Jacob M Appel

Sinai Hospital, New York, New York, United States

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Publications (14)16.15 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.
    No preview · Article · Dec 2012 · Journal of Bioethical Inquiry
  • Jacob M Appel

    No preview · Article · Oct 2012 · Cambridge Quarterly of Healthcare Ethics
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    Jacob M Appel

    Preview · Article · Sep 2012 · The American Journal of Bioethics
  • 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.
    No preview · Article · Mar 2012 · Journal of Bioethical Inquiry
  • Jacob M Appel
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    ABSTRACT: One of the most fundamental tenets of medical research, enshrined in the World Medical Association's Declaration of Helsinki, is that scientific investigation involving human beings requires the informed consent of the subjects.
    No preview · Article · Jan 2012 · Cambridge Quarterly of Healthcare Ethics
  • 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.
    No preview · Article · Jan 2012 · JONA'S healthcare law, ethics and regulation
  • 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.
    No preview · Article · Mar 2011 · Journal of Bioethical Inquiry
  • 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.
    No preview · Article · Mar 2011 · The American Journal of Psychoanalysis
  • 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.
    No preview · Article · Mar 2010 · Journal of medical ethics
  • 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.
    No preview · Article · Dec 2009 · Journal of Bioethical Inquiry
  • 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.
    No preview · Article · Oct 2009 · Journal of medical ethics
  • 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.
    No preview · Article · Aug 2009 · Journal of medical ethics
  • Jacob Appel

    No preview · Article · Feb 2009 · The Journal of clinical ethics
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    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.
    Preview · Article · Sep 2008 · Journal of medical ethics

Publication Stats

58 Citations
16.15 Total Impact Points

Institutions

  • 2012
    • Sinai Hospital
      New York, New York, United States
    • Mount Sinai Medical Center
      New York, New York, United States
    • Icahn School of Medicine at Mount Sinai
      Borough of Manhattan, New York, United States
  • 2010-2012
    • Mount Sinai Hospital
      New York City, New York, United States
  • 2009
    • NYU Langone Medical Center
      New York, New York, United States