Steven Levine, MD

This episode of Medical Ethics Unpacked focuses on the changing climate surrounding vaccine hesitancy and public policy.

Medical Ethics Unpacked: Shifting Vaccine Regulation and Policy, with Jason Schwartz, PhD

00:00 – Introduction and Vaccine Policy in Crisis

03:00 – The Long History and New Politics of Vaccine Skepticism

09:30 – Erosion of Public Health Infrastructure and Expert Advisory Systems

14:50 – Why Vaccines Became a Political Flashpoint

19:10 – Clinician Ethics and the Vaccine-Hesitant Patient

32:00 – Data, Misinformation, and the Future of Vaccine Trust

, hosts Dominic Sisti and Steve Levine welcome Jason Schwartz, PhD, associate professor at the Yale School of Public Health, for a discussion on vaccine ethics, public health infrastructure, and the challenges of maintaining trust in immunization programs.

Together, they explore how the COVID-19 pandemic reshaped public attitudes toward vaccines, while also underscoring long-standing tensions between individual autonomy and collective responsibility. Schwartz, whose work focuses on vaccine policy and history, offers perspective on the systems and institutions, such as the CDC's Advisory Committee on Immunization Practices (ACIP), helping to translate scientific evidence into public health recommendations.

This episode comes at a time when ACIP is once again in the headlines as HHS Secretary Robert F. Kennedy Jr. recently 

replaced all 17 members with a new slate of individuals

, citing concerns about groupthink and conflicts of interest. The move has generated widespread commentary about the role and value of such expert advisory bodies in shaping public health decisions, especially in the face of growing skepticism and political scrutiny.

Ethical questions about equity, communication, and responsibility are threaded throughout the discussion. The hosts and Schwartz reflect on what it means to make fair vaccine recommendations in the context of incomplete data, and how institutions can maintain public trust amid scientific uncertainty. They also discuss how the infrastructure behind public health decisions—committees, advisory boards, and interagency coordination—can either strengthen or undermine confidence depending on how they function and how well they are understood.



This podcast explores complex and sensitive topics. The views and opinions expressed by the hosts and guests are their own and do not necessarily reflect those of HCPLive or MJH Life Sciences. This content is intended to encourage thoughtful discussion and does not constitute medical advice or endorsement of any particular position. Listeners are encouraged to approach these subjects with care and consult appropriate resources for further information.


Stone W. RFK Jr. names new slate of vaccine advisers after purging CDC panel. NPR. Published June 11, 2025. Accessed June 17, 2025. 

https://www.npr.org/sections/shots-health-news/2025/06/11/nx-s1-5430870/cdc-vaccine-experts-rfk-jr

Asturias EJ, Brewer NT, Brooks O, et al. Advisory Committee on Immunization Practices at a Crossroads. 

Podcasts

Explore the ethical dilemmas of vaccine policy and public trust in health systems as experts discuss the impact of COVID-19 on immunization attitudes.

Medical Ethics Unpacked: Unique Ethical Challenges of Psychedelics

As regulatory agencies weigh the approval of psychedelic therapies, the field of 

 stands on the brink of a paradigm shift—one that offers patients a new treatment option that has a direct impact on brain activity.

recent rejection of Lykos Therapeutics’ MDMA-assisted therapy for PTSD

 has reignited debates over the ethical concerns surrounding psychedelic treatments.

, psychiatrist Steve Levine, MD, and bioethicist Dominic Sisti, PhD, are joined by special guest Amy McGuire, JD, PhD, from Baylor College of Medicine, to discuss unique ethical challenges of psychedelic therapies—consent, access, setting intentions, and integration of traditional practices into mainstream medicine.

“It means there’s values and traditions that are embedded in these treatments that may not be compatible with mainstream medicine,” Sisti said.

Other ethical topics discussed included dosing sessions, therapeutic models, differences between psychedelics and empathogens like MDMA, and the focus on veterans in psychedelic clinical trials.

“To me, it's the combination of the altered state of consciousness that it brings you into and …they can be used in exceptional ways,” McGuire said. “Ceremonial use of these substances…is quite different. Now, whether we think they're different or not, I think it's a separate question of whether they should be treated [differently] as we go through the FDA pipeline, as we go through standard clinical practice. If they're adopted into Western medicine… I'm not so sure that there should be exceptional rules related to them, but I think that…to [not] acknowledge their distinctive features, and their potential to be used in really different types of ways…would be a mistake.”

 Chief patient officer at Compass Pathways

 Associate professor in the Department of Medical Ethics & Health Policy and the director of the Scattergood Program for the Applied Ethics of Behavioral Health Care at the University of Pennsylvania

 Leon Jaworski professor of biomedical ethics and director at Baylor College of Medicine

Relevant disclosures included Lykos Therapeutics and Tactogen for Sisti and Compass Pathways for Levine. McGuire has no reported disclosures.

