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Testing the Human Small Intestine under Different Preservation Conditions Segmentally with a Look Into the Ethics of Health Insurance Involvement

Description

Intestinal Transplant is becoming more prevalent with time as an powerful alternative to other therapies for intestinal failure such as parenteral nutrition. The small intestine is an organ especially susceptible to ischemia, or the lack of blood and oxygen supply

Intestinal Transplant is becoming more prevalent with time as an powerful alternative to other therapies for intestinal failure such as parenteral nutrition. The small intestine is an organ especially susceptible to ischemia, or the lack of blood and oxygen supply to an organ. I studied ischemia at Yale Medical School in the lab of Dr. John Geibel. The purpose of this study was to find which kind of solution best protects the intestine from ischemia as well as which segments of the intestine are more susceptible to ischemic damage. This was done by cold static storage as well as through perfusing the organ with a unit developed in the lab called the Intestinal Perfusion Unit (IPU). Intestines were procured from deceased donors following the protocol for handling human specimen and then flushed with either the University of Wisconsin (UW) solution or the Histidine-tryptophan-ketoglutarate solution (HTK). It was found that the jejunum is more susceptible ischemia than the ileum. It was also found that in the jejunum, when using UW solution there was less damage then when using HTK. Clinically, this means that in transplant, if the ileum part is used, there is less risk for ischemic damage. The potential applications of this research raise many ethical issues related to organ transplantation more broadly. The ethical issues include but are not limited to: consent, distribution and need-based donation, transplant tourism, and cost and access. The costs for transplant are exorbitant for the average American. Private insurance companies and Medicare have no policy for intestinal transplant and are therefore not covering many patients in need. In this thesis, I briefly explore the role of insurance companies in the equitable distribution of innovative medical interventions.

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Date Created
2018-05

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Scalpel Slaves and Surgical Sculptors: Cosmetic surgery, management of the media and the implications of commercialized medicine

Description

Of the over 17 million surgical and minimally-invasive cosmetic procedures performed in the United States in 2016, women accounted for over 90% of patients and nearly 70% of all patients were white. The goal of cosmetic surgery is to surgically

Of the over 17 million surgical and minimally-invasive cosmetic procedures performed in the United States in 2016, women accounted for over 90% of patients and nearly 70% of all patients were white. The goal of cosmetic surgery is to surgically restructure a healthy body part to more closely represent the contemporary ideal of what defines a particular gender. For example, femininity being linked to large breasts and small waist-to-hip ratio maintains binary heteronormative standards of what female body should look like. Plastic surgeons rely on advertising to attract patients for their businesses, since insurances do not cover elective cosmetic procedures. The ethical dilemma with this medical profession is with establishing aesthetic criteria for categorizing which bodies are considered normal and which are deviant. To understand the role of the physician in perpetuating cultural standards of beauty and promote surgery through their advertising, a random sample of 5 board-certified plastic surgeons from Scottsdale, AZ 85258 was obtained, focusing primarily on the images and textual content of their web pages. Of the 50 images sampled, nearly 75% of images portrayed white women. Women of color did not present in any of the photos. 52% of the home page images sexualized female clients using seductive posing and lingerie and promoted femininity using makeup and long hair. The language used in these websites criticized the presurgical female body and suggested that only physicians could eradicate their deficiencies, thereby normalizing cosmetic surgery as a means of beauty enhancement and maintaining the cultural superiority of doctors. 60% of websites failed to include adequate description of surgical risk. By choosing cosmetic surgery, women are negotiating their lives and acting as agents, even under circumstances that they cannot control such as the withholding of information, minimizing of risk or the social context and its corresponding pressures. Although the forewarning of surgical risk is rarely effective as a deterrent, it is the responsibility of the physician to provide the patient with all the information to the best of their ability so that they can decide what's best for their present circumstance, although rarely taken under conditions of perfect knowledge or absolute freedom from societal pressures. The American Society of Plastic Surgeons should work in conjunction with the Better Business Bureau's National Advertising Review Council to mediate regulatory solutions and increase public assurance in the credibility of advertising, perhaps an initiative similar to that of advertising for the cigarette industry. A pledge from the cosmetic surgery industry in conjunction to the Hippocratic Oath of the American Medical Association, which outlines the physician's responsibility to the patient within the context of advertising and marketing, could strengthen social responsibility and foster stronger, more honest relationships between surgeons and consumers.

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Date Created
2017-05

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Physician and Medical Ethics Committee Members' Perceptions of Death with Dignity in Arizona

Description

Death with Dignity is a concept that initially began as a set of philosophical and ethical principles that sought to define what it meant to die a "good" death that was reasonable to the person experiencing the dying process. This

