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- All Subjects: ethics
- All Subjects: medicine
- Creators: Brian, Jennifer
Description
Corporations in biomedicine hold significant power and influence, in both political and personal spheres. The decisions these companies make about ethics are critically important, as they help determine what products are developed, how they are developed, how they are promoted, and potentially even how they are regulated. In the last fifteen years, for-profit private companies have been assembling bioethics committees to help resolve dilemmas that require informed deliberation about ethical, legal, scientific, and economic considerations. Private sector bioethics committees represent an important innovation in the governance of emerging technologies, with corporations taking a lead role in deciding what is ethically appropriate or problematic. And yet, we know very little about these committees, including their structures, memberships, mandates, authority, and impact. Drawing on an extensive literature review and qualitative analysis of semi-structured interviews with executives, scientists and board members, this dissertation provides an in-depth analysis of the Ethics and Public Policy Board at SmithKline Beecham, the Ethics Advisory Board at Advanced Cell Technology, and the Bioethics Committee at Eli Lilly and offers insights about how ideas of bioethics and governance are currently imagined and enacted within corporations. The SmithKline Beecham board was the first private sector bioethics committee; its mandate was to explore, in a comprehensive and balanced analysis, the ethics of macro trends in science and technology. The Advanced Cell Technology board was created to be like a watchdog for the company, to prevent them from making major errors. The Eli Lilly board is different than the others in that it is made up mostly of internal employees and does research ethics consultations within the company. These private sector bioethics committees evaluate and construct new boundaries between their private interests and the public values they claim to promote. Findings from this dissertation show that criticisms of private sector bioethics that focus narrowly on financial conflicts of interest and a lack of transparency obscure analysis of the ideas about governance (about expertise, credibility and authority) that emerge from these structures and hamper serious debate about the possible impacts of moving ethical deliberation from the public to the private sector.
ContributorsBrian, Jennifer (Author) / Robert, Jason S (Thesis advisor) / Maienschein, Jane (Committee member) / Hurlbut, James B (Committee member) / Sarewitz, Daniel (Committee member) / Brown, Mark B. (Committee member) / Moreno, Jonathan D. (Committee member) / Arizona State University (Publisher)
Created2012
Description
This paper sought to answer the question of how to improve the American healthcare system. The Affordable Care Act aimed to do this by increasing access to insurance. What this has done, however, is exacerbate the already rising rate of physician shortages. As a way to fix this problem, it is suggested that state legislatures and the federal government adopt the rising trend of expanding scope of practice to the extent of the care providers' certification. This is a movement has garnered support throughout the country and 20 states already allow for nearly autonomous practice by advanced practice nurses (APNs). This paper looked at systematic review, peer-reviewed papers, state/federal legislation and labor statistics to demonstrate how this move could increase access to healthcare providers as well as decrease cost by nearly 25%. This paper also evaluated how to formalization of nursing education has had positive impacts on the French healthcare system. Additionally, it evaluated a more specific look at Arizona and used data provided by the Arizona Board of Nursing and The Arizona Medical Board to make a compelling argument as to why this is a viable option for solving the disparity between rural and urban healthcare. The conclusion of the paper was to push policy makers to make the statutory constraints of the profession closer to the certification the people receive in their education as opposed to relying on case law. Additionally, it would be helpful to use technological innovations, like project echo, to help these professionals practice in rural areas. This will ultimately lead to a healthcare system that better serves the needs of all populations, as well as decreasing the overall cost of care.
ContributorsKingsbury, Andrew (Author) / Brian, Jennifer (Thesis director) / McGregor, Joan (Committee member) / Reddy, Swapna (Committee member) / School of Nutrition and Health Promotion (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
My thesis project, "An Ethical Evaluation of the Practice of Psychiatric Patient Boarding in the Emergency Department" sets out to address a relatively nameless problem in the healthcare system in the United States. This problem is the boarding of psychiatric patients in emergency departments nationwide. What is psychiatric patient boarding? This term refers to the increasingly common practice of care provided to psychiatric patients upon arrival at an emergency department. When inpatient psychiatric beds or services are not available, "boarding" is performed by simply storing mentally ill patients in hallways or other emergency room areas while they wait for the availability of psychiatric treatment, which may take hours, or in more extreme cases has been cited to last for days at a time (Alakeson et. al, 2010). While any individual can expect to wait a prolonged period of time for medical care in the increasingly overcrowded emergency departments, the psychiatric patient experience is astonishingly unique. A psychiatric patient presenting, or arriving, at the ED in crisis can often times find him or herself not only waiting hours to be admitted and assessed as a medical patient would, but with a limited and ever attenuating supply of psychiatric treatment rooms and services, these patients will often times be harbored in an ED room designed for short-term medical treatment without care until psychiatric services become available. Patients can be left waiting for days for an in-patient vacancy; all the while not receiving true psychiatric treatment and in some cases being held against their will in a chaotic environment far from conducive for treatment of a mental health ailment. In this analysis, I will discuss and review aspects of psychiatric patient boarding from various literature, such as why boarding occurs from a hospital and historical standpoint, negative implications of boarding for psychiatric and medical patients, and the burden placed on the hospital when practicing psychiatric boarding. To learn further on the topic, I will share the results from 14 semi-structured, qualitative interviews performed with ED healthcare professionals, being physicians, charge nurses, nursing staff, and certified nursing assistants or patient safety advocates. This portion of my investigation is designed to offer a perspective that the literature cannot, being a first hand outlook on psychiatric boarding from those working on the front line, focusing on topics of all aspects, such as causation, consequences for all involved parties, and proposed solutions.
