Matching Items (7)
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- All Subjects: Medical Ethics
- All Subjects: HIV
- Creators: Hurlbut, Ben
- Member of: Theses and Dissertations
Description
The HIV pandemic spawned a global biomedical research effort which continues today. Because of multinational clinical studies, doctors and health officials possess more tools than ever before for the effective prevention and treatment of HIV/AIDS. The relationship between the United States and Sub-Saharan African nations features prominently within this global research effort. More specifically, many of the most significant HIV-related research findings emanate from clinical trials with a unique multinational configuration: the study protocol is largely designed and funded by American sources but executed at clinical research sites in Sub-Saharan African countries like South Africa and Zimbabwe. This thesis investigates the context and ethics of this configuration, with a focus on US-backed trials conducted in South Africa specifically. Using data collected from semi-structured interviews conducted at South African HIV clinical research sites, this thesis uncovers two significant ethical problems: insufficient benefits delivered to South African clinical trial participants, and informal processes occurring alongside formal protocol. By examining scope, effects, and implications of these problems, it becomes clear that although this research system delivers powerful results, there exists room for improvement.
ContributorsGill, Kohinoor Singh (Author) / Hurlbut, Ben (Thesis director) / Ripley, Charles (Committee member) / Vanig, Thanes (Committee member) / School of Politics and Global Studies (Contributor) / WPC Graduate Programs (Contributor) / Barrett, The Honors College (Contributor)
Created2016-12
Description
Since the Acquired Immune Deficiency Syndrome (AIDS) crisis began in the early 1980s, there has been a significant amount of stigma attached to the disease and the virus that causes it, Human Immunodeficiency Virus (HIV). At the time, HIV/AIDS was viewed as a death sentence. A large part of the stigma came from the fact that in the early days of the crisis, AIDS patients were predominantly part of the LGBTQ+ community. With the discovery of effective antiretroviral therapies, today HIV can be thought of as a preventable, yet manageable, chronic illness, although it remains a huge public health concern (About HIV/AIDS, 2018). While the virus is now rarely viewed as a death sentence, there is still considerable stigma that surrounds people living with HIV/AIDS (PLWHA). Research shows that the shows and movies people watch can affect their attitudes on a variety of issues, and HIV is no exception. Because HIV is such a big threat to public health, and because people often adopt views they see in media, analyzing the ways shows and movies portray PLWHA is an important aspect in understanding where stigma surrounding HIV/AIDS comes from. The writers behind today's HIV+ characters on television and in movies all seemingly made an effort to decrease stigma, but they went about it in different ways, and with varying amounts of success. A common method to dispel stigma was to use the entertainment-education method (Singhal & Rogers, 1999), which in these cases means characters had discussions about topics like safe sex, Pre-Exposure Prophylaxis (PrEP), and the importance of getting tested. A few shows showed serodiscordant couples, which was also effective at fighting stigma. In contrast, by trying to be representative of PLWHA, some shows actually contributed to the stereotypes behind the stigma, or had characters be openly stigmatizing towards PLWHA. After analyzing what I found the shows and movies did well and what they did poorly, I'll analyze why it is important that shows maintained historical accuracy, and how doing so appeared to fight the stigma associated with HIV/AIDS. I will also evaluate what's missing \u2014 such as which high-risk groups are not represented. Ultimately, this thesis will argue that shows and movies made in the last 12 years all aimed to decrease stigma, through a variety of techniques.
ContributorsEvans, Celia Grace (Author) / Hurlbut, Ben (Thesis director) / Berkel, Cady (Committee member) / Blattman, Joseph (Committee member) / School of Life Sciences (Contributor) / Department of Psychology (Contributor) / Barrett, The Honors College (Contributor)
Created2018-12
Description
According to my 2016 survey of ASU undergraduate students, 33% have used stimulant medications (e.g. Adderall or Ritalin) without a prescription to study. I view this practice as a step towards cognitive enhancement, which is the deliberate application of biotechnology to radically alter the human condition. From a foresight perspective, the ability to actively improve human beings, to take our evolutionary destiny into our own hands, may be a turning point on par with agriculture or the use of fossil fuels. The existential risks, however, may be greater than the benefits—and many of the most radical technologies have made little documented progress.
