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Chan, See-ching, and 陳詩正. "Bioethics of living donor liver transplantation." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B5070087X.
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Bioethics has been central to living donor liver transplantation (LDLT), which mandates a high recipient benefit and an acceptably low donor risk. The double equipoise imposes the contextual features of this already technically complex treatment. This research aimed at looking into key bioethical issues of LDLT in the light of the contemporary practice standards.
In adult LDLT, in order to provide a partial graft of adequate size, donor right hepatectomy is often required. This procedure pioneered by The University of Hong Kong is now being performed at many centers and by many surgeons. Through close guidance and gradual granting of surgical privilege, newer surgeons can now perform this operation safely with low blood loss (400 mL) and low complication rates ( 30%). Analysis of our series also showed that right liver donors with a smaller remnant left liver had higher peak bilirubin level and longer peak prothrombin time after the operation. Severe complications were associated with hyperbilirubinemia (p=0.031) while prolonged hospital stay was associated with prolonged prothrombin time (p=0.011) and smaller remnant left liver (p=0.036). Facts need to be known to potential right liver donors before operation.
Donor left hepatectomy, which carries a lower donor risk, is more feasible for donors with a larger left liver and recipients with a smaller body size. Lowering the graft size requirement also allows more LDLTs being done using left livers. The percentages of left liver LDLTs feasible with a graft to standard liver volume (G/SLV) ≥ 40%, ≥ 35%, ≥ 30%, and ≥ 25% were 5.8%, 12.5%, 29.1%, and 62.3% respectively. For every 5% decrease in G/SLV ratio, twice as many left liver LDLTs could be performed.
The 5-year survival rate was 85.7% for liver transplantation recipients with hepatocellular carcinoma (HCC) within the Up-to-7 criteria, unaffected by the presence of microvascular invasion (88.2% vs. 85.1%, p=0.652). This is comparable with that of liver resection patients with HCC without microvascular invasion (81.2%, p=0.227) but far superior to that of liver resection patients with lesions with microvascular invasion (50.0%, p<0.0001). Primary liver transplantation for HCC with microvascular invasion and within the Up-to-7 criteria in fact doubled the chance of cure as compared with liver resection. LDLT has been criticized of fast-tracking patients with more aggressive HCC for transplant. Waiting does select out patients with better survival to undergo transplantation. With careful selection though without waiting, LDLT nevertheless does not confer poorer survival.
Progressive liver failure following a major hepatectomy for HCC is a known and uncommon cause of mortality. Proceeding to LDLT is an ethical challenge because of the possibility of coercion. Tumor status as confirmed by histopathological examination of resected specimens can demonstrate features of more aggressive cancer, which warns against a rescue transplantation for the increase in chance of tumor recurrence.
In order to overcome ABO blood group incompatibility, paired donor interchange (between two pairs: A to B and B to A) has been practiced for the liver. The extension to matching with one pair of universal donor (O) and universal recipient (AB) was also performed at our center. The obvious biological advantage of this treatment modality has to be weighed against the potential increase in risks to patients involved.
Media coverage of advances and successes in liver transplantation stimulates deceased donor organ donation (DDOD). The relation between widely reported key events and DDOD can be recognized as celebrity hero influence, medical success, or emotional response. An accountable liver transplant service answerable to the public is vital to a region where the DDOD rate is low. Selective disclosure of patient information to the media for public interest in promoting organ donation can be justified.
LDLT now has a two-decade history of clinical practice. Basic and clinical research has provided a clearer picture of the efficacy and fallibility of LDLT. We can now be more accurate in defining and interpreting the applicability of LDLT for a wider spectrum of disease indications.published_or_final_version
Medicine
Master
Doctor of Medicine
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Krauss, Edward L. "A study of bioethics for Christian students at a secular university." Theological Research Exchange Network (TREN), 1995. http://www.tren.com.
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Dyer, Sarah Elizabeth. "Applying bioethics : local research ethics committees and their regulation of medical research." Thesis, King's College London (University of London), 2006. https://kclpure.kcl.ac.uk/portal/en/theses/applying-bioethics--local-research-ethics-committees-and-their-regulation-of-medical-research(c0840da4-23fb-49a1-a712-eb2a0d5a08ac).html.
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McLaurin, Jennie Anderson. "To what end medicine? an examination of Christian bioethics and the nature of medicine /." Theological Research Exchange Network (TREN) Theological Research Exchange Network (TREN) Access this title online, 2007. http://www.tren.com.
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Carry, Wendy M. "Public bioethics : an intermediary between public health and the media /." abstract and full text PDF (free order & download UNR users only), 2007. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1448328.
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Thesis (M.P.H.)--University of Nevada, Reno, 2007."December, 2007." Includes bibliographical references (leaves 52-54). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2007]. 1 microfilm reel ; 35 mm.
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MacFarlane, Matthew Phillip. "Proposal for a Gender, Sex, and Sexuality Curriculum in Undergraduate Medical Education at the Lewis Katz School of Medicine at Temple University." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/502268.
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Urban BioethicsM.A.
Understanding gender, sex, and sexuality is required in order to be a competent, patient-centered physician, and, therefore, inclusion of these topics in undergraduate medical education is essential. Current medical education is not producing physicians equipped to manage the complaints and issues that face their patients in these areas. LGBTQ populations are most affected by the inadequacy of training related to these topics. LGBTQ patients face unique issues in healthcare in terms of their normal development, pathology, social determinants of health, and healthcare system practices. Additionally, LGBTQ people and those who engage in behaviors that parallel these identities are prevalent in the general population. The addition of a gender, sex, and sexuality curriculum would simultaneously address LGBTQ disparities as well as the need for improved sexual health education that would benefit all patients. Currently, undergraduate medical curricula have limited, non-standardized education on gender, sex, and sexuality. A few American institutions have published both qualitative and quantitative studies that indicate medical students’ attitudes are malleable and their clinical skills can be improved in these areas. Further, numerous national medical societies have created curriculum guidelines and recommendations in order to aid medical schools looking to bolster their gender, sex, and sexuality related curricula. This paper will synthesize research and these guidelines to propose a robust gender, sex, and sexuality curriculum that is tailored to the environment found at the Lewis Katz School of Medicine at Temple University.
Temple University--Theses
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Greco, Alesandra. "Pediatric Bioethics: The Complexities of Contextualizing Seriously Ill Newborns." Thesis, Boston College, 2017. http://hdl.handle.net/2345/bc-ir:107416.
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Thesis advisor: Cherie McGillThesis advisor: Marius Stan
Seriously ill newborns are a part of a recent bioethical phenomenon that emerged during the late 1970s. With the rise of new, innovative medical technology, doctors can keep these seriously ill newborns alive, but at monumental financial and psychological costs. This thesis utilizes several economic and ethical frameworks to contextualize these newborns within our healthcare system. After all, our healthcare resources are limited. We must therefore discern between the continuation of an infant’s treatment and conversely, the withdrawal of treatment
Thesis (BA) — Boston College, 2017
Submitted to: Boston College. College of Arts and Sciences
Discipline: Departmental Honors
Discipline: Philosophy
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Thor, Danielle Claire. "Ethics in Emergency Medical Services: A Contextual Analysis." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/592304.
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Urban BioethicsM.A.
The modern concept of Emergency Medical Services (EMS) has grown from its humble volunteerism origins to a multidisciplinary enterprise, outstretched into the realms of both healthcare and public service. As the American EMS community continues to assume greater responsibilities and further develop its professional standards, the moral foundations of this field open themselves to more thorough scrutiny. Upon examination, the major deficit in the ethical structuring of EMS becomes glaringly obvious: it exists as a piecemeal collection of its medical and militaristic counterparts unified by theoretical generalizations that avoid its inherently unique structure. If EMS wishes to matriculate into complete professionalism, or even continue its assumption of critical responsibilities surrounding the health and safety of others, then it must also develop and maintain its own individual ethical framework from which it operates. In doing so, an urban bioethical approach rooted in context-driven analysis and pragmatic solutions may provide the best guidance and protections for all those who interact with the EMS system while respecting the values of this distinctively prideful service.
