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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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2018-05

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

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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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2017-05

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

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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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The Eugenics Movement: Humanity Chosen and Humanity Refined

Description

Genetic engineering has become an increasingly prevalent topic in the media today. It has raised bioethical concerns nationwide as philosophers and scientists alike realize the challenges behind where to draw the line in certain modifications. As an introduction to the

Genetic engineering has become an increasingly prevalent topic in the media today. It has raised bioethical concerns nationwide as philosophers and scientists alike realize the challenges behind where to draw the line in certain modifications. As an introduction to the topic, this paper discusses the history behind eugenics and its importance in modern society. There is a discussion on what gene alterations are and the many processes of its scientific background. This is followed by how certain procedures and the ethical issues they raise are not cut and dry. The basis of the arguments in this paper focus on two ethical approaches: Kantian and Utilitarian. These approaches exemplify the difficulty on the decision making process behind what sort of therapeutic or enhancement therapies should be legalized or denied. These approaches can be applied to the two types of gene alterations: somatic cell therapy and germline therapy. The concluding decisions made in regards to what should or should not be accepted could have an effect on future generations, altering our species subsequently, and leading to an advancement in medicine and science.

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2016-05

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Understanding Bioethical Concerns of Laboratory Research: A Case Study On Discovering Programmed Necrosis Pathways

Description

The concept of “good” research is concrete in terms of technique, but complex in theory. As technology advances, the complexity of problems we must solve also grows. Research is facing an ethical dilemma—which projects, applied or basic, should be funded.

The concept of “good” research is concrete in terms of technique, but complex in theory. As technology advances, the complexity of problems we must solve also grows. Research is facing an ethical dilemma—which projects, applied or basic, should be funded. Research is no longer an isolated sector in society, and the decisions made inside of the laboratory are affecting the general public more directly than ever before. While there is no correct answer to what the future of research should be, it is clear that good research can no longer be only defined by the current classification system, which is rooted in antiquated, yet ingrained, social status distinctions.
Differences between basic and applied research were explored through a wet-lab case study. Vaccinia virus (VACV) infections are a prime model of the competition between a virus and its host. VACV contains a gene that is highly evasive of the host immune system, gene E3L. The protein encoded by E3L is E3, which contains two highly conserved regions, a C-terminus, and a N-terminus. While the C-terminus is well-understood, the mechanism by which the N-terminus grants IFN resistance was previously unknown. This project demonstrated that the N-terminus prevents the initiation of programmed necrosis through host-encoded cellular proteins RIP3 and DAI. These findings provide insight into the function of the N-terminus of E3, as well as the unique functions of induced programmed necrosis.
This project was an example of “basic” research. However, it highlights the interconnectivity of basic and applied research and the danger in isolating both projects and perspectives. It points to the difficult decisions that must be made in science, and the need for a better research classification system that considers what makes science “good” outside of antiquated social class ideologies that have shaped science since ancient Greece. While there are no easy answers to determine what makes research “good,” thinking critically about the types of research projects that will be pursued, and the effects that research has on both science and society, will raise awareness, initiate new conversations, and encourage more dialogue about science in the 21st century.

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2016-12

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Instagram and Adoption Rates: The Impact of Proactive Social Media on Adoption Rates at the Arizona Animal Welfare League & SPCA

Description

This thesis explores how we can harness new technology to improve our relationship with companion animals and promote shelter animal welfare. The study looked into using the photo-sharing application Instagram to increase adoption rates at the Arizona Animal Welfare League

This thesis explores how we can harness new technology to improve our relationship with companion animals and promote shelter animal welfare. The study looked into using the photo-sharing application Instagram to increase adoption rates at the Arizona Animal Welfare League & SPCA. An Instagram page was created and managed for the shelter, and data was collected regarding the impact the page had on adoption rates. The results were mixed, but overall it was determined that the Instagram page has unique value for the shelter.

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2015-05

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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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2015-05

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The Hwang Woo-Suk Scandal and the Development of Bioethics in South Korea

Description

In 2004, the South Korean geneticist Woo-Suk Hwang published what was widely regