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An Ethical Evaluation of the Boarding of Psychiatric Patients in the Emergency Department

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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

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.

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2017-05

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THE ETHICAL AND ECONOMICAL IMPLICATIONS OF HUMAN GENETIC ENGINEERING

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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

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.

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2020-05

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Assessing corporate bioethics: a qualitative exploration of how bioethics is enacted in biomedicine companies

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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,

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.

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2012