Temple University--Theses
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Parker, J. Charles. "Euthanasia mercy or sacrilege? /." Theological Research Exchange Network (TREN), 1992. http://www.tren.com.
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Gunn, Megan. "Disparities in Kidney Donation and Transplantation in African Americans and the Role of Mistrust." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/566571.
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Urban BioethicsM.A.
Organ transplantation has the potential to improve and prolong the lives of many chronically ill people. However, organs are a scarce resource and a commodity to which not everyone has equal access. Equity issues are particularly evident amongst African Americans concerning kidney donation and transplantation. In this paper, I discuss the history of kidney transplantation and the disparities that exist in the African American community for both organ donation and transplantation. I explain how the organ allocation system has structural barriers that do not account for the social determinants of health. Then I explore the significant barrier of African Americans’ mistrust of the health care system and its role in kidney donation and transplantation. I use the principles of urban bioethics to discuss possible solutions to mistrust including community engagement, diversifying the physician work force, and concepts that move beyond cultural competency to cultural humility and structural competency.
Temple University--Theses
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English, Adele. "Ethical Dilemmas in Pain Management Within the Context of Addiction." Scholarship @ Claremont, 2019. https://scholarship.claremont.edu/cmc_theses/2046.
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The opioid epidemic is a public health crisis. How the crisis developed, how to mitigate its effects, and how to prevent it from spreading is less transparent. The practice of pain management poses a myriad of ethical challenges. The following essay will examine ethical dilemmas that arise during the decision-making process with regards to pain management in the context of addiction after a brief history of pain management and discussion of the corresponding legal and medical regulations.
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Beaugard, Carol R. "How hospital nurses reason about ethical dilemmas of practice /." Access Digital Full Text version, 1990. http://pocketknowledge.tc.columbia.edu/home.php/bybib/10937985.
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Onuoha, Chikezie. "Bioethics Across Borders : An African Perspective." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Universitetsbiblioteket [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7844.
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Flanagan, Ellen Cecelia. "AN URBAN BIOETHICS APPROACH TO PARENTAL INFORMED CONSENT FOR PEDIATRIC CLINICAL RESEARCH." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/537038.
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Urban BioethicsM.A.
In the current healthcare landscape, parents generally make decisions regarding whether or not their children are allowed to take part in clinical research, with the general assumption being that parents know what is best for children. Investigations have been conducted regarding what is likely to lead parents to consent or not consent to their child’s participation in a trial, but research plans seldom incorporate the consideration that not all parents come into the consent process with equal social, academic, and economic footing. Since the burden of the ultimate decision lies primarily on the parents, it is supremely important that they are capable of making a well-informed and thoughtful choice. Bioethical understanding of the influence of parental decisions in clinical research must consider demographic variables and how they may affect parents’ decisions to allow or disallow their child to participate in a clinical trial. Those differences could affect the consent process and have ramifications for the research findings, as research results are affected in numerous ways by which children do, and do not, participate in studies. This paper looks specifically at parents in the process of informed consent for pediatric research, taking into account several social determinants of health and how they affect who participates in research and how that affects research as a whole.
Temple University--Theses
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Künig, Damian. "Les institutions de l'éthique discursive face au droit dans la régulation des nouvelles technologies médicales /." Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30309.
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Discourse ethics relates to an argumentative discussion about our moral norms and their foundations. The purpose of my research is to describe and evaluate the functioning of several institutions of discourse ethics as sources of normativity for the regulation of new medical technologies and to propose some possible interactions between law and these institutions.The institutions of discourse ethics I will look at are: national commissions of experts, national ethics committees, technology assessment committees and consensus conferences. Used in these institutions, argumentative discussion has the capacity to influence the meaning we give to our moral norms as well as the context and the conditions for their application. These discussions generate a special kind of normativity, which ought to be recognised by our legal system. Law itself would benefit from an interaction with such normativity.
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Fukushima, Corinna. "Autonomy and Distributive Justice at the End of Life." Scholarship @ Claremont, 2016. http://scholarship.claremont.edu/scripps_theses/878.
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Discussions of autonomy at the end of life in health care contexts is no new phenomenon. However, what seems to have changed in issues of autonomy is cases where patients want to refuse a treatment to cases where patients are demanding more treatment when medical professionals may not agree or be able to provide them with the medical treatment. Some key competing interests impacting patient autonomy include beneficence-doing what is in the best interests of the health or well-being of the patient- and resource limitations. Here, I will explore distributive justice theories that impact the end of life and how they constrain autonomy.
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Burger, Julia. "Health Literacy, its Effect on Emergency Department Utilization, and a Smartphone-based Intervention." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/531766.
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Urban BioethicsM.A.
Health literacy is not only the ability to read, but also the ability of an individual to obtain, process, and understand the basic health information needed to make appropriate health decisions. Over time the concept of health literacy has evolved from considering it a risk factor to be managed to considering it an asset which can be continually built upon. With this in mind health professionals should continue to communicate in simple language, but should also provide their patients with high-quality educational materials and aid them in making the best choices about their health. One way to do this could be with the use of symptom-checking and decision-aiding smartphone apps. In this study, the primary caretakers of children aged 30 months and younger with publicly funded health insurance will be randomized to receive a pediatric symptom-checking smartphone app or a developmental milestone smartphone app. Caretaker health literacy will be measured, and data will be collected on emergency department and primary care office sick visits. It is hypothesized that the use of the pediatric symptom-checking smartphone app will decrease non-urgent visits to the pediatric emergency department.
Temple University--Theses
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Edelstein, Jonathan. "THE PRISONER DILEMMA: A BIOETHICAL ANALYSIS OF THE ACCESS TO HEALTHCARE OF INCARCERATED POPULATIONS." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/591995.
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Urban BioethicsM.A.
Correctional populations account for about 2% of persons in the United States, who have a unique right to health care guaranteed by the Constitution per court decisions. However, the quality and breadth of this care is not standardized, and incarceration itself creates risk factors for one’s health. A review of the literature was done to evaluate the health and access to care of prison populations. Prison populations are largely minorities from poor neighborhoods with low socioeconomic status who usually have limited engagement with health services prior to incarceration; there is a large amount of morbidity of chronic diseases in prisons, and prisoners are at increased risk for communicable diseases, substance abuse and mental illness. Former inmates are also at increased risk of death following release. While advances such as telemedicine help to bridge the gaps in correctional health, more research needs to be done to assess the needs of this population, and more education and linkage to care should be accomplished to do right by these populations and ensure they get the care they need. This will in turn lead to better health outcomes in this population and may have a beneficial effect on the communities from which these prisoners come.
Temple University--Theses
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Gracyk, Tatiana Athena. "A Structured Principlist Framework for Decision Making in Healthcare." Bowling Green State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1587048784866015.
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Kruger, Mariana. "Ethics education in a problem-based medical curriculum." Thesis, Stellenbosch : Stellenbosch University, 2005. http://hdl.handle.net/10019.1/50339.
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Thesis (MPhil)--Stellenbosch University, 2005.ENGLISH ABSTRACT: The complex ethical dilemmas created by advanced technological medicine and problematic doctor-patient relationships have lead to an increasing interest in medical ethics education since the 1980's. The Medical School of the University of Pretoria has embarked on a new undergraduate medical curriculum in 1997. Ethics is educated in a longitudinal fashion over the six years of the medical curriculum and has focussed largely on the principal-based approach as described by Beauchamp and Childress. The research participants were the first final year class of this new curriculum, while the facilitators were medical educators or philosophers. The major finding was that the students were not yet able to identify ethical dilemmas with ease, although they were successful in the application of the principal-based approach to the vignettes of the study. The students did not cope well with the uncertainty created by ethical dilemmas and sought to solve the situation by creating boundaries provided by medical law. Therecommendations of the study are that the theoretical component of the ethics curriculum should: 1) include more approaches to ethics, than only the principal-based approach; 2) address daily experienced ethical dilemmas during the study years in small group discussions; 3) and implement a portfolio assessment which can serve as a tool for students to track their own development in reflection on ethical dilemmas. In conclusion, the question remains whether we are currently ready to come ""face to face" with the "other" as Levinas argues or are we still divided into "only two classes of mankind in the world - doctors and patients" as remarked by Kipling in the 19th century.
