD=$35,872.96) for those with a masters as (...)
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  8.  8
    Cooptation or solidarity: food sovereignty in the developed world.Mark Christopher Navin & J. M. Dieterle - 2018 - Agriculture and Human Values 35 (2):319-329.
    This paper builds on previous research about the potential downsides of food sovereignty activism in relatively wealthy societies by developing a three-part taxonomy of harms that may arise in such contexts. These are direct opposition, false equivalence, and diluted goals and methods. While this paper provides reasons to resist complacency about wealthy-world food sovereignty, we are optimistic about the potential for food sovereignty in wealthy societies, and we conclude by describing how wealthy-world food sovereignty can be a location of either (...)
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  9.  7
    Harm and Parental Permission: A Response to Our Critics.Mark Christopher Navin & Jason Adam Wasserman - 2017 - American Journal of Bioethics 17 (11):W1-W4.
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  10.  17
    The Irrelevance of Origins: Dementia, Advance Directives, and the Capacity for Preferences.Jason Adam Wasserman & Mark Christopher Navin - 2020 - American Journal of Bioethics 20 (8):98-100.
    We agree with Emily Walsh (2020) that the current preferences of patients with dementia should sometimes supersede those patients’ advance directives. We also agree that consensus clinical ethics guidance does a poor job of explaining the moral value of such patients’ preferences. Furthermore, Walsh correctly notes that clinicians are often averse to treating patients with dementia over their objections, and that this aversion reflects clinical wisdom that can inform revisions to clinical ethics guidance. But Walsh’s account of the moral value (...)
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  11.  19
    Conscientious Objection to Aggressive Interventions for Patients in a Vegetative State.Jason Adam Wasserman, Abram L. Brummett, Mark Christopher Navin & Daniel Londyn Menkes - forthcoming - American Journal of Bioethics:1-12.
    Some physicians refuse to perform life-sustaining interventions, such as tracheostomy, on patients who are very likely to remain permanently unconscious. To explain their refusal, these clinicians often invoke the language of “futility”, but this can be inaccurate and can mask problematic forms of clinical power. This paper explores whether such refusals should instead be framed as conscientious objections. We contend that the refusal to provide interventions for patients very likely to remain permanently unconscious meets widely recognized ethical standards for the (...)
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  12.  15
    Considering Whether the Dismissal of Vaccine-Refusing Families Is Fair to Other Clinicians.Michael J. Deem, Mark Christopher Navin & John D. Lantos - 2018 - JAMA Pediatrics 172 (6):515-516.
    A recent American Academy of Pediatrics (AAP) clinical report states that it is an acceptable option for pediatric care clinicians to dismiss families who refuse vaccines. This is a clear shift in guidance from the AAP, which previously advised clinicians to “endeavor not to discharge” patients solely because of parental vaccine refusal. While this new policy might be interpreted as encouraging or recommending dismissal of vaccine-refusing families, it instead expresses tolerance for diverse professional approaches. This is unlike the earlier guidance, (...)
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  13.  81
    Reasons to Accept Vaccine Refusers in Primary Care.Mark Christopher Navin, Jason Adam Wasserman & Douglas Opel - 2020 - Pediatrics 146 (6):e20201801.
    Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal.
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  14.  6
    Limits on Parental Discretion in Medical Decision-Making: pediatric intervention principles converge.Mark Christopher Navin, Jason Adam Wasserman, Douglas S. Diekema & Thaddeus M. Pope - 2024 - Perspectives in Biology and Medicine 67 (2):277-289.
    Pediatric intervention principles help clinicians and health-care institutions determine appropriate responses when parents’ medical decisions place children at risk. Several intervention principles have been proposed and defended in the pediatric ethics literature. These principles may appear to provide conflicting guidance, but much of that conflict is superficial. First, seemingly different pediatric intervention principles sometimes converge on the same guidance. Second, these principles often aim to solve different problems in pediatrics or to operate in different background conditions. The potential for convergence (...)
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  15.  10
    Capacities to Refuse Treatment: A Reply.Mark Christopher Navin, Abram Brummett & Jason Adam Wasserman - 2023 - American Journal of Bioethics 24 (3):15-19.
    The three of us work as academics and clinical ethicists. In our clinical ethics work, we often encounter patients who lack decision-making capacity, but who nonetheless have strong preferences abo...
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  16.  7
    Ethics of age de-escalation in pediatric vaccine trials.Ami Harbin, Naomi Laventhal & Mark Christopher Navin - forthcoming - Vaccine.
    In the development of new vaccines, many trials use age de-escalation: after establishing safety and efficacy in adult populations, progressively younger cohorts are enrolled and studied. Age de-escalation promotes many values. The responsibility to protect children from potential risks of experimental vaccines is significant, not only given increased risks of adverse effects but also because parents and medical professionals have a moral responsibility to protect children from harms associated with novel, uncertain interventions. Further, given that young children cannot provide informed (...)
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  17. Childhood Vaccination Mandates: Scope, Sanctions, Severity, Selectivity, and Salience.Katie Attwell & Mark Christopher Navin - 2019 - Milbank Quarterly 97 (4):978–1014.