I turn to an actual example where people are trying to make themselves marginally better at academic tasks, as a guide to how future transformative development in human enhancement may be incorporated into everyday practice. This project examines the history and context that led to the widespread use of stimulant medication on college campuses. I describe how Attention Deficit Hyperactivity Disorder (ADHD), for which stimulant medication is prescribed and diverted, governs students, negotiates relationships between parents and school authorities, and manages anxieties resulting from a competitive neoliberal educational system. I extend this archeology of ADHD through the actions and ethical beliefs of college students, and the bioethical arguments for and against human enhancement. Through this work, I open a new space for an expanded role for universities as institutions capable of creating experimental communities supporting ethical cognitive enhancement.
I turn to an actual example where people are trying to make themselves marginally better at academic tasks, as a guide to how future transformative development in human enhancement may be incorporated into everyday practice. This project examines the history and context that led to the widespread use of stimulant medication on college campuses. I describe how Attention Deficit Hyperactivity Disorder (ADHD), for which stimulant medication is prescribed and diverted, governs students, negotiates relationships between parents and school authorities, and manages anxieties resulting from a competitive neoliberal educational system. I extend this archeology of ADHD through the actions and ethical beliefs of college students, and the bioethical arguments for and against human enhancement. Through this work, I open a new space for an expanded role for universities as institutions capable of creating experimental communities supporting ethical cognitive enhancement.
ContributorsBurnam-Fink, Michael (Author) / Miller, Clark (Thesis advisor) / Hurlbut, Ben (Thesis advisor) / Wetmore, Jameson (Committee member) / Arizona State University (Publisher)
Created2016
Description
Vaccinations are important for preventing influenza infection. Maximizing vaccination uptake rates (80-90%) is crucial in generating herd immunity and preventing infection incidence. Vaccination of healthcare professionals (HCP) against influenza is vital to infection control in healthcare settings, given their consistent exposure to high-risk patients like: those with compromised immune systems, children, and the elderly (Johnson & Talbot, 2011). Though vaccination is vital in disease prevention, influenza vaccination uptake among HCP is low overall (50% on average) (Pearson et al., 2006). Mandatory vaccination policies result in HCP influenza vaccination uptake rates substantially higher than opt-in influenza vaccination campaigns (90% vs. 60%). Therefore, influenza vaccination should be mandatory for HCP in order to best prevent influenza infection in healthcare settings. Many HCP cite individual objections to influenza vaccination rooted in personal doubts and ethical concerns, not best available scientific evidence. Nevertheless, HCP ethical responsibility to their patients and work environments to prevent and lower influenza infection incidence overrules such individual objections. Additionally, mandatory HCP influenza vaccination policies respect HCP autonomy via including medical and religious exemption clauses. While vaccination as a prevention method for influenza is logically sound, individuals’ actions are not always rooted in logic. Therefore, I analyze HCP perceptions and actions toward influenza vaccination in an effort to better explain low HCP uptake rates of the influenza vaccine and individual objections to influenza vaccination. Such analysis can aid in gaining HCP trust when implementing mandatory HCP influenza vaccination policies. In summary, mandatory HCP influenza vaccination policies are ethically justified, effective, scientifically-supported method of maximizing HCP influenza vaccine uptake and minimizing the spread of the influenza virus within healthcare settlings.
ContributorsGur-Arie, Rachel (Author) / Maienschein, Jane (Thesis advisor) / Hurlbut, Ben (Thesis advisor) / Ellison, Karin (Committee member) / Arizona State University (Publisher)
Created2016
Description
In 1996, President Clinton ordered the formation of the Advisory Committee on Human Radiation Experiments (ACHRE), which undertook to evaluate the morality of a myriad of secret and publicized radiation experiments ranging from 1944 to 1974. The goal of this thesis is to analyze the ways in which that committee formed moral evaluations and the extent to which its strategies related to a broader historical and philosophical discourse. Here I attempt to describe two specific techniques of simplification the committee deploys in order to make a retrospective moral analysis possible. Although the techniques comprise specific problems, frameworks, subjective perspectives, and conceptual links, their unifying principle is the field of choices the techniques produce. In the first technique I outline, I argue that by focusing on the problem of historical relativism, the committee gains a platform through which it would be granted flexibility in making a distinction between moral wrongdoing and blameworthiness. In the second technique of simplification I outline, I argue that the committee's incorporation of a principle to reduce uncertainty as an ethical aim allow it to establish new ways to reconcile scientific aims with moral responsibility. In addition to describing the structure of these techniques, I also demonstrate how they relate to the specific experiments the analysts aim to evaluate, using both the ACHRE experiments as well as the Nuremberg Trial experiments as my examples. My hope is not to show why a given committee made a particular moral evaluation, or to say whether a decision was right or wrong, but rather to illustrate how certain techniques open up a field of choices that allow moral analysts to form retrospective moral judgments.