AFRIKAANSE OPSOMMING: Die komplekse etiese dilemmas, veroorsaak deur hoogs gespesialiseerde tegnologiese medisyne en die problematiese dokter-pasiënt verhouding, het gelei tot 'n verhoogde belangstelling in mediese etiekonderrig sedert die 1980's. Die Mediese Skool van die Universiteit van Pretoria het in 1997 'n nuwe voorgraadse mediese kurrikulum geïmplimenteer. Etiek is op 'n longitudinale manier onderrig oor ses jaar in die mediese kurrikulum en het gefokus op die beginsel-benadering soos beskryf deur Beauchamp en Childress. Die navorsingsdeelnemers was die eerste finale-jaar klas van die nuwe kurrikulum, terwyl die fasiliteerders mediese dosente of filosowe was. Die hoofbevinding van die kurrikulum was dat die studente nie die etiese dilemmas met gemak kon identifiseer nie, alhowel hulle suksesvol die beginsel-benadering kon toepas op die gevallestudies. Die studente hanteer nie onsekerheid, veroorsaak deur die etiese dilemmas, met gemak nie en probeer om die saak op te los deur die skep van grense verskaf deur mediese reg. Die aanbevelings van die studie is dat die teoretiese komponent van die etiekkurrikulum die volgende moet bevat: 1) bekendstelling aan meerdere benaderings tot die etiek, bo en behalwe die beginsel-gebaseerde benadering; 2) aanspreek van die daaglikse etiese dilemmas gedurende die studiejare in kleingroepbesprekings; 3) en die implementering van 'n portfolio-evaluasie, wat kan dien as 'n instrument vir die studente om hul eie ontwikkeling aangaande nadenke oor etiese dilemmas na te gaan. Opsommend, die vraag is steeds of ons tans gereed is om "aangesig-tot-aangesig" te verkeer met die "ander" soos Levinas redeneer of is ons steeds verdeel in "slegs twee klasse van menswees in die wêreld - dokters en pasiënte" soos opgemerk deur Kipling in die 19deeeu.
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Esser, Jan Hendrik. "Who cares? : moral reflections on business in healthcare." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52612.
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Thesis (MPhil)--University of Stellenbosch, 2001.ENGLISH ABSTRACT: This evaluation serves the purpose of illuminating concepts and ideas behind the moral impact of business values in healthcare and to establish a framework for the analysis of moral dilemmas found in the sphere ofbio-medical ethics. The historic developments of business in healthcare are examined, looking at how and why business became an integral part of the health care system. The concept of "managed healthcare" is introduced and used as the context in which the different institutional role-players are brought together. Managed healthcare is defined by a discussion of the different organisational structures through which it manifests itself. The policies, procedures and regulations that managed healthcare organisations implement and control to fulfil their general function are also examined. Some normative aspects pertaining to the concept of managed health care are explored, including the institutional values of business and that of medicine. A brief discussion of the economic system in which the business agents or role players function are included in the evaluation of the institutional values of business. Further arguments are made to show how the healthcare system with all its role players displays the characteristics of a complex system. Discussions on the fundamental values of medicine concentrate on the basic ideas behind virtues and principles of medical ethics. It is argued that the development of these virtues and principles are important foundations on which the medical profession stands. The moral impact of combining these institutional values within the context of managed healthcare relationships is examined and some important moral dilemmas or conflicts are identified. It is further argued that the fundamental relationships between all the role players in the health care system have changed as all the agents function within a complex system, giving rise to new organisational structures and relationships, with new conceptual roles, ideals, values and practices.
AFRIKAANSE OPSOMMING: Hierdie evaluasie het dit ten doelom sekere konsepte en idees agter die morele impak van besigheidswaardes in gesondheidsorg te illumineer en om 'n raamwerk daar te stel vir die verdere analise van morele dilemmas in die sfeer van bio-mediese etiek. Die historiese ontwikkeling van besigheid in gesondheidsorg word verken deur die redes aan te voer waarom besigheid deel van die gesondheidsorgsisteem geword het. Die konsep "bestuurde gesondheidsorg" word gebruik as die konteks waarin die verskillende institusionele rolspelers bymekaar gebring word. Bestuurde gesondheidsorg word gedefinieer deur die verskillende organisatoriese strukture waardeur dit manifesteer. Die prosedures, regulasies en bereid wat bestuurde gesondheidsorgorganisasies implementeer om hul funksies te vervul word ook verken. Normatiewe aspekte van bestuurde gesondheidsorg word verken, waarby ingesluit word die institusionele waardes van besigheid sowel as dié van medisyne. 'n Kort beskrywing van die ekonomiese sisteem waarin die besigheidsagente, of rolspelers funksioneer word ingesluit by die evaluasie van die institusionele waardes van besigheid. Verdere argumente word gevoer om te wys daarop hoe die gesondheidsorgsisteem met al sy rolspelers die karakter toon van 'n komplekse sisteem. Die basiese idees agter deugsaamheid en morele beginsels van bio-mediese etiek word bespreek om die fundamentele waardes van medisyne te beskryf. Daar word geargumenteer dat die ontwikkeling van hierdie waardes 'n belangrike fondament is waarop die mediese professie staan. Die morele impak van die kombinasie tussen die institusionele waardes van besigheid en medisyne binne die konteks van bestuurde gesondheidsorg word geevalueer en belanrike morele dilemmas en konflikte word geidentifiseer. Verder word geargumenteer dat die fundamenrele verhouding tussen al die rol spelers in die gesondheidsisteem verander het danksy die funksionering van die agente binne hierdie komplekse sisteem. Dit lei op sy beurt na veranderinge in organisatoriese strukture en verhoudinge met nuwe konsepsuele rolle, idiale, waardes en praktyke.
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Alla, Stanislaus Subba Reddy. "Care and Access: Catholic and Hindu Approaches to Ethics in Healthcare." Thesis, Boston College, 2014. http://hdl.handle.net/2345/bc-ir:103743.
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Thesis advisor: James F. KeenanSecular voices have contributed immensely to the emergence of bioethical discourse in India. The media and the intellectuals frequently employ the language of human dignity, rights and justice to critique the policies of the government or medical institutions and the contemporary healthcare practices. In analyzing the healthcare concerns and in proposing remedial measures to better the situation, they also refer to the notions of care and access but in secular terms. Recognizing that insufficient attention has been paid to the religious dimension in this process and arguing that peoples' religious worldviews bear enormous influence on the entire spectrum of healthcare and in making it better accessible, the thesis examines the Catholic and Hindu religious traditions to find out how they have historically wrestled with and incorporated the theological values of care and access in dealing with healthcare. The study also draws upon the contemporary practices and policies of two select Catholic and Hindu healthcare institutions to illustrate how care and access inform their services and policies. In conclusion, I propose that the inclusion of religious insights and foundational theological values and principles into the mainstream bioethical discourse in India will both enrich the interreligious learning and enhance the various initiatives to promote basic healthcare more participatory and successful
Thesis (PhD) — Boston College, 2014
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Theology
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Patel, Hamish Rajni. "When the Invisible Becomes Visible: Deconstruction Stigma and Changing Identity by Exploring the Lived Experience of Those with Multiple Sclerosis." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/441109.
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Urban BioethicsM.A.