    Context In response to outbreaks of vaccine‐preventable disease and increasing rates of vaccine refusal, some political communities have recently implemented coercive childhood immunization programs, or they have made existing childhood immunization programs more coercive. Many other political communities possess coercive vaccination policies, and others are considering developing them. Scholars and policymakers generally refer to coercive immunization policies as “vaccine mandates.” However, mandatory vaccination is not a unitary concept. Rather, coercive childhood immunization policies are complex, context‐specific instruments. Their legally and morally (...)
     
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  18.  5
    How policymakers employ ethical frames to design and introduce new policies: the case of childhood vaccine mandates in Australia.Katie Attwell & Mark Christopher Navin - 2022 - Policy and Politics 50 (4):526-547.
    Australian states exclude unvaccinated children from early education and care via ‘No Jab No Play’ policies, but some offer exemptions for the socially disadvantaged. Such mandatory vaccination policies provoke heated arguments about morality and potential downstream impacts, and the politics of which kinds of people get exempted from mandates are often fraught. Synthesising existing frameworks for considering the role of moral principles and rational-technical justifications in policymaking, we show how the same values can be the focus of both ‘rational-instrumental’ and (...)
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  19.  5
    Healthcare Ethics Consultation as Public Philosophy.Lisa Fuller & Mark Christopher Navin - 2022 - In Lee C. McIntyre, Nancy Arden McHugh & Ian Olasov (eds.), A companion to public philosophy. Hoboken, NJ: Wiley-Blackwell. pp. 371–380.
    Healthcare ethics consultation is therefore one of the most consequential, institutionally accepted, and widespread forms of public philosophy in the United States. In this chapter, the authors begin with an overview of the development of healthcare ethics and its emergence as a concrete practice embedded in healthcare settings. They then describe the core ethical principles that inform the everyday practice of ethics consultations and the generally accepted steps involved in conducting a consultation. The authors discuss the role of clinical ethicists (...)
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  20.  16
    Harming Children to Benefit Others: A Reply.Heidi Malm & Mark Christopher Navin - 2020 - American Journal of Bioethics 20 (12):W1-W6.
    We are pleased to have received such a varied set of commentaries on our target article, “Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices,” and we are thankful for the opportunity to respond to some of them here. We regret that space limitations preclude us from responding to each. In what follows we will begin by addressing commentaries that expand the application of our arguments. We will then correct some seeming misunderstandings about our distinctions, arguments and thesis. We (...)
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  21.  9
    School staff as vaccine advocates: Perspectives on vaccine mandates and the student registration process.Mark Christopher Navin, Aaron Scherer, Ethan Bradley & Katie Attwell - 2023 - Vaccine 41 (5):1169-1175.
    Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online survey to assess Michigan public-school employees (...)
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  22.  8
    Pediatric Assent and Treating Children Over Objection.Jason Wasserman, Mark Christopher Navin & John Vercler - 2019 - Pediatrics 144 (5):e20190382.
    More than 20 years ago, the pioneering pediatric ethicist William Bartholome wrote a fiery letter to the editor of this journal because he thought a recently published statement on pediatric assent, from the Committee on Bioethics of the American Academy of Pediatrics (AAP), showed insufficient respect for children. That AAP statement, like its 2016 update, asserts that pediatric assent should be solicited only when a child’s dissent will be honored. Bartholome objected that pediatricians should always solicit children’s assent and that (...)
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  23.  12
    Practising what we preach: clinical ethicists’ professional perspectives and personal use of advance directives.Jason Adam Wasserman, Mark Christopher Navin, Victoria Drzyzga & Tyler S. Gibb - 2022 - Journal of Medical Ethics 48 (2):144-149.
    The field of clinical bioethics strongly advocates for the use of advance directives to promote patient autonomy, particularly at the end of life. This paper reports a study of clinical bioethicists’ perceptions of the professional consensus about advance directives, as well as their personal advance care planning practices. We find that clinical bioethicists are often sceptical about the value of advance directives, and their personal choices about advance directives often deviate from what clinical ethicists acknowledge to be their profession’s recommendations. (...)
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  24.  15
    Guidance and Intervention Principles in Pediatrics: The Need for Pluralism.Mark Christopher Navin & Jason Wasserman - 2019 - Journal of Clinical Ethics 30 (3):201-6.
    Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians’ and parents’ decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child’s basic needs or primary goods, and (...)
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  25.  25
    Dismissal Policies for Vaccine Refusal -- A Reply.Michael J. Deem, Mark Christopher Navin & John D. Lantos - 2018 - JAMA Pediatrics 172 (11):1101-1102.
    Marshall and O’Leary’s thoughtful response to our article suggests that dismissal policies are ethically justifiable because they might induce parents to immunize their children. This outcome is conceivable, but we have only anecdotes about how often it occurs. Such evidence became the thin reed on which the American Academy of Pediatrics rested its new policy of tolerating the practice of dismissing vaccine-hesitant parents. It seems likely that relatively few parents would agree to vaccinate because they were threatened with dismissal. Other (...)
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  26. Perspectives of Public Health Nurses on the Ethics of Mandated Vaccine Education.Mark Christopher Navin, Andrea T. Kozak & Michael J. Deem - 2020 - Nursing Outlook 68 (1):62-72.
    Background Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. -/- Purpose To attend to the activity and dispositions of the public health staff who provide “waiver education”. -/- Method This study reports results of focus group interviews (...)
     
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