Jacob M Appel

Mount Sinai Medical Center, New York City, New York, United States

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Publications (13)13.37 Total impact

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    ABSTRACT: Successful formulation and implementation of end-of-life care requires ongoing communication with the patient. When patients, for reasons of general medical or psychiatric illness, fail to verbally communicate, providers must be receptive to messages conveyed through alternate avenues of communication. We present the narrative of a man with schizophrenia who wished to forgo hemodialysis as a study in the ethical importance of attention to nonverbal communication. A multilayered understanding of the patient, as may be provided by both behavioral and motivational models, can inform the provider's ability to receive, process, and represent communicated content to the patient or his or her surrogate decision-maker.
    Journal of Bioethical Inquiry 12/2012; 9(4):439-41. · 0.59 Impact Factor
  • Jacob M Appel
    Cambridge Quarterly of Healthcare Ethics 10/2012; 21(4):527-36. · 0.85 Impact Factor
  • Jacob M Appel
    The American Journal of Bioethics 09/2012; 12(9):9-11. · 4.00 Impact Factor
  • Jacob M Appel
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    ABSTRACT: Chemical castration laws, such as one recently adopted in the U.S. State of Louisiana, raise challenging ethical concerns for physicians. Even if such interventions were to prove efficacious, which is far from certain, they would still raise troubling concerns regarding the degree of medical risk that may be imposed upon prisoners in the name of public safety as well as the appropriate role for physicians and other health care professionals in the administration of pharmaceuticals to competent prisoners over the inmates' unequivocal objections. This paper argues that the concerns raised by chemical castration are grave enough that, until they are adequately addressed by policymakers, physicians ought not to participate in the process.
    Journal of Bioethical Inquiry 03/2012; 9(1):85-91. · 0.59 Impact Factor
  • Jacob M Appel
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    ABSTRACT: Preimplantation genetic diagnosis offers the possibility of screening and terminating embryos with severe and life-threatening disabilities. This article argues that under certain conditions, the use of this technology is not merely desirable as a means to reduce human suffering but also an ethically required duty of a parent to a potential child.
    JONA'S healthcare law, ethics and regulation 01/2012; 14(1):7-13.
  • Jacob M Appel
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    ABSTRACT: Although many first-generation bioethicists were psychiatrists and some received psychoanalytic training, the field of bioethics has developed largely in isolation from psychodynamic theory. While much has been written regarding the ethics of psychoanalysis, only a few scholars have attempted to explain bioethical phenomena in psychodynamic terms. This paper argues for the development of a comprehensive theory of "psychodynamic bioethics" that attempts to explain individual and collective attitudes toward bioethical controversy in psychodynamic terms.
    The American Journal of Psychoanalysis 03/2011; 71(1):58-66.
  • Jacob M Appel
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    ABSTRACT: The public discourse surrounding sex and severe disability over the past 40 years has largely focused on protecting vulnerable populations from abuse. However, health professionals and activists are increasingly recognising the inherent sexuality of disabled persons and attempting to find ways to accommodate their intimacy needs. This essay explores several ethical issues arising from such efforts.
    Journal of medical ethics 03/2010; 36(3):152-4. · 1.42 Impact Factor
  • J M Appel
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    ABSTRACT: One of the basic tenets of paediatric ethics is that competent parents may render healthcare decisions for children who are too young or too incapacitated to make meaningful medical choices for themselves. In the USA, many jurisdictions have expanded this principle to include the right to terminate a child's life support, including nutrition and hydration, when that child enters a persistent vegetative state. However, this approach to the withdrawal of care in the paediatric setting has been put to the test by an increasing number of cases in which one or both parents are themselves accused of causing the child's life-threatening injuries. In such "mixed-motive" situations, parents may express a desire to keep a child on life support for religious or moral reasons; at the same time, forestalling the child's death may also prevent a murder charge against the accused parent. Principles need to be established for handling such tragic cases.
    Journal of medical ethics 10/2009; 35(10):635-7. · 1.42 Impact Factor
  • J M Appel
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    ABSTRACT: Advances in genetics may soon make possible the development of ethnic bioweapons that target specific ethnic or racial groups based upon genetic markers. While occasional published reports of such research generate public outrage, little has been written about the ethical distinction (if any) between the development of such weapons and ethnically neutral bioweapons. The purpose of this paper is to launch a debate on the subject of ethnic bioweapons before they become a scientific reality.
    Journal of medical ethics 08/2009; 35(7):429-32. · 1.42 Impact Factor
  • Jacob Appel
    The Journal of clinical ethics 02/2009; 20(2):136-40. · 0.47 Impact Factor
  • Source
    J M Appel
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    ABSTRACT: Neurocognitive enhancement, or cosmetic neurology, offers the prospect of improving the learning, memory and attention skills of healthy individuals well beyond the normal human range. Much has been written about the ethics of such enhancement, but policy-makers in the USA, the UK and Europe have been reluctant to legislate in this rapidly developing field. However, the possibility of discrimination by employers and insurers against individuals who choose not to engage in such enhancement is a serious threat worthy of legislative intervention. While lawmakers should not prevent individuals from freely pursuing neurocognitive enhancement, they should act to ensure that such enhancement is not coerced. This paper offers one model for such legislation, based upon a proposed US law, the Genetic Information Nondiscrimination Act of 2008, to address precisely this particular pitfall of the impending neuroscience revolution.
    Journal of medical ethics 09/2008; 34(8):616-8. · 1.42 Impact Factor
  • Jacob M. Appel
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    ABSTRACT: The Dutch rules governing neonatal euthanasia, known as the Groningen Protocol, require parental consent for severely disabled infants with poor prognoses to have their lives terminated. This paper questions whether parental consent should be dispositive in such cases, and argues that the potential suffering of the neonate or pediatric patient should be the decisive factor under such unfortunate circumstances.
    Journal of Bioethical Inquiry 6(4):477-482. · 0.59 Impact Factor
  • Jacob M. Appel
    [Show abstract] [Hide abstract]
    ABSTRACT: Chemical castration laws, such as one recently adopted in the U.S. State of Louisiana, raise challenging ethical concerns for physicians. Even if such interventions were to prove efficacious, which is far from certain, they would still raise troubling concerns regarding the degree of medical risk that may be imposed upon prisoners in the name of public safety as well as the appropriate role for physicians and other health care professionals in the administration of pharmaceuticals to competent prisoners over the inmates’ unequivocal objections. This paper argues that the concerns raised by chemical castration are grave enough that, until they are adequately addressed by policymakers, physicians ought not to participate in the process.
    Journal of Bioethical Inquiry 9(1). · 0.59 Impact Factor

Publication Stats

24 Citations
13.37 Total Impact Points

Institutions

  • 2012
    • Mount Sinai Medical Center
      New York City, New York, United States
  • 2011–2012
    • Mount Sinai Hospital
      New York City, New York, United States
  • 2010–2012
    • Icahn School of Medicine at Mount Sinai
      • Department of Psychiatry
      Manhattan, New York, United States
  • 2009
    • CUNY Graduate Center
      New York City, New York, United States