This paper examines the lived experience of multiple sclerosis (MS) through the lens of stigma. Stigma is a social phenomenon through which people who are deemed outside the norm, due to either behavior or appearance, become vulnerable to being discredited or ostracized. The case of MS is interesting, because while it eventually manifests in distinct outward physical signs, individuals with the disease often live for years without outward symptoms, meaning that their stigma-inducing qualities are latent, but not yet seen. Pre-symptomatic individuals, in attempting to manage the inevitable stigma, must balance the risks and benefits of choosing whether to pass or reveal. The seismic physiologic shifts MS flares cause result in changes to both an individual’s physical and social capabilities, thus affecting individual’s roles and subsequent emotional well-being, which can be further impacted by social stigmatization. As a result of physical limitations, individuals with MS experience stigma in the form of employment discrimination, co-worker misunderstandings, and familial over or under attention to their illness. These factors only exacerbate the emotional despondence these individuals experience from a loss in their identity. By looking at the literature on stigma formation, management of invisible social identities, and the stigma of MS, an appreciation for the lived experience of MS can be gained. Such an appreciation can hopefully lead to methods to prevent the marginalization of such groups and foster supportive measures and education that helps deconstruct the stigma.
Temple University--Theses
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Devlin, Amie. "The Role of Compensation in Clinical Research and the Ethical Considerations." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/495415.
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Urban BioethicsM.A.
In order to ensure the generalizability of clinical research studies, researchers and study sponsors are tasked with making efforts to ensure that research participants are racially and ethnically representative of the population at large. However, minorities and women continue to be underrepresented in medical research studies. To encourage participation in medical research studies, researchers are often inclined to offer compensation for study participation. However, it is vital that researchers consider the ethical implications of monetizing participation in medical research studies. The first aim of this paper is to discuss the ethical ramifications of providing compensation for research participation. Additionally, this paper will critically analyze the various ways of handling financial compensation for participation in medical research studies involving experimental drugs, devices or surgical techniques. Information for this paper was gathered by conducting a literature review and by analyzing 121 semi-structured interviews. Using an ethical framework, and supported by qualitative data from the interviews, this paper will discuss the ethical concerns that researchers must consider when offering monetary compensation in exchange for participation in medical research. Overall, the paper aims to show that in order for clinical research to be conducted ethically, we must grant potential participants the autonomy to use their own decision making framework when deciding whether or not to participate in a medical research study. While a potential participant’s decision to join a research study in exchange for financial compensation may raise concerns to some people, autonomy requires that the research institution respect each individual’s own motivations and decisions.
Temple University--Theses
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Hason, LaiQuannah. "IF NOT NOW, WHEN?" Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/578705.
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Urban BioethicsM.A.
Maternal Health requires a bioethical evaluation to thoroughly address and reduce the troubling statistics and events of pregnancy-related complications and maternal mortality. Maternal mortality affects African American women three to four times more than any other race, therefore presenting race as a factor. Types of experienced racism and the overall scientific pathway are explored in relation to the health of African-American women. Race-related stress and its association with adverse maternal health outcomes is an important issue to consider when evaluating the maternal health complications. In addition, addressing the result of unethical inequalities in the healthcare system in combination with other societal contributions is essential when trying to recognize its impact on the experience of pregnancy. This thesis explores the impact of racism on maternal outcomes and health of African-American mothers, beyond the commonly understood influences of other socio-economic factors.
Temple University--Theses
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Albanesi, Thomas Samuel. "Advocacy: The Ethical Duty of Every Physician." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/598621.
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Urban BioethicsM.A.
The American medical profession has publicly pondered its roles and duties since its inception in the 18th century. Recently, that discussion has included whether or not advocacy by physicians is a responsibility of the profession. The following work is an argument and plan to support the ethical, professional imperative of physician advocacy. The historical underpinnings of the American medical profession suggest a responsibility to patients and interactions with society. In addition, there is a strong bioethical argument in favor of physician advocacy as an essential duty. Although there is a well-recognized set of barriers to physician advocacy, this article details solutions to help implement advocacy as a daily practice in the lives of all physicians. This piece will describe a way forward for physicians to take on their professional responsibility to advocate.
Temple University--Theses
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Keyserlingk, Edward W. "Treating seriously disabled newborn children : the role of bioethics in formulating decision-making policies in interaction with law and medicine." Thesis, McGill University, 1985. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=72022.
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The goal of this work is to explore the role of theological bioethics in influencing the formulation of existing or proposed policies dealing with treatment decisions for seriously disabled newborns in our pluralist society. Part I of the paper attempts to determine as precisely as possible what bioethics is, particularly Judeo-Christian bioethics. After comparing the latter to the Hippocratic tradition and to secular bioethics, the distinctive characteristics and potential contribution of theological bioethics are identified. The policies then examined in Part II are: medical policies formulated by physicians, bioethical policies proposed by bioethicists and legal policies enunciated by court decisions and legal writers. In each case they are evaluated in the light of a number of specific ethical tests proposed as central to Judeo-Christian bioethics. The paper concludes that Judeo-Christian bioethics has not been particularly influential in our pluralist society. A final section proposes a model treatment policy.
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Halsey, Brenton Shaw. "The Ethical Argument for Implementing Screening For Adverse Childhood Experiences in the Care of Adult Patients." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/540882.
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Urban BioethicsM.A.
Childhood trauma greatly impacts the lives of patients and their future health outcomes. Since the discovery of the utility of the Adverse Childhood Experiences (ACEs) screening tool in the 1990s, many providers have attempted to screen and intervene on these past experiences of trauma with mixed results. ACEs have an outsized impact on adult health. There is considerable literature documenting the changing state of screening for ACEs in adult populations, and the compelling rationales for doing so. There are also a number of interventions available currently, but providers face challenges to use them. Ethical considerations and issues with the current state of screening for ACEs exist, due to some of these challenges and differential availability of interventions between populations. Here, I use the principles of urban bioethics to explain the ethical obligation of screening for ACEs despite these challenges and to dispute previous discussions on this topic. This article will show that there are general strategies that providers can take to implement ACEs screening in an ethical manner and specifically discusses trauma-informed care’s utility to help achieve these strategies. Through this discussion, I hope to encourage providers to reconsider ACEs screening and give them strategies to do so.
Temple University--Theses
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Beaty-Edwards, Dawn Tanesha. "ETHICS AT THE BEDSIDE: ADVOCACY FOR THE PATIENT AND THE COST." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/563468.
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Urban BioethicsM.A.
As a healthcare professional at the bedside, it has been very difficult to advocate for the patient while all parties involved cannot respect what the patient wants. Four out of five Americans do not have an advance directive. The history and court cases that have led the country to make patient’s right to make their own healthcare decisions has been decades in the making, yet still bring daily challenges within the healthcare system. When a patient’s wishes are not being honored, medical futility may lead to moral distress and compassion fatigue. Institutions provide multidisciplinary teams to address these issues, but if a patient’s capacity or competence is in question, their voice may not be heard. The toll on the healthcare provider and the patient can be permanently damaging, causing many nurses to leave the profession all together. I will attempt to determine the barriers to implementing the patient’s wishes, address the syndrome of moral distress among healthcare professionals, and attempt to offer solutions to promote well rounded, patient-centered care.
Temple University--Theses
30
Arnman, Reet. "Doctor's experiences of work related moral problems : responsibility without clear boundaries /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-870-X/.
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Honeycutt, Willie E. "Bioethical education in the local church." Deerfield, IL : Trinity Evangelical Divinity School, 2008. http://dx.doi.org/10.2986/tren.006-1595.
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Coulter, Andrew Mark. "EFFECT OF A MEDICAL STUDENT-LED END-OF-LIFE PLANNING INTERVENTION IN COMPLETION OF ADVANCED DIRECTIVES AMONG HOMELESS PERSONS." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/380271.
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Urban BioethicsM.A.
