Bio(un)ethical with Leah Pierson and Sophie Gibert

Content warning: This episode contains discussions of suicide, suicidal ideation, and symptoms of mental illness. If you or someone you know or love is struggling, please seek help. You can call or text 988 to reach the suicide and crisis lifeline.
In this episode, we interview Dr. Marie Nicolini, a psychiatrist and bioethicist who testified to the Canadian Parliament as an expert witness on the issue of medical aid in dying (MAID) for mental disorders. With Marie, we discuss whether we should legalize MAID for mental illness, what practical and conceptual challenges we face in constructing appropriate safeguards, and how legalizing MAID might interact with efforts to prevent suicide and improve psychosocial services for people with mental illness.


(00:00) Our introduction
(13:02) Interview begins
(14:07) Safeguards: The voluntariness requirement
(23:16) Safeguards: The unbearable suffering requirement
(33:01) Safeguards: The incurability requirement
(42:38) Safeguards: Retrospective oversight
(46:07) Is MAID for mental illness at odds with suicide prevention?
(1:01:08) Does legalizing MAID disincentivize improving psychosocial services
(1:06:13) What does MAID express about how we value people’s lives?
(1:12:44) The future of MAID policy


Bio(un)ethical is a bioethics podcast written and edited by Leah Pierson and Sophie Gibert, with production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we interview Dr. Govind Persad, an expert on resource allocation whose work influenced COVID-19 allocation policies, about how we should allocate scarce medical resources, what stood in the way of optimal allocation during the covid pandemic, and how we can improve resource allocation within the US healthcare system. 
(00:00) Our Introduction
(04:05) Interview begins
(12:06) What is a “framework” for allocating health resources?
(14:20) What normative assumptions are baked into allocation frameworks?
(19:36) What principles are included in allocation frameworks?
(20:24) Overview of first two principles: Maximizing benefits and favoring the worst off
(26:11) Overview of second two principles: Equal treatment and rewarding social usefulness
(39:37) Which benefits matter when allocating health resources?
(43:33) Should we account for quality of life?
(49:22) Should we prioritize the youngest first?
(53:29) When does reciprocity matter?
(57:32) Putting principles into practice
(1:02:22) Legal considerations
(1:07:25) Improving resource allocation in the US healthcare system
(1:13:16) How living through the pandemic influenced Govind’s research

Mentioned:
“Principles for Allocation of Scarce Medical Interventions” by Govind Persad, Alan Wertheimer, and Ezekiel Emanuel (2009)“Fair Allocation of Scarce Medical Resources in the Time of COVID-19” by Ezekiel Emanuel et al. (2020)“The Rebugnant Conclusion” by Jeff Sebo (Draft)“Equality and Priority” by Derek Parfit (1997)“Should the Numbers Count?” by John Taurek (1977)“In the Line For Scarce Covid Treatments, Immunocompromised Americans Should Go Before the Unvaccinated” by Govind Persad and Emily Largent (Opinion in The Washington Post, 2022)“How COVID-19 Hollowed Out a Generation of Young Black Men” by Akilah Johnson and Nina Martin (ProPublica, 2020)Thoughts? Guest suggestions? Email us at biounethical@gmail.com
You can find more episodes of Bio(un)ethical at biounethical.com. Sign up for our email list at biounethical.com to receive episode alerts and submit questions for upcoming guests.
To support us, please subscribe, rate, and review our show wherever you get your podcasts, and recommend it to a friend. For updates, follow Leah and Sophie on Twitter (leah_pierson and sophiehgibert).
Bio(un)ethical is a bioethics podcast written and edited by Leah Pierson and Sophie Gibert, with production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

In this episode, we interview Dr. Robert Steel about how we should assess the risks and benefits of research, what justifies research oversight, and whether there should be upper limits on the amount of risk research participants are exposed to.

(00:00) Our introduction
(05:06) Start of interview; IRB background
(13:34) The notion of minimal risk
(24:49) Justifying IRB risk evaluation: Initial discussion
(37:07) Justifying IRB risk evaluation: Group soft paternalism
(45:57) Justifying IRB risk evaluation: Maintaining social trust
(54:13) IRB assessment of social value
(56:25) Alternative justifications (beneficence, non-maleficence, non-exploitation)
(01:02:36) Implications: Benefits to society count; No upper limits on risk
(01:15:07) Robert’s future work on government policy trials
Mentioned:
Survey of pediatric IRB chairs: “How do institutional review boards apply the federal risk and benefit standards for pediatric research?” by Shah et al. (2004)Exploitation by Alan Wertheimer (1996)“Facing up to paternalism in research ethics” by Franklin Miller and Alan Wertheimer (2007)Public Trust: “Is there an ethical upper limit on risks to study participants?” by Nir Eyal (2020)“What makes clinical research ethical?” by Ezekiel Emanuel, David Wendler, and Christine Grady (2000)“Reconceptualizing Risk-Benefit Analyses: the Case of HIV Cure Research” by Robert Steel (2020)“A framework for risk-benefit evaluations in biomedical research” by Annette Rid and David Wendler (2011)Thoughts? Guest suggestions? Email us at biounethical@gmail.com
You can find more episodes of Bio(un)ethical at biounethical.com and sign up for our email list to receive episode alerts and submit questions for upcoming guests.
To support us, please subscribe, rate, and review our show wherever you get your podcasts, and recommend it to a friend. For updates, follow Leah and Sophie on Twitter (leah_pierson and sophiehgibert).
Bio(un)ethical is written and edited by Leah Pierson and Sophie Gibert, with production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.
Bio(un)ethical is a bioethics podcast written and edited by Leah Pierson and Sophie Gibert, with production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

Welcome to Bio(un)ethical, the podcast where we question existing norms in medicine, science, and public health.
In this episode, we (Leah Pierson and Sophie Gibert) introduce the podcast and talk about why we started it and what we hope to achieve.
If you want to support us, the best way is to subscribe, rate, and review our show wherever you get your podcasts, and recommend it to a friend. You can find more episodes at our website, biounethical.com, and can also join our email list to receive episode alerts and submit questions for upcoming guests. 
Thoughts? Guest suggestions? Email us at biounethical@gmail.com
For the latest updates, follow us on Twitter (leah_pierson and sophiehgibert)


Bio(un)ethical is a bioethics podcast written and edited by Leah Pierson and Sophie Gibert, with production by Audiolift.co. Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.