ContributorsChun, Tristan Eric (Author) / Brian, Jennifer (Thesis director) / Foy, Joseph (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05
Description
While the transition from sectarian to allopathic medicine was almost entirely beneficial due to our perceived value in the type of evidence and transparency that science provides, key values within sectarian practice were lost in this transition. Attention to these values helps us better understand the role and treatment of patients in modern medicine. Modern scientific physicians have proven the inefficacy of sectarian treatments by scientific practices, but the efficacy of exact sectarian remedies may not have bearing on the importance of sectarian values. These values were: medical simplicity, harmlessness in treatment, independence from physicians and accessibility of treatment. A more in-depth analysis of sectarian values allows us to understand that while the values of allopathic medicine have become ubiquitous, it has not always been that way. It is time to consider the validity in the sectarian values we have abandoned; this analysis was one of many on medicine's imminent developmental horizon. This realization allows us to call into question the importance of our current practicing values, and the necessity that they continue to stand alone.
ContributorsAyala, Erik Richard (Author) / Brian, Jennifer (Thesis director) / Ross, Christian (Committee member) / Department of Psychology (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05
Description
Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder that is becoming increasingly common. Autism does not yet have a known etiology, nor a definitive diagnostic test, thus making diagnosis a difficult and rarely uniform task. Currently, ASD is behaviorally diagnosed based on criteria defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Recently, a change was made in the criteria from more lenient criteria in DSM-IV-TR, to more narrow criteria laid out by the DSM-V, which supersedes the DSM-IV-TR. This drastic change raised many questions and debates about which set of criteria are better. The more lenient criteria offers a more inclusive diagnosis giving greater access to therapies; while the narrow diagnostic criteria excludes some individuals, creating a more uniform diagnosis that's easier to use in research. This thesis analyzes the change in diagnostic criteria from the DSM-IV-TR to the DSM-V and the effects of these changes on the practices of diagnosis. In addition, it explores the implications of this change for the families of children with autism and for those involved in autism research, examining their respective opinions and interests pertaining to narrow verses broad diagnostic criteria. Building on this analysis, the thesis offers recommendations about diagnostic criteria should be set. It argues that the wellbeing of patients takes priority over the interests of researchers, and thus diagnosis should be done in a way that offers the best prognosis for all children who suffer from autistic symptoms.
ContributorsBremer, Michelle Nichole (Author) / Hurlbut, Ben (Thesis director) / Robert, Jason (Committee member) / Brian, Jennifer (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2016-12
Description
Though schizophrenia was categorized as a mental illness over 100 years ago, there is a plethora of knowledge that continues to perplex the scientific and medical community alike. This tragic mental disorder affects approximately 1% of the general population, and many of these individuals are homeless if left untreated. Each schizophrenia patient has a different set of symptoms, so all of these patients experience a variety of positive and negative symptoms. Negative symptoms are called so as they are in absence, and some examples include apathy, anhedonia, lack of motivation, reduced social drive, and reduced cognitive functioning. Positive behavior, on the other hand, is a change in behavior or thoughts such as visual or auditory hallucinations, delusions, confused thoughts, disorganized speech, and trouble concentrating. Because schizophrenia patients do not share the exact same set of symptoms, research in schizophrenia requires a tremendous amount of medical resources. Over the last few years, new studies have started in the field of schizophrenia involving proteomics, or the study of proteins and their function. This new frontier gives doctors and scientists alike a new opportunity to improve the quality of life of schizophrenia patients by providing a potential method through which patients would receive individualized treatment based on their specific symptoms.
ContributorsPeterson, Rozabel (Author) / Brian, Jennifer (Thesis director) / School of Molecular Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
Description
2023 has been a record-breaking year for legislation aimed at restricting and even criminalizing access to gender affirming care for minors. In response to these legislative efforts, many advocates rely on invocations of medical authority to defend the right of individuals to access gender affirming care. However, this reliance on the pathologization of transgender identity both reaffirms stigmatization of transgender identity as mental illness as well as forecloses on opportunities to affirm access to gender affirming care otherwise. The purpose of this research is to use disability justice scholarship, predominantly crip theory, to analyze these legislative efforts in-depth beyond the predominant critique offered by the medical-model. I demonstrate that these legislative moves to ban access to gender affirming care are part of a larger effort to prevent a trans future more broadly. Trans childhood has become a particularly fruitful site for this political action due to the ways in which normativities relating to time, biological plasticity, and capacity shape the way that their bodies are understood. I term those individual bodies which have such characteristics of non-normative temporalities, plasticity, and capacity/incapacity grafted onto them become “bodies of normative intervention” and explore how they become the laboratory sites for producing population-wide normative interventions. This legislative effort to restrict access to gender affirming care for minors represents a broader effort to legislate a trans future out of existence through the strategic targeting of trans children. This robs society of valuable trans knowledge and experience.