Importance – The homeless face higher rates of morbidity and mortality than the general population, and have lower rates of end-of-life care planning. An effective and sustainable intervention, to provide living wills and durable power of attorney, is required to protect the autonomy of a vulnerable population. Objective – To determine if medical student-led 1:1 counseling is as effective as social worker-led counseling as reported in the literature, determined by rate of advanced directive completion. Design – A focus groups and educational sessions on EOL care and ADs were conducted at 2 shelters, after which participants were offered the opportunity to sign up for a 1:1 counseling session with a medical student volunteer. Rates of sign-ups and completion were recorded. Setting – 2 North Philadelphia homeless shelters, requiring either an Axis I or current substance abuse diagnosis for residence. Participants – A convenience sample of 20 homeless men were approached; 10 enrolled in the study. Interventions – Educational sessions, focus groups, and 1:1 AD completion counseling sessions Main Outcomes – Interest in and completion of an advanced directive. Results – 9 participants signed up to complete ADs after an informational session. At the conclusion of the study, 8 of them (88.8%) completed ADs. 40% of the total participants completed an AD. Conclusions – Similar rates of advanced directive completion were achieved with the student-led intervention compared to a previous intervention in the literature. Further study with a larger sample including homeless women should be conducted to provide a generalized conclusion.
Temple University--Theses
33
Luscumb, Jane Marie. "Willingness of Nurses to Respond after Alaskan Earthquake| Systematic Literature Review." Thesis, Walden University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10257330.
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Nurses may share a commonality of issues which can affect their willingness and ability to respond as post-disaster emergency care providers. Guided by expectancy, locus of control, and chaos theory, a systematic literature review was conducted to identify the barriers which affect nurses’ willingness and ability to report to their unit after a disaster occurs. Briggs methodology guided this systematic review, and Fineout-Overholt’s and Melnyk levels of evidence were used to evaluate the reliability of information and effectiveness of their interventions. Fifteen articles meeting the inclusion criteria (addressed nurses’ willingness to report to their unit or to contact the incident command center for mobilization, published in 2005 or after, and written in English) were reviewed. Twelve were systemic reviews of descriptive and qualitative studies (Level 5), one was a cohort study (Level 4), one was a report of expert committees (Level 7), and one reported findings from a pilot study. Five articles reported personal barriers related to the nurses’ home caregiver responsibilities and four articles reported personal barriers related to nurses’ concern for personal and family safety. Three articles reported institutional barriers related to unsure availability of necessary safety equipment and two articles reported lack of disaster preparedness. Developing a disaster plan that includes emergency phone numbers, a prepared backpack of basic survival gear, and a plan for emergency child and elder care arrangements, as well as providing disaster training for nurses was recommended. Understanding health provider needs and willingness to respond to emergency situations contributes to positive social change by contributing to disaster risk reduction and ensuring safer and more resilient communities.
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Randolph, Micheal L. "The Need for Soft Skills in a Medical Assistant Program." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2754.
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There is a perceived soft skills problem within the medical assistant program (MAP) at a 2-year technical college in the Midwestern United States. Soft skills refer to relational skills such as practicing self-management, communicating with various groups, adapting to change, negotiating, and resolving conflict. The purposes of this intrinsic case study were to (a) understand the perspectives of faculty, staff, and leadership regarding students' soft skills ability within the study MAP and (b) identify important soft skills needed in the workplace. An integrative conceptual framework that drew upon vocational and organizational theories was used as a theoretical framework for the study. Fourteen participants, comprised of program faculty, program leadership, and staff members from local healthcare clinics, participated in open-ended interviews. Documents were also collected, including the college mission, class syllabi, and attendance records. The interview transcripts and documents were analyzed through Creswell's 6-step process of data preparation/organization, data sorting, developing description codes, narration/visual representation of findings, reflective interpretation of results, and finding validation strategies. Findings confirmed a perceived need for soft skills instruction in communication skills, professionalism, work ethic, interpersonal skills, and good judgement. Positive social change could occur from the organization improving students' workplace success through a deeper understanding of these needed soft skills. Further, MAP students at the study site would be better positioned to provide an increased quality of patient care.
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Wytiaz, Victoria. "Physician-as-patient literature: Introducing and fostering a culture of empathy in medicine." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/449267.
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Urban BioethicsM.A.
The physician-patient dichotomy is reinforced continuously in medical education and medical practice. The physician possesses knowledge that will be used to help the patient in some way. However, as human beings, physicians are subject to the illnesses and diseases that affect their patients. Physicians moved by this role-reversal may feel compelled to record their experiences, leading to an accumulation of “physician-as-patient literature.” Five examples of “physician-as-patient” literature illustrate five fundamental lessons that can be adapted by physicians: relating to patient vulnerability, fostering hope for patients, mobilizing support systems, recognizing physical consequences of disease, and appreciating patient quality of life. By generalizing these individual stories, it is not necessary for physicians to experience the exact disease or illness they treat. Rather, they can draw from their unique life experiences to practice empathy. The concept of empathetic medicine can be introduced in medical school training by integrating empathy education into scientific curriculum. Current practitioners can benefit from narrative exercises, reflection and physician self-disclosure in efforts to promote empathy. Medical practice requires solid relationships between human beings, physicians and patients. This basic principle is further emphasized in “physician-as-patient” literature and concerted efforts by institutions and individual physicians can lead to a foundation for a culture of empathy.
Temple University--Theses
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Schmutzer, D. E. "A survey indicating evangelical pastoral needs and preparation with regard to bioethical issues in the ministry." Theological Research Exchange Network (TREN), 2008. http://www.tren.com/search.cfm?p006-1583.
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Fragassi, Christopher. "SCHIZOPHRENIA AND STIGMA: AN OUTLOOK ON THE MEDICAL, LEGAL, AND SOCIAL ASPECTS OF LIVING WITH SCHIZOPHRENIA." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/488872.
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Urban BioethicsM.A.
Schizophrenia is a disease which presents many challenges. Medically, legally, and socially, afflicted individuals face obstacles that decrease their overall quality of life. Some of these are sequela of the disease and its decrease in social functioning, or symptoms of paranoia and disorganization. However, others are placed on these individuals by society. This has created a lifestyle which is marred by comorbid medical conditions and a resistance to receive treatment. It also creates frequent contact with the legal system, leading to a disorganized home life, and a significant amount of time spent behind bars, and being victimized by others. Finally, many schizophrenic patients are unable to find jobs, and report being without significant supportive relationships in their lives, creating stress both on themselves and their families and caregivers. These difficulties in life can be inseparable from their disease and place schizophrenic patients at a further disadvantage.
Temple University--Theses
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Heyman, Brooke Nicole. "A Nod Doesn't Always Mean Yes." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/372451.
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Urban BioethicsM.A.
This thesis explores the role of formal bioethics instruction in preparing medical students to face ethical issues pertinent to diverse populations in clinical practice. The importance of bioethics education has been widely recognized and as a result, it is formally required in all medical schools. However, with little standardization on the actual logistics, ethics education in medical schools is extremely variable, producing students who are naïve and/or inconsistently capable of managing ethically complex situations. During medical school I pursued a Masters of Arts in Urban Bioethics (MAUB), which heavily focused on the social determinants of health and how they manifest in health care settings. I acquired new skills that gave me perspective and awareness into ethical issues that urban populations face, and during my clerkships I found I was better equipped and more comfortable navigating my patients’ non-medical complexities than my non-MAUB peers. Using three personal patient encounters as examples, I illustrate how a comprehensive urban bioethics education can positively impact patient care. Finally, I suggest improvements to medical schools’ bioethics curricula that will likely influence and mold each student’s thought processes to be more ethically-aware and culturally-sensitive. The goal of reforming bioethics education is to give students a set of real-world skills rather than a theoretical book of knowledge. Without a comprehensive and multifaceted approach to bioethics, students will likely lack the cultural sensitivity, awareness, and perspective necessary to treat a diverse patient population.
Temple University--Theses
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Anthony, John. "The justfiable limitations of patient autonomy in contemporary South African medical practice." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/2859.
