Jacob M Appel
Biographic Data
| ID | 6484852 |
|---|---|
| NAME | Jacob M Appel |
| GIVEN NAMES | Jacob M |
| FAMILY NAME | Appel |
| SIGNATURE | APPEL J M |
| AFFILIATIONS | Icahn School of Medicine at Mount Sinai |
| ORCID | 0000-0003-3523-9145 |
| VERIFIED | Yes |
| TOTAL WORKS | 45 |
| TOTAL CITATIONS | 0 |
| WORKS AS AUTHOR | 45 |
| WORKS AS EDITOR | 0 |
| FIRST PUBLICATION YEAR | 2004 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 0 |
Irrational People Have Rights Too
The Replicant Will See You Now
Moving Beyond “Malingering”
Malingering—traditionally defined as the intentional production of false or exaggerated symptoms for external gain—has long been treated as a unitary construct. Yet patients who feign illness do so for widely divergent reasons, from seeking material necessities to avoiding legal accountability. This paper critiques the limitations of “malingering” as a clinical category and proposes a motivation‐based taxonomy of feigned symptoms: Resource‐Driven…
Invisible Victims and the Case for OTC SSRIs
Major depressive disorder is one of the most common serious illnesses worldwide; the disease is also among those with the lowest rates of treatment. Barriers to access to care, both practical and psychological, contribute significantly to these low treatment rates. Among such barriers are regulations in many nations that require a physician’s prescription for most pharmacological treatments including selective serotonin reuptake inhibitors (SSRIs…
Physician assessment, comparative abilities and artificial intelligence
While artificial intelligence’s (AI’s) potential role in enhancing diagnostic accuracy and personalising treatment is well-recognised, its application in evaluating physicians raises critical ethical concerns as well. The paper examines the impact of AI on the ‘comparative abilities’ exception to informed consent, which currently exempts physicians from disclosing information about the performance of other providers. With AI’s ability to generate…
Artificial intelligence, invisible victims and the trolley problem
The allocation of scarce healthcare resources inherently involves trade-offs between the interests of ‘visible’ and ‘invisible’ victims (ie, individuals who are aware that they are shortchanged by trade-offs and those who are not). At present, decisions regarding such trade-offs are often based on highly speculative predictions; the vast array of possible trade-offs simply cannot be enumerated, let alone the optimal outcomes calculated, by human …
The Roboagents Are Coming! The Promise and Challenge of Artificial Intelligence Advance Directives
Advance directives have historically relied upon human agents. But what happens when a patient appoints an artificial intelligence system as an agent? This essay introduces the idea of roboagents-chatbots authorized to make medical decisions when individuals lose capacity. After describing potential models, including a personal AI companion and a chatbot that has not been trained on a patient's values and preferences, the essay explores the ethic…
Applying Rawls’ Theory of Public Reason to Controversies over Parental Surrogacy
Parental surrogacy remains a highly controversial issue in contemporary ethics with considerable variation in the legal approaches of different jurisdictions. Finding a societal consensus on the issue remains highly elusive. John Rawls’ theory of public reason, first developed in his A Theory of Justice (1971), offers a unifying model of political discourse and engagement that enables reasonable citizens to accept policies that they do not necess…
Medical Trainees Abroad
Medical trainees (applicants, students, and house officers) often engage in global health initiatives to enhance their own education through research and patient care. These endeavors may concomitantly prove of value to host nations in filling unmet clinical needs. At present, healthcare institutions generally focus on the safety of the trainee and the welfare of potential patients and research subjects when sanctioning such programs. The America…
Artificial intelligence in medicine and the negative outcome penalty paradox
Artificial intelligence (AI) holds considerable promise for transforming clinical diagnostics. While much has been written both about public attitudes toward the use of AI tools in medicine and about uncertainty regarding legal liability that may be delaying its adoption, the interface of these two issues has so far drawn less attention. However, understanding this interface is essential to determining how jury behaviour is likely to influence ad…
The commonsense case for common morality
Medical ethics has historically been grounded in principles and values that can be logically deduced from the broader moral principles of ordinary life or common morality. This approach has recently been challenged by philosopher Rosamond Rhodes, who argues the opposite: namely, that medical ethics embodies a system of beliefs that cannot be logically deduced from the moral principles of daily living. She offers seven “counterexamples” that seek …
The short tenure and long legacy of interior secretary Stanley K. Hathaway