ContributorsMills, Raegan Lenore (Author) / Hurlbut, Ben (Thesis advisor) / Brian, Jennifer (Thesis advisor) / Hlava, Terri (Committee member) / Arizona State University (Publisher)
Created2023
Description
Writing speculative fiction is a valuable method for exploring the potential societal transformations elicited by advances in science and technology. The aim of this project is to use speculative fiction to explore the potential consequences of precision medicine for individuals’ daily lives. Precision medicine is a vision of the future in which medicine is about predicting, and ultimately preventing disease before symptoms arise. The idea is that identification of all the factors that influence health and contribute to disease development will translate to better and less expensive healthcare and empower individuals to take responsibility for maintaining their own health and wellness. That future, as envisioned by the leaders of the Human Genome Project, the Institute for Systems Biology, and the Obama administration’s Precision Medicine Initiative, is assumed to be a shared future, one that everyone desires and that is self-evidently “better” than the present. The aim of writing speculative fiction about a “precision medicine” future is to challenge that assumption, to make clear the values underpinning that vision of precision medicine, and to leave open the question of what other possible futures could be imagined instead.
ContributorsVenkatraman, Richa (Author) / Brian, Jennifer (Thesis advisor) / Maienschein, Jane (Thesis advisor) / Hurlbut, James (Committee member) / Arizona State University (Publisher)
Created2022
Description
Birth control promised to curb growing human populations while liberating women individually and socially. Instead, these technologies reinforce a feedback loop associating only women’s bodies with family-planning responsibilities. As a result, many diverse female contraceptives have reached markets while few male contraceptives have. Cis-men’s attitudes are commonly offered as explanation for why novel male contraceptives have not reached markets at the same pace, but little research has investigated this. I address this gap through thematic analysis of focus group interviews exploring cis-men’s attitudes on existing and novel male contraceptives. Focus group findings suggest cis-men experience less urgency to contracept due to differences in physiological burdens of pregnancy and childbirth. Decreased urgency does not mean that cis-men are uninterested in contracepting or in novel contraception options, but that cis-men express boundaries to what they will endure when contracepting. Knowing men’s articulated boundaries can help male contraceptive research and development (R&D) efforts moving forward. Additionally, these findings call into question current clinical risk assessment systems wherein risk of the medication is compared to how the individual experiences (unintended) pregnancy in a purely physical sense. Lastly, these data crucially demonstrate cis-men’s interest in contracepting and having a complete clinical risk assessment system for developing, novel male contraceptives is still not enough. Systemic changes must occur for male contraceptive technologies to be accessible and utilized by cis-male populations. Because interviews were conducted before the Supreme Court’s landmark 2022 decision that overturned federal abortion protections, I expanded my research to include a follow-up survey gauging how participants’ attitudes from the focus groups were impacted, if at all. The follow-up survey demonstrated increased urgency for novel male contraceptives as a result of the Dobbs decision, for example, can increase cis-men’s urgency/interest in trying the interventions regardless of their lack of familiarity with the method or its potential side effects. Follow-up survey findings also demonstrate how cis-men’s urgency/interest for novel male contraceptives is highly influenced by the current socio-political context surrounding reproductive justice issues. This finding affirms that the focus group data finding that the current FDA (Food and Drug Administration) clinical risk assessment is incomplete.
ContributorsGardner, Kara Diane (Author) / Hurlbut, Ben (Thesis advisor) / Brian, Jennifer (Thesis advisor) / Gur-Arie, Rachel (Committee member) / Arizona State University (Publisher)
Created2022
Description
When an individual is conceived there is a metaphorical roll of the dice. A game of chance is played with their genetics to which they cannot consent. Unlucky players could have inherited mild conditions such as chronic allergies to terrible diseases such as Cystic Fibrosis or Tay-Sachs. Controlling the genetics of an individual through the use of gene editing technology could be the key to ending this cycle of genetic diseases. Once detrimental diseases are now being cured through direct applications of genetic engineering. Even as we see the uses of genetic engineering technologies change the world, the more “sci-fi” applications have yet to be fully realized or explored. Editing hereditary genes before birth may have the ability to eliminate diseases from entire genetic lines, reduce the possibility for certain cancers and diseases, and perhaps even modify phenotypes in humans to create enhanced humans. Although this scientific field shows promise, it does have its reservations. Like any other scientific field, its ability to benefit humanity depends on its use.
ContributorsSchuler, Jacob (Co-author) / Silva, Anthony (Co-author) / Brian, Jennifer (Thesis director) / Ross, Christian (Committee member) / Harrington Bioengineering Program (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05