The Lancet Regional Health-Europe. Psychedelic-assisted psychotherapy: hope and dilemma. Lancet Reg Health Eur. 2023 Sep 4;32:100727. doi: 10.1016/j.lanepe.2023.100727. PMID: 38222970; PMCID: PMC10784116.

Derman, C. The Rise, Fall (and Future?) of MDMA-Assisted Therapy. HCPLive. December 23, 2024. 

https://www.hcplive.com/view/the-rise-fall-and-future-of-mdma-assisted-therapy

Videos

This episode unpacks ethical challenges of psychedelic therapies, such as consent and integrating traditional practices into mainstream medicine.

Medical Ethics Unpacked: Unique Ethical Challenges of Psychedelic Therapies

Medical Ethics Unpacked: Ethical Considerations for Euthanasia & Medically-Assisted Suicide

00:00 - The Parity Between Mental and Physical Illness

05:09 - Requiring Treatment Before Considering Euthanasia 

08:19 - The Complexity of Egosyntonic Psychiatric Conditions 

11:21 - The Potential for "Terminal Addiction" 

16:30 - The Societal Impact and Implications of Psychiatric Euthanasia

, hosts Dominic Sisti, PhD, and Steve Levine, MD, continue their deep dive into the controversial topic of medical aid in dying (MAID) and euthanasia for individuals with severe psychiatric conditions. Part 2 of a 2-part series, this episode shifts from foundational concepts to the intricate ethical considerations surrounding these practices, touching on autonomy, capacity, treatment equity, and societal implications.

Sisti, an associate professor in the Department of Medical Ethics & Health Policy and the director of the Scattergood Program for the Applied Ethics of Behavioral Health Care at the University of Pennsylvania, begins by discussing the notion of parity between psychiatric and physical illnesses in evaluating eligibility for MAID, calling attention to recent research from Kious et al—who argues that mental illnesses should be given equal ethical consideration as physical conditions, though he acknowledges the challenges in assessing long-term trajectories for psychiatric disorders. For instance, conditions like borderline personality disorder may remit over time, but requiring patients to endure suffering for years in anticipation of potential improvement raises moral concerns.

Levine, a psychiatrist and the senior vice president of Patient Access at Compass Pathways, builds on this by exploring how psychiatric illnesses often blur the line between mental and physical health, emphasizing that mental health conditions, like depression or anorexia nervosa, can have physical manifestations that further complicate prognosis and decision-making.

The discussion highlights critical issues with capacity evaluations. Levine outlines the nuanced frameworks used to assess a patient’s ability to make decisions about MAID and stresses the dynamic nature of capacity, which can fluctuate with psychiatric symptoms. Both agree that insufficient or inconsistent evaluations, as seen in some jurisdictions permitting psychiatric euthanasia, risk undermining the ethical integrity of these practices.

Sisti cites evidence from Belgium and the Netherlands, where "assertions" of capacity rather than thorough assessments have led to controversial cases, particularly among patients with mood or personality disorders. The gender disparity in psychiatric euthanasia, with women disproportionately represented, adds another layer of ethical complexity, raising questions about justice and societal biases.

The conversation also examines whether patients should be required to attempt all available treatments, including experimental options, before pursuing MAID. While Sisti suggests this could prevent premature decisions, Levine cautions against infringing on autonomy, noting that some patients may validly reject certain treatments. They grapple with cases like anorexia nervosa, a psychiatric condition with high mortality rates, and whether its ego-syntonic nature—where patients often do not view their condition as a problem—impedes true capacity for MAID decisions.

Finally, the hosts address societal implications. Sisti warns that expanding access to psychiatric euthanasia without addressing underlying structural issues, such as inadequate mental health care and social determinants like poverty and isolation, risks normalizing preventable suffering. Levine reflects on how offering MAID as an option might paradoxically provide hope for some patients but could also undermine their optimism for recovery.

As they conclude, both Levine and Sisti emphasize the need for robust ethical frameworks, thorough capacity evaluations, and thoughtful policymaking to navigate this morally complex issue. They encourage listeners to engage with the growing body of bioethics literature and reflect on how these debates shape our understanding of autonomy, human suffering, and the value of life.

Relevant studies and documentation mentioned in this episode:

Doernberg, Samuel N., John R. Peteet, and Scott YH Kim. "Capacity evaluations of psychiatric patients requesting assisted death in the Netherlands." Psychosomatics 57, no. 6 (2016): 556-565.

Kim, Scott YH, Raymond G. De Vries, and John R. Peteet. "Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014." JAMA psychiatry73, no. 4 (2016): 362-368.

Kious, Brent M., and Margaret Battin. "Physician aid-in-dying and suicide prevention in psychiatry: A moral crisis?." The American Journal of Bioethics 19, no. 10 (2019): 29-39.