The second half of the 20th century saw significant progress toward the destigmatization of psychiatric illness and the embrace of mental health care by the American public. Attitudes toward political leaders and candidates with psychiatric diagnoses also evolved during this period—although not at the same pace. From the 1940s through the early 1970s, such diagnoses damaged the careers of prominent officials including Secretary of Defense James F…
Hospital policies regarding patients who refuse transgender roommates
Decisional Capacity After Dark
The model for capacity assessment in the United States and much of the Western world relies upon the demonstration of four skills including the ability to communicate a clear, consistent choice. Yet such assessments often occur at only one moment in time, which may result in the patient expressing a choice to the evaluator that is highly inconsistent with the patient’s underlying values and goals, especially if a short-term factor (such as frustr…
Social Support
One of the criteria used by many transplant centers in assessing psychosocial eligibility for solid organ transplantation is social support. Yet, social support is a highly controversial requirement that has generated ongoing debate between ethicists and clinicians who favor its consideration (i.e., utility maximizers) and those who object to its use on equity grounds (i.e., equity maximizers). The assumption underlying both of these approaches i…
Capacity Reconceptualized
Capacity evaluation has become a widely used assessment device in clinical practice to determine whether patients have the cognitive ability to render their own medical decisions. Such evaluations, which might be better thought of as “capacity challenges,” are generally thought of as benign tools used to facilitate care. This paper proposes that such challenges should be reconceptualized as significant medical interventions with their own set of …
The Insidious Foreseeability Revolution
The laws of medical malpractice have historically differed in significant ways from general liability laws. Until the mid‐twentieth century, physician liability in the United States was limited to cases in which the doctor and patient had an established professional relationship. In the 1970s, courts and legislatures began carving out exceptions when patients posed an imminent threat to identifiable third parties. Recently, a series of cases invo…
The Pandemic of Invisible Victims in American Mental Health
Although considerable attention has been devoted to the concepts of “visible” and “invisible” victims in general medical practice, especially in relation to resource allocation, far less consideration has been devoted to these concepts in behavioral health. Distinctive features of mental health care in the United States help explain this gap. This essay explores three specific ways in which the American mental health care system protects potentia…
Ethics of surgically treating cleft lip for patients who lack legal authority to consent
The Historical Presidency
The illnesses of United States presidents have long been a subject of interest to both scholars and the American public. One particular area that has generated considerable study is the management of information surrounding such illnesses. An extensive literature has developed around efforts by the White House to conceal, downplay, or ignore presidential maladies. This literature has largely focused on the period from the Gilded Age to the presen…
Reconsidering Capacity to Appoint a Healthcare Proxy
Clinicians are often called upon to assess the capacity of a patient to appoint a healthcare agent. Although a consensus has emerged that the standard for such assessment should differ from that for capacity to render specific healthcare decisions, exactly what standard should be employed remains unsettled and differs by jurisdiction. The current models in use draw heavily upon analogous methods used in clinical assessment, such as the “four skil…
Against Intelligence
Intelligence, as measured by grades and/or standardized test scores, plays a principal role in the medical school admissions process in most nations. Yet while sufficient intelligence is necessary to practice medicine effectively, no evidence suggests that surplus intelligence beyond that threshold is correlated with providing higher quality medical care. This paper argues that using perceived measures of intelligence to distinguish between appli…
“When Appearances Matter
Requests by patients for providers of specific demographic backgrounds pose an ongoing challenge for hospitals, policymakers, and ethicists. These requests may stem from a wide variety of motivations; some may be consistent with broader societal values, although many others may reflect prejudices inconsistent with justice, equity, and decency. This paper proposes a taxonomy designed to assist healthcare institutions in addressing such cases in a …
Engagement without entanglement
The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or t…
Patient portal access for caregivers of adult and geriatric patients
Patient portals are poised to transform health communication by empowering patients with rapid access to their own health data. The 21st Century Cures Act is a US federal law that, among other provisions, prevents health entities from engaging in practices that disrupt the exchange of electronic health information—a measure that may increase the usage of patient health portals. Caregiver access to patient portals, however, may lead to breaches in…
No prominent works on this page.