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Thesis (MPhil (Philosophy))--University of Stellenbosch, 2009.ABSTRACT: The European Enlightenment secured man’s freedom from doctrinal thought. Scientific progress and technological innovation flourished in the 18th Century, radically changing the lives of all. Man’s mastery and transformation of his environment was matched by revolutionary political reform, resulting in the dissolution of empire and the transfer of power into the hands of the people. Social transformation saw the city-states of pre-modern man supplanted by a globalized community whose existence grew from time and space distantiation facilitated by the new technologies and the development of symbolic forms. These sweeping social, political and ideological changes of the 18th Century fostered the belief that man’s transformative authority was indeed his to command. Man believed he had a right to self-governance and to autonomous decision-making. Kant described moral autonomy as the freedom men have to show rational accountability for their actions and he saw in men a dignity beyond all price because of this moral autonomy. Personal autonomy is seen as the expression of the free will of individuals and is justifiably constrained by the need to respect the interests and agency of others. The principle of autonomy, in the context of medical practice, was not clearly articulated until the early 20th century. Prior to this, the ethical practice of medicine relied upon the beneficent intentions of the practitioners. The limits to patient autonomy have been delineated largely by issues of social justice based upon the need to share scarce resources fairly among members of society. However, autonomy remains a dominant principle and is most clearly exemplified by the process of informed consent obtained prior to any medical intervention. This thesis provides a conceptual analysis of autonomy in the context of informed consent. Following this, several different clinical scenarios are examined for evidence of justifiable limitations to patient autonomy. Each scenario is examined in the light of different moral theories including deontology, utilitarianism, communitarianism and principlist ethical reasoning. Kantian ethical reasoning is found to be resilient in rejecting any limitation to the autonomy principle whereas each of the other theories allow greater scope for morally-justified curtailment of individual autonomy. The thesis concludes with reflection on post-modern society in which the radicalization of what began with the European Enlightenment sees the transformation of pre-modern society into a global community in which epistemological certainty is no longer available. In this environment, the emerging emphasis on global responsibility requires ethical accountability, not only when individuals secure transactions between one another but also between individuals and unknown communities of men and women of current and future generations. The thesis concludes that patient autonomy is justifiably limited in South African medical practice because of issues related to social justice but that the impact of the new genetic technologies and post-modernity itself may in future set new limits to individual patient autonomy.
OPSOMMING: Die Europese Verligting het die mensdom bevry van verstarde, dogmatiese denke. Wetenskaplike en tegnologiese ontwikkelinge het tydens the 18de Eeu die lewens van almal radikaal verander. Die mens se bemeestering en transformasie van sy omgewing het gepaard gegaan met revolusionêre politieke hervormings wat gelei het tot die ontbinding van tradisionele politieke ryke en die oordrag van mag aan die mens. Sosiale transformasie het veroorsaak dat die politieke ordeninge van voor-moderne mense deur ‘n globale gemeenskap vervang is wat ontstaan het as gevolg van onder meer die ontkoppeling van tyd en plek (Giddens), en wat deur nuwe tegnologiese ontwikkelings en die ontstaan van simboliese vorms moontlik gemaak is. Hierdie uitgebreide ontwikkelinge het die idee laat ontstaan dat niks vir die 18de Eeuse mens onmoontlik is nie. Die mens het geglo dat hy ‘n reg het op self-bestuur en outonome besluite. Kant het die morele outonomie van die mens beskou as sy vryheid om verantwoordlikheid te neem vir sy eie rasioneel-begronde handelinge en verder het hy ‘n besondere waardigheid in die mens geïdentifiseer vanweë sy morele outonomie. Omdat ‘n mens hierdie eienskap besit, beskik hy oor ‘n hoër waardigheid as alle alle ander lewensvorme. Persoonlike outonomie is die uitoefenimg van die vrye wil van die individu en word om geregverdigde redes beperk deur die regte van ander mense. Die beginsel van outonomie met verwysing na mediese etiek het nie voor die begin van die 20ste eeu prominent geword nie. Voor hierdie tyd het mediese etiek staatgemaak op die goeie voorneme van die praktisyn. Die grense van individuele outonomie word nou bepaal deur die noodsaak van sosiale geregtigheid. Al is dit die geval, bly die beginsel van outonomie die belangrikste beginsel in die etiese debat en word meestal gesien as ‘n deel van die proses van ingeligte toestemming. Hierdie tesis verskaf ‘n omvattende ontleding van outonomie met betrekking tot ingeligte toestemming. Daarna word verskillende kliniese gevalle beskryf en ontleed, en verskeie etiese teorieë gebruik om die wyse waarop pasiënt outonomie reverdigbaar ingekort behoort te word, te bespreek. Die teorie van Kant is in staat om enige inkorting van outonomie in alle gevalle the weerstaan. Elkeen van die ander teorieë verskaf redes waarom die outonomie van individuele pasiënte legitiem ingekort mag word. Hierdie werk sluit af met besinning oor die post-moderne gemeenskap wat ‘n globale samelewing moet aanvaar sowel as die ontoereikenheid van enige kenteoretiese sekerheid. Die ontwikkelende verantwoordelikheid vir die totale mensdom in hierdie wêreld veroorsaak dat individue nie meer slegs moet besluit oor die morele verhouding met sy medemens nie, maar ook oor sy verhouding met mense van gemeenskappe wat geskei is in tyd en ruimte, insluitend sy verhouding met die mense van toekomstige generasies. Hierdie werk sluit af met die gevolgtrekking dat pasiënt outonomie regverdigbaar beperk word in die Suid Afrikaanse mediese praktyk deur die noodsaaklikheid van sosiale geregtigheid. Die verwagte impak van nuwe genetiese tegnologieë en die ontwikkeling van ‘n post-moderne gemeenskap mag nuwe beperkings bring vir pasiënt outonomie.
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Braunack-Mayer, Annette. "General practitioners doing ethics : an empirical perspective on bioethical methods /." Title page, contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09PH/09phb8253.pdf.
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Lucki, Joseph Max. "Examining the Impact of Health Literacy on Communication: A Quantitative and Qualitative Analysis of a Previously Under-Studied Patient Population." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/437487.
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Urban BioethicsM.A.
Low health literacy is highly prevalent in the United States and can significantly impact health outcomes for patients. Prior research has shown that communication is a major mediator between health literacy and health outcomes. However, there has been limited investigation into the quality of communication of patients who attend clinics staffed by medical residents. The patient population attending the resident clinic at Temple University Hospital is made up mostly of African Americans from lower-income neighborhoods of North Philadelphia. This investigation aims to gather data regarding the relationship between health literacy and communication in this previously under-studied patient population. Using a rapidly self-administered health literacy screening tool, the quantitative data reveals a high prevalence of low health literacy in this patient population. Additionally, using a semi-structured interview with a two-staged coding process, the qualitative data describes several ways in which limited health literacy can diminish optimal patient-provider communication. The patients in this study population express a high desire for information about their health status, as incomplete communication was a potential source of anxiety. Suggestions from patients in this population focus on increasing active participation in clinic visits. Study subjects agreed that interventions targeted towards medical residents would help to improve communication with low health literacy patients. Novel approaches to educating medical trainees about health literacy should be investigated in the future.
Temple University--Theses
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Rivera, Victor. "HOW TRADITIONAL DEFINITIONS OF AUTONOMY IMPAIR DECISION-MAKING IN SPINAL MUSCULAR ATROPHY AND ALZHEIMER DISEASE." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/553526.
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Urban BioethicsM.A.
Clinical decision making is influenced by available literature, technology, and guidelines, but also by cultural expectations, physician experience, and personal biases. The treatment of various forms of disability is especially vulnerable to these prejudices. Alzheimer Dementia (AD) and Spinal Muscular Atrophy (SMA) represent forms of cognitive and physical disability, respectively. In severe forms of both diseases, patients are often unable to communicate and do not meet traditional definitions of autonomy. However, physicians and consensus guidelines adhere to these very same definitions of autonomy, which subsequently disadvantages patients that cannot verbalize. This bias is reflected in available guidelines for catheter-directed thrombectomy for acute ischemic strokes, which passively discourage physicians from treating patients with baseline AD. Inversely, pediatric definitions of autonomy may expose patients to over-treatment with nusinersen, a medication recently approved for the treatment of SMA. Adapting theories of bodily autonomy will allow physicians to approach the treatment of those who cannot verbalize in a more ethical fashion.