Nicolini, Marie E., Scott YH Kim, Madison E. Churchill, and Chris Gastmans. "Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons." Psychological medicine 50, no. 8 (2020): 1241-1256.

Nicolini, Marie E., Chris Gastmans, and Scott YH Kim. "Psychiatric euthanasia, suicide and the role of gender." The British Journal of Psychiatry 220, no. 1 (2022): 10-13.

Sisti, Dominic, J. John Mann, and Maria A. Oquendo. "Suicidal behaviour is pathological: implications for psychiatric euthanasia." Journal of Medical Ethics (2024).

Relevant disclosures for Sisti include Lykos Therapeutics and Tactogen. Relevant disclosures for include Levine include Compass Pathways.

This podcast explores complex and sensitive topics, including medically assisted suicide and the ethics of euthanasia. The views and opinions expressed by the hosts and guests are their own and do not necessarily reflect those of HCPLive or MJH Life Sciences. This content is intended to encourage thoughtful discussion and does not constitute medical advice or endorsement of any particular position. Listeners are encouraged to approach these subjects with care and consult appropriate resources for further information.

In part 2 of this 2-part discussion, hosts discuss ethical considerations and the growing evidence base around euthanasia and medical assistance in dying.

Medical Ethics Unpacked: Ethical Considerations for Euthanasia & Medical Assistance in Dying

Medical Ethics Unpacked: Ethical Foundations and Background of Euthanasia & Medically-Assisted Suicide

00:00 Introduction to Medical Ethics Unpacked

00:45 Key Issues in the Debate on Euthanasia and Mental Illness

07:25 Clinical Perspective on Capacity and Competence

12:45 Challenges in Evaluating Capacity in Mental Illness

19:32 Treatment Options and the Role of Social Structures

In their inaugural episode of Medical Ethics Unpacked, hosts Steve Levine, MD, a psychiatrist, and Dominic Sisti, PhD, a bioethicist, begin a 2-part discussion examining medically-assisted suicide, often referred to as medical assistance in dying (MAID), and euthanasia, particularly in the context of severe 

. Part 1 of the discussion featured above focuses on foundational concepts and the broader context of MAID, laying the groundwork for an in-depth ethical discussion in part 2.

Sisti, an associate professor in the Department of Medical Ethics & Health Policy and the director of the Scattergood Program for the Applied Ethics of Behavioral Health Care at the University of Pennsylvania, introduces 2 critical questions at the heart of the debate: determining whether individuals with severe psychiatric illnesses have the capacity to make autonomous decisions about euthanasia and whether psychiatric conditions can be considered terminal. As Sisti notes, these questions are particularly challenging given the complexities of suicidality, which is both a symptom of certain psychiatric illnesses and a factor influencing the desire for euthanasia.

Sisti also examines data from jurisdictions where psychiatric euthanasia is legal, such as Belgium and the Netherlands, noting trends like gender disparities and inconsistent capacity evaluations that raise concerns about equity and justice. He emphasizes the need for robust societal safeguards to ensure that MAID is not prematurely offered to individuals whose suffering might be mitigated through other means.

Later, Levine provides a clinical perspective, delving into the distinction between capacity and competence, explaining how capacity evaluations are conducted by physicians, and discussing the nuances of suicidality as a dynamic and context-dependent phenomenon. He highlights the episodic nature of conditions like major depressive disorder and the potential for recovery through treatments, such as ketamine or psychedelics. However, he acknowledges the limitations of psychiatric care, including gaps in treatment effectiveness and accessibility, which complicate decisions regarding MAID.

Levine also raises the philosophical question of whether a wish to die is always pathological or whether it can sometimes be an expression of autonomy, further blurring the lines in this debate.

The episode sets the stage for part 2, which will explore the ethical considerations surrounding MAID and euthanasia in greater depth. Levine and Sisti aim to address the broader implications of permitting euthanasia in psychiatric populations, touching on justice, societal values, and the role of clinicians in these life-and-death decisions. Stay tuned for the continuation of this complex and thought-provoking discussion.


The inaugural episode of "Medical Ethics Unpacked" delves into the ethical complexities of medically-assisted suicide (MAID) and euthanasia, particularly for individuals with severe psychiatric conditions. Hosts Steve Levine, MD, and Dominic Sisti, PhD, explore foundational concepts, focusing on the capacity for autonomous decision-making and whether psychiatric conditions can be deemed terminal. They discuss data from jurisdictions where psychiatric euthanasia is legal, highlighting concerns about equity and justice. The episode also examines the philosophical and clinical nuances of suicidality, setting the stage for a deeper ethical exploration in the next episode.

In part 1 of this 2-part discussion, hosts explore the ethical foundation and background of euthanasia and medically-assisted suicide. 

Steven Levine, MD

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