A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906
This essay seeks to chronicle the controversy surrounding euthanasia that came to a head in the United States around 1906, and to situate that debate in a meaningful historical context. An extensive examination of newspaper coverage of the legislative proposals to legalize the practice in Ohio and Iowa reveals that (1) the discourse occurred in a context in which both supporters and opponents of euthanasia generally agreed that the practice alrea…
Case Study
"Physicians are not Bootleggers"
This essay seeks to chronicle the effort of physicians to secure the right to prescribe beer, liquor, and other alcoholic beverages to their patients for medicinal uses during the Prohibition era. A review of the medical literature and popular press from the period 1920–26 reveals that the physicians who lobbied for the right to prescribe alcohol and, ultimately, took their claim to the United States Supreme Court, were not uniformly antiprohibit…
Toward a Psychodynamic Approach to Bioethics
Failing in the Field
All across the social sciences, from development economics to political science departments, researchers are going into the field to collect data and learn about the world. While much has been gained from the successes of randomized controlled trials, stories of failed projects often do not get told. In Failing in the Field, Dean Karlan and Jacob Appel delve into the common causes of failure in field research, so that researchers might avoid simi…
Failing in the Field
All across the social sciences, from development economics to political science departments, researchers are going into the field to collect data and learn about the world. While much has been gained from the successes of randomized controlled trials, stories of failed projects often do not get told. This book delves into the common causes of failure in field research, so that researchers might avoid similar pitfalls in future work. Drawing on th…
Medical School
Evidence‐based medicine has become both the mantra of clinical practice and the dominant contemporary approach to patient care. Gordon Guyatt et al. first proposed applying the concept to medical education in the early 1990s, arguing for training that “de‐emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale” in favor of “examination of evidence from clinical research”; over the following twenty‐five years, nearly…
Tainted Largess
Rather than being a neutral phenomenon, the authors propose that medical school donations should be viewed as a social good for advancing education and improving healthcare. Seen in this light, they aim to offer a framework for analysis that will be useful to medical institutions and their stakeholders in addressing proposed donations from contentious or divisive sources, and in managing those donations that subsequently appear controversial
Goldwater After Trump
The “Goldwater rule,” a policy adopted by the American Psychiatry Association (APA) in 1973, prohibits organization members from diagnosing or offering professional opinions regarding the mental health of public figures without both first-hand evaluation and authorization. Initially developed in response to a controversial survey of APA members during the 1964 Presidential election campaign, the ethics rule faced few large scale challenges until …
Divided Loyalties
This essay explores the challenges of dual loyalty in the emergency setting. The author, an emergency room psychiatrist, finds himself caring for a patient who has been detained by U.S. Immigration and Customs Enforcement for potential deportation under circumstances that the author finds unjust. He also recognizes that the patient's reported psychiatric symptoms are likely not of the nature or severity to justify a psychiatric admission that mig…
A Realpolitik for Presidential Health
The health and fitness of United States presidents has been a matter of concern since the Constitutional Convention. Several United States presidents, including James Madison, James Garfield, and Woodrow Wilson, were significantly impaired during portions of their tenure. Yet how to address this issue has proved both ethically and politically challenging, increasingly so during our nation's current period of elevated polarization. This essay revi…
Crisis Standards of Care in the USA
A Philosophy for Choosing Doctors
This essay advocates for the wholesale reevaluation of the process used by American medical schools for selecting physicians, examining fundamental questions such as the purpose of physicians and the nature of meritocracy. It raises questions about the size of medical school classes, the specific academic requirements, and the inadequacy of current efforts to increase diversity. Ultimately, the essay argues for consideration of a range of reforms…
The draw of the few
The COVID-19 pandemic has focused considerable attention on crisis standards of care (CSCs). Most public CSCs at present are effective tools for allocating scarce but not uncommon resources (like ventilators and dialysis machines). However, a different set of challenges arise with regard to extremely scarce resources (ESRs), where the number of patients in need may exceed the availability of the intervention by magnitudes of hundreds or thousands…