Temple University--Theses
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Rossouw, Theresa Marie. "Identity, personhood and power : a critical analysis of the principle of respect for autonomy and the idea of informed consent, and their implementation in an androgynous and multicultural society." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/19906.
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Thesis (PhD)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Autonomy and informed consent are two interrelated concepts given much prominence in contemporary biomedical discourse. The word autonomy, from the Greek autos (self) and nomos (rule), originally referred to the self-governance of independent Hellenic states, but was extended to individuals during the time of the Enlightenment, most notably through the work of Immanuel Kant and John Stuart Mill. In healthcare, the autonomy model is grounded in the idea of the dignity of persons and the claim people have on each other to privacy, self-direction, the establishment of their own values and life plans based on information and reasoning, and the freedom to act on the results of their contemplation. Autonomy thus finds expression in the ethical and legal requirement of informed consent. Feminists and multiculturalists have however argued that since autonomy rests on the Enlightenment ideals of rationality, objectivity and independence, unconstrained by emotional and spiritual qualities, it serves to isolate the individual and thus fails to rectify the dehumanisation and depersonalisation of modern scientific medical practice. It only serves to exacerbate the problematic power-differential between doctor and patient. Medicine is a unique profession since it operates in a space where religion, morality, metaphysics, science and culture come together. It is a privileged space because health care providers assume responsibility for the care of their patients outside the usual moral space defined by equality and autonomy. Patients necessarily relinquish some of their autonomy and power to experts and autonomy thus cannot account for the moral calling that epitomizes and defines medicine. Recognition of the dependence of patients need not be viewed negatively as a lack of autonomy or incompetence, but could rather reinforce the understanding of our shared human vulnerability and that we are all ultimately patients. There is however no need to abandon the concept of autonomy altogether. A world without autonomy is unconceivable. When we recognise how the concept functions in the modern world as a social construct, we can harness its positive properties to create a new form of identity. We can utilise the possibility of self-stylization embedded in autonomy to fashion ourselves into responsible moral agents that are responsive not only to ourselves, but also to others, whether in our own species or in that of another. Responsible agency depends on mature deliberators that are mindful of the necessary diversity of the moral life and the complex nature of the moral subject. I thus argue that the development of modern individualism should not be rejected altogether, since we cannot return to some pre-modern sense of community, or transcend it altogether in some postmodern deconstruction of the self. We also do not need to search for a different word to supplant the concept of autonomy in moral life. What we rather need is a different attitude of being in the world; an attitude that strives for holism, not only of the self, but also of the moral community. We can only be whole if we acknowledge and embrace our interdependence as social and moral beings, as Homo moralis.
AFRIKAANSE OPSOMMING: Outonomie en ingeligte toestemming is twee nou verwante konsepte wat beide prominensie in moderne bioetiese diskoers verwerf het. Die woord outonomie, van die Grieks autos (self) en nomos (reël), het oorspronklik verwys na die selfbestuur van onafhanklike Griekse state, maar is in die tyd van die Verligting uitgebrei om ook na individue te verwys, grotendeels deur die werk van Immanuel Kant en John Stuart Mill. In medisyne is die outonomie model gegrond op die idee van die waardigheid van die persoon en die beroep wat mense op mekaar het tot privaatheid, selfbepaling, die daarstelling van hulle eie waardesisteem en lewensplan, gebasseer op inligting en redenasie, en die vryheid om op die uitkoms van sulke redenasie te reageer. Outonomie word dus vergestalt in die etiese en wetlike bepaling van ingeligte toestemming. Feministe en multikulturele denkers beweer egter dat, siende outonomie gebasseer is op die Verligting ideale van rasionaliteit, objektiwiteit en onafhanklikheid, sonder die nodige begrensing deur emosionele en spirituele kwaliteite, dit die individu noodsaaklik isoleer en dus nie die dehumanisering en depersonalisering van moderne wetenskaplike mediese praktyk teenwerk nie. As sulks, vererger dit dus die problematiese magsverskil tussen die dokter en pasiënt. Die beroep van medisyne is ‘n unieke professie aangesien dit werksaam is in die sfeer waar geloof, moraliteit, metafisika, wetenskap en kultuur bymekaar kom. Dit is ‘n bevoorregde spasie aangesien gesondheidswerkers verantwoordelikheid vir die sorg van hulle pasiënte aanvaar buite die gewone morele spasie wat deur gelykheid en outonomie gedefinieer word. Pasiënte moet noodgedwonge van hulle outonomie en mag aan deskundiges afstaan en outonomie kan dus nie genoegsaam die morele roeping wat medisyne saamvat en definieer, vasvang nie. Bewustheid van die afhanklikheid van pasiënte hoef egter nie in ‘n negatiewe lig, as gebrek aan outonomie of onbevoegtheid, beskou te word nie, maar moet eerder die begrip van ons gedeelde menslike kwesbaarheid en die wete dat ons almal uiteindelik pasiënte is, versterk. Dit is verder nie nodig om die konsep van outonomie heeltemal te verwerp nie. ‘n Wêreld sonder outonomie is ondenkbaar. Wanneer ons bewus word van hoe die konsep in die moderne wêreld as ‘n sosiale konstruk funksioneer, kan ons die positiewe aspekte daarvan inspan om ‘n nuwe identiteit te bewerkstellig. Ons kan die moontlikheid van self-stilering, ingesluit in outonomie, gebruik om onsself in verantwoordelike morele agente te omskep sodat ons nie slegs teenoor onsself verantwoordelik is nie, maar ook teenoor ander, hetsy in ons eie spesie of in ‘n ander. Verantwoordelike agentskap is afhanklik van volwasse denkers wat gedagtig is aan die noodsaaklike diversiteit van die morele lewe en die komplekse aard van die morele subjek. Ek voer dus aan dat die ontwikkeling van moderne individualisme nie volstrek verwerp moet word nie, siende dat ons nie na ‘n tipe premoderne vorm van gemeenskap kan terugkeer, of dit oortref deur ‘n postmoderne dekonstruksie van die self nie. Ons het verder ook nie ‘n nuwe woord nodig om die konsep van outonomie in die morele lewe mee te vervang nie. Ons het eerder ‘n ander instelling van ons menswees in die wêreld nodig; ‘n instelling wat streef na volkomendheid, nie net van onsself nie, maar ook van die morele gemeenskap. Ons kan slegs volkome wees wanneer ons ons interafhanklikheid as sosiale en morele entiteite, as Homo moralis, erken en aangryp.
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Doyle, Jamie L. "My Experience with Oncology Clinical Research: How Clinical Trials Silently Exclude Urban Patients and What I Have Done to Make One Research Program More Inclusive." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/550374.
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Urban BioethicsM.A.
As an oncology clinical researcher at an urban hospital, I reflected on patient stories and see overlying themes: financial hurdles, treatment delays, difficulties completing treatment, ineligibility for clinical trials, and other barriers to care specific to urban patients. Delays in cancer treatment have been linked to a decrease in overall survival; consequently, reducing observed blockades could be a matter of life and death. Clinical trials provide more treatment options while researching possible standard of care therapies for future patients. As novel anticancer treatments become more biomolecule specific and low minority enrollment on clinical trials used to validate these drugs continues, I ask, “Why”? I believe urban patients are unethically excluded from participating in clinical trials by overly restrictive study eligibility criteria, high out-of-pocket costs, lengthy informed consents written either not at the patient’s reading level or not in their language, as well as other deterrents associated with low socioeconomic status. More minority representation in clinic trials is necessary to ensure drugs seeking FDA approval are more representative of the population. I argue more needs to be done to make studies more inclusive. Though challenges enrolling urban patients onto clinical trials remains, I believe there are still ways to enhance their cancer care: 1) identifying or writing treatment clinical trials that are more inclusive; and 2) developing studies with interventions that target socioeconomic barriers to care.