ContributorsCirjan, Cristian (Author) / Hurlbut, Ben (Thesis director) / Humphrey, Ted (Committee member) / Zachary, Gregg (Committee member) / Barrett, The Honors College (Contributor)
Created2015-05
Description
Informed Consent is a ubiquitous way of enshrining choice in the United States which regulates social relations in domains as varied as health, research, access to institutions, and prisons. Informed consent describes an imagined epistemic relationship between right knowledge and legitimate choice, where judgements of capacitation determine whether a person is the right sort of person to take up knowledge which will render them agential under conditions of asymmetrical power. It has been developed over and over to solve problems of injustice, where the injustice in question is understood in terms of undue infringement on individual autonomy, and the logic of informed consent is re-invented to reframe the problem at hand as a rightful matter of individual choice. It is imagined to respect autonomy, and to perform a transformative "moral magic" that makes the forbidden quotidian. This dissertation develops this account of informed consent through a series of cases, each of which explicates different aspects of the technopolitics of informed consent. It begins with genetic counseling as a paradigm case in the logic of informed consent: a well-developed field that emerged to inform people about genetics and genomics in the interest not only of individual reproductive choice, but in opposition to eugenic shaping of populations through genetic knowledge. Next, pro- and anti- abortion deployments of informed consent illustrate an epistemology of information itself, which is understood to agentialize as well as to serve as a site for refusing choice to those deemed incapacitated. Third, liability waivers and requests for student informed consent on university campuses during the pandemic show informed consent to be a tool for the exercise of biopolitics and, in particular, for making responsible subjects. Finally, civil libertarian opposition to migrant genetic testing on the grounds that migrants weren’t asked for consent demonstrates a tight coupling between consent, imaginations of just state-subject relations, and what it means to be recognized as a person. Ultimately, this dissertation argues for a practice of attention that sees informed consent as an important site for the exercise of power and offers frameworks for analyzing it as such.
ContributorsDietz, Elizabeth A (Author) / Hurlbut, Ben (Thesis advisor) / Reynolds, Joel M (Committee member) / Brian, Jennifer (Committee member) / Ellison, Karin (Committee member) / Arizona State University (Publisher)
Created2023
Description
In the last 200 years, advancements in science and technology have made understanding female sexual function and the female body more feasible; however, many women throughout the US still lack fundamental understanding of the reproductive system in the twenty-first century. Many factors contribute to the lack of knowledge and misconceptions that women still have. Discussing sexual health tends to make some people uncomfortable and this study aims to investigate what aspects of somewhat recent US history in women’s health care may have led to that discomfort. This thesis examines the question: what are some of the factors that shaped women’s reproductive medicine in the US from the mid 1800s and throughout the 1900s and what influence could the past have had on how women and their physicians understand female sexuality in medicine and how physicians diagnose their female patients in the twenty-first century. A literature review of primary source medical texts written at the end of the 1800s provides insight about patterns among physicians at the time and their medical practice with female patients. Factors like gendered expectations in medical practice, misconceptions about the female body and behaviors, and issues of morality in sex medicine all contributed to women lacking understanding of sex female reproductive functions. Other factors like a physician’s role throughout history and non-medical reproductive health providers and solutions likely also influenced the reproductive medicine women received. Examining the patterns of the past provides some insight into some of the outdated and gendered practices still exhibited in healthcare. Expanding sexual education programs, encouraging discussion about sex and reproductive health, and checking gendered implicit bias in reproductive healthcare could help eliminate echoes of hysteria ideology in the twenty-first century medicine.
ContributorsHorwitz, Rainey (Author) / Maienschein, Jane (Thesis advisor) / Hurlbut, Ben (Committee member) / Ellison, Karin (Committee member) / Arizona State University (Publisher)
Created2019