Trial by Triad
Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with …
If it ducks like a quack
Physicians expressing opinions on medical matters that run contrary to the consensus of experts pose a challenge to licensing bodies and regulatory authorities. While the right to express contrarian views feeds a robust marketplace of ideas that is essential for scientific progress, physicians advocating ineffective or dangerous cures, or actively opposing public health measures, pose a grave threat to societal welfare. Increasingly, a distinctio…
Substituted judgment for the never‐capacitated
Since several landmark legal decisions in the 1970s and 1980s, substituted judgment has become widely accepted as an approach to decision‐making for incapacitated patients that incorporates their autonomy and interests. Two notable exceptions have been cases involving minors and those involving cognitively or psychiatrically impaired individuals who never previously possessed the ability to contemplate the medical decisions involved in their care…
Personal responsibility and transplant revisited
Priority for solid organ transplant generally does not consider the underlying cause of the need for transplantation. This paper argues that a distinctive set of factors justify assigning lower priority to willfully unvaccinated individuals who require transplant as a result of suffering from COVID‐19. These factors include the personal responsibility of the patients for their own condition and the public outrage likely to ensue if willfully unva…
Do Hospital Leaders Live in the Communities They Serve? A Comparative Analysis
Purpose: Many factors contribute to persistent intractable disparities in health care, but the geographic separation of health care executives and patient communities has not been explored. From Congresspeople to police officers, individuals engaged in public service often face criticism for not living in the neighborhoods where they work. These critiques stem from the belief that to engage meaningfully with a community, one has to understand its…
Reconsidering Capacity to Appoint a Healthcare Proxy
Clinicians are often called upon to assess the capacity of a patient to appoint a healthcare agent. Although a consensus has emerged that the standard for such assessment should differ from that for capacity to render specific healthcare decisions, exactly what standard should be employed remains unsettled and differs by jurisdiction. The current models in use draw heavily upon analogous methods used in clinical assessment, such as the “four skil…
Against Intelligence
Intelligence, as measured by grades and/or standardized test scores, plays a principal role in the medical school admissions process in most nations. Yet while sufficient intelligence is necessary to practice medicine effectively, no evidence suggests that surplus intelligence beyond that threshold is correlated with providing higher quality medical care. This paper argues that using perceived measures of intelligence to distinguish between appli…
“When Appearances Matter
Requests by patients for providers of specific demographic backgrounds pose an ongoing challenge for hospitals, policymakers, and ethicists. These requests may stem from a wide variety of motivations; some may be consistent with broader societal values, although many others may reflect prejudices inconsistent with justice, equity, and decency. This paper proposes a taxonomy designed to assist healthcare institutions in addressing such cases in a …
Engagement without entanglement
The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or t…
Patient portal access for caregivers of adult and geriatric patients
Patient portals are poised to transform health communication by empowering patients with rapid access to their own health data. The 21st Century Cures Act is a US federal law that, among other provisions, prevents health entities from engaging in practices that disrupt the exchange of electronic health information—a measure that may increase the usage of patient health portals. Caregiver access to patient portals, however, may lead to breaches in…
Assessing the competitiveness of medical humanities research on psychiatry, otolaryngology, and ophthalmology residency program applications
Medical humanities research is an increasing area of interest for students as medical schools become more aware of the benefits of humanities and the arts on patient care. However, medical students may feel dissuaded from pursuing medical humanities work for fear of how it will be perceived on their residency applications. In this study, residency program directors (PDs) in New York state in psychiatry, ophthalmology, and otolaryngology were surv…
Political science (27 works) · Medicine (25 works) · Law (24 works) · Psychology (24 works) · Computer Science (14 works) · Health care (9 works) · Ethics in medical practice (8 works) · Public relations (8 works) · Philosophy (7 works) · Politics (7 works)