Death with Dignity is a concept that initially began as a set of philosophical and ethical principles that sought to define what it meant to die a "good" death that was reasonable to the person experiencing the dying process. This dying process is terminal illness, or any condition that cannot be cured and who's ultimate prognosis is death. Today, Death with Dignity still embodies this, but it is also a set of legal and medical treatments and practices that can be used to aid terminal patients in accomplishing a "good" death. The Death with Dignity treatment options that are chiefly discussed in this study are patient withdrawal of care, patient control of pain medications, and physician-assisted suicide. Physician-assisted suicide is legal in six states in the US excluding Arizona. Considering that Oregon is the first state to pass a Death with Dignity Act and that it is the precedent for all other Acts, this study sought to understand the differences in perception of physician-assisted suicide between Arizona and Oregon in the pursuit of clarifying what barriers are still in place in Arizona to passing a Death with Dignity act. To ask the question of "Do physicians and ethics committee members in Arizona support Death with Dignity in the forms of patient control of pain medications, withdrawal of treatment, and physician-assisted suicide?", a literature review was conducted to determine important national and local perceptions of physician-assisted suicide and Death with Dignity, a 14-question, structured survey was created with the identified concerns, and it was distributed to Arizona health care workers by email and in person. This survey was approved by ASU's Institutional Review Board. This survey found that 100% of participants would vote for a Death with Dignity Act in Arizona if it were on a ballot measure. 76% of participants would aid a terminally-ill and eligible patient in physician-assisted suicide under some circumstances if it were legal in Arizona, and 24% of participants would never aid a patient in physician-assisted suicide. The concerns with physician-assisted suicide that were marked most important by Arizona healthcare workers were that hospice is a better option for the terminally ill and that physician-assisted suicide may be misused with disadvantaged persons. The most important factors of terminal illness that influence views of physician-assisted suicide marked by Arizona healthcare workers were the amount of pain the patient is expected to experience in the end of life, the amount of pain that can be relieved for the patient, the expected quality of life of the patient, and the patient's right to autonomy in healthcare. The significant differences between Oregon and Arizona in this study were the importance of expected mental decline of patient, patient's wishes that differ from family's, and hospice being a better option than suicide in influencing views of physician-assisted suicide. These differences could be deemed hurdles to Death with Dignity legislation in Arizona. This study recommended addressing those differences in public education and medical education and seeking Death with Dignity legislation via ballot measure.

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2017-05

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Physicians-Assisted Suicide as a Legal Option in the United States

Description

The purpose of this thesis project is to analyze the legalization of physician-assisted suicide (PAS) as an option for the terminally ill in the United States from a rule-utilitarian perspective. The moral theory of utilitarianism is a consequentialist theory that

The purpose of this thesis project is to analyze the legalization of physician-assisted suicide (PAS) as an option for the terminally ill in the United States from a rule-utilitarian perspective. The moral theory of utilitarianism is a consequentialist theory that judges the moral permissibility of an action or rule based on the best possible outcomes. Rule-utilitarianism conforms an action to an articulated moral rule that leads to the greatest good whereas act-utilitarianism only considers the best possible consequences on a case-by-case basis. Since legalization of PAS is a policy that requires passage of laws, rule-utilitarianism is more appropriate compared to act-utilitarianism. Euthanasia is a controversial topic worldwide that dates as far back as the 5th century BC with the Greeks and Romans. Comparing the euthanasia then and now, the nations are slowly but surely reconsidering the policies regarding PAS. There are both benefits and harms that the paper addresses. The possible benefits include the prevention of elongation of suffering, both physically and psychologically, respect for the patient autonomy, the right to die with dignity, and the decriminalization of the innocents. The potential harms include undermining the integrity of the medical profession and the aim of medicine, violation of the Hippocratic Oath, targeting of the vulnerable population, unmotivating the efforts to develop and improve better palliative and hospice care, and the slippery slope argument, which implies that the legalization of PAS would eventually set the precedence to legalizing voluntary active euthanasia and nonvoluntary euthanasia. Overall, the moral calculus that the paper provides comes to the conclusion that the benefits outweigh the harms.

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Date Created
2017-05

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The Market For Bodies: Investigating the Landscape of Nontransplant Anatomical Donation Organizations

Description

While there is extensive information available about organizations that receive donated organs for transplant, much less is known about those that accept tissue and whole bodies for medical education and research. Throughout the United States, nontransplant anatomical donation organizations exist

While there is extensive information available about organizations that receive donated organs for transplant, much less is known about those that accept tissue and whole bodies for medical education and research. Throughout the United States, nontransplant anatomical donation organizations exist within an ambiguous sector of the donation industry, unencumbered by federal regulations. Although these companies adhere to the Uniform Anatomical Gift Act, the lack of a single entity responsible for overseeing their operations has led to public skepticism and animosity among competing businesses. Legislation has the potential to legitimize the industry. For it to be successful, however, the intricacies of a complex market that deals directly with the movement of human remains and intangible issues of human integrity and morality, must be thoroughly understood.

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Date Created
2015-05

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The Ethics of Defining Somatic and Germline Genetic Modifications: Where Should the Line Be Drawn?

Description

Genetic engineering and gene alterations are a very rich and complex issue that have been the talk of many ethical debates. Somatic and germline genetic engineering technologies are becoming more prevalent in the scientific community and could be provided for

Genetic engineering and gene alterations are a very rich and complex issue that have been the talk of many ethical debates. Somatic and germline genetic engineering technologies are becoming more prevalent in the scientific community and could be provided for public use in a matter of time. These technologies raise bioethical concerns as society recognizes the challenges behind where to draw the line in use of this relatively new science. The basis of this paper is focused around a meta-analysis and systematic assessment of previous publications of major ethical debates to show the complex interests and ideas that need to be reflected and contemplated upon when deciding to genetically alter our species. A short description of background literature takes place first to show the ideas of major philosophers and bioethic figures to introduce these topics. This analysis will then continue with discussion from a religious point of view and the concerns that they have on these technologies. Next, there is a discussion regarding violation of consent, rights, and autonomy. A discussion of the potential consequential grounds of these enhancements on our species and what they could mean for our future takes ensues after this. At the end of this paper, there is a last discussion about the injustice and inequity that could form from these technologies becoming available to the public. These technologies could affect the future of our entire species and drastically shape our society, medicine, and science in ways we could never imagine.

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2020-05

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

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,

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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Date Created
2012

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Diagnosing Autism Spectrum Disorder: Implications for Research, Medicine, and Patients

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

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.

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2016-12