Temple University--Theses
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Sodomin, Elizabeth Marie. "INTERPROFESSIONAL DECISION MAKING AS A TOOL FOR IMPROVED ETHICAL AND CLINICAL OUTCOMES IN COMPLEX MEDICAL CASES." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/387731.
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Urban BioethicsM.A.
In the setting of the health care field, multiple decisions must be made on each patient’s care from a variety of viewpoints on the medical team. In these settings, Interprofessional Decision Making is becoming a tool that can incorporate shared decision making with the patients and multiple care team members’ goals in order to optimize and keep an ethical focus on clinical outcomes. By reviewing a patient case below and evaluating the body of literature at the present, it can be determined that a disassembly of the current medical hierarchical structure and the barriers to team based interaction it creates, with a move toward open and ethical interactions, collaborations, and discussions will result in shared consensus on a patients management and care. While this may be difficult to achieve, interventions such as multidisciplinary team building and medical training, prior to matriculation, may provide a foundation for improved Interprofessional Decision Making and overall collaboration.
Temple University--Theses
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Diaz-Amado, Eduardo. "The transformation of the medical ethos and the birth of bioethics in Colombia : a Foucauldian approach." Thesis, Durham University, 2013. http://etheses.dur.ac.uk/6952/.
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In the late 1960s and early 1970s bioethics was born in the USA and rapidly spread across the world. Bioethicists have traditionally argued that their discipline was the answer to the ethical challenges posed by the scientific and technological progress in biomedicine, although others have emphasised the abuses committed in biomedical human research and the dehumanisation of medicine. Notwithstanding the great excitement produced by the rise of the new field, its foundations, scope, and official historical accounts have been criticised. Calls to give bioethics better philosophical foundations –beyond the American principlism- and to broaden the field, particularly to include problems typical of the developing world such as poverty, exploitation and inequality have grown in the last twenty years. In Colombia, the idea that bioethics is an advocate of life, a discipline to protect life on earth from the dangers of an irresponsible scientific and technological advance as well as from a wrong model of development has been promoted by the Colombian bioethical establishment. Drawing on the Foucauldian view on power and knowledge, this thesis analyses the connections between the flourishing of bioethics in Colombia and the implementation of a neoliberal healthcare system in the 1990s. The historiographies and hagiographies that have dominated the official history of bioethics in Colombia are criticised and, instead, a historical approach is offered. The central argument is that bioethics, and other discourses of surveillance of medical practice such as medical liability are part of the governmentalization of the Colombian medical ethos, and that bioethics has become a totalising, all-embracing field, constituting a form of power exercise over the biomedical scenario. Complementing the analysis, information from 27 semi-structured interviews is provided. Chapter one, the introductory chapter, discusses medicine as a contemporary cultural phenomenon and the birth of bioethics in the USA, while chapter two describes the elements of the Foucauldian toolkit that I use in the analysis. Chapters three and four critically approach the arrival and development of bioethics in Latin America and Colombia. Chapter five discusses the transformation of the Colombian medical ethos, describing the political transformation of the country in the 1990s and the healthcare reform. Chapters six and seven examine the discourses and practices around medical ethics in Colombia as well as how bioethics, medical practice, medical liability and biopolitically relevant legal decisions in the context of the new constitutional reality of the country became intertwined discourses.
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Boren, Shedrick John. "Ignoring Ambiguity: Legitimating Clinical Decisions." Scholarly Repository, 2008. http://scholarlyrepository.miami.edu/oa_dissertations/170.
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As technology advances, health care decisions have become increasingly complex. American hospitals, based on accreditation standards, are required to have a system and process to address ethics, patient rights, and responsibilities. These practices vary widely, and there is very little consistency and few standards across the country. Key court cases have provided minor structure, and the federal government has been silent in the formulation of these structures but not necessarily in this arena. Most often, these accreditation standards related to clinical ethics are managed by Healthcare Ethics Committees (HEC). Bioethics has become a growing field, the level of integration between this discipline and healthcare practice varies widely. Using qualitative methods based on Grounded Theory, this analysis presents six key thematic findings, as well as interpretations to identify current challenges and opportunities to make recommendations for improvement by enhancing clarity and reducing ambiguity.
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Cruice, Jane F. "Barriers and Facilitators of Healthy Eating and Physical Activity After Childbirth: A Qualitative Investigation Among Low-Income African American Mothers." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/380335.
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Urban BioethicsM.A.
Background: The childbearing years place socioeconomically disadvantaged African American women at increased risk for poor diet quality, excess weight gain, and cardiometabolic complications. Little is known about the attitudes, beliefs, values, and contextual constraints that shape these high risk mothers’ dietary and physical activity behaviors. Objective: The purpose of this study was to examine health perceptions of diet quality and physical activity among low-income African American women in the early postpartum period, and how these perceptions manifest as barriers or facilitators to health. Additionally, we examined how they may differ by known predictors of health, such as education, age, parity, and BMI. Methods: We conducted semi-structured, individual interviews with 20 women who were between 3-6 months postpartum. Mothers were approached and recruited in the waiting room of a university-affiliated, outpatient prenatal care clinic in Philadelphia, PA. Enrollment in the study was restricted to women who self-identified as African American, were at least 18 years old, and met the federal income guidelines to qualify for assistance (Medicaid, WIC). Individual interviews were audio recorded and transcribed verbatim, with transcripts verified by research staff. Thematic coding and content analysis were performed by 3 researchers using NVivo 10 software to assist with data management. Results: Barriers and facilitators of healthy eating and physical activity after childbirth fell into 4 major themes of mothers’ lives: 1) new structural reality in the postpartum period; 2) physiologic changes after delivery; 3) correct/incorrect perceptions of healthy eating and activity; and 4) social determinants influencing behaviors. Mothers described the transition from pregnancy to the early postpartum period as having a significant negative impact on their eating and activity behaviors due to heightened fatigue, time constraints, and the monotony of daily life with a newborn. We found more than double the number of perceived barriers to engaging in healthy eating than facilitators with regard to fluctuations in food supply, cost of food, and the built environment. Mothers with obesity and less education were more likely to have misperceptions; these misperceptions additionally served as strong barriers to making healthy lifestyle choices. Changes in mothers’ physical symptoms and health status (e.g., developing diabetes, hypertension), on the other hand, facilitated healthy behaviors. Conclusion: This research deepens our understanding of the primary drivers of health behaviors among low-income African American women in the postpartum period. We identified barriers which limit and facilitators which support these mothers’ ability to engage in healthy behaviors, though there were far fewer facilitators of healthy eating and physical activity. Interventions designed to overcome these barriers and capitalize on these facilitators have the potential to improve health outcomes for this population.
Temple University--Theses
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Foppiano, Palacios Carlo. "THE IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON HOSPITAL READMISSIONS." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/381898.
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Urban BioethicsM.A.
The current fragmented delivery of health care has contributed to unplanned hospital readmissions as a leading problem in the United States. Reducing readmissions to urban teaching hospitals is difficult. Many patients living in urban communities face social, economic, language, and transportation barriers to maintaining their health. Both the patient and the medical center experience the burden of readmission and are challenged with addressing SDoH and social injustices at several levels. Medicare views hospital readmissions as a marker representing lower quality of health care delivery to penalize hospitals providing care to the poor. This thesis addresses multiple social and economic factors associated with hospital readmissions, explores the interrelated components of readmissions at the personal and hospital system level, and delves into the interactions of bioethical principles associated with urban living. Hospital readmissions remain a serious issue nationwide and in order to reduce the rates of re-hospitalization the social and economic inequalities contributing to hospital readmissions are significant and must be addressed.
Temple University--Theses
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Crosland, J. Grady. "The separation of craniopagus conjoined twins : a bioethical analysis." Theological Research Exchange Network (TREN) Theological Research Exchange Network (TREN) Access this title online, 2007. http://www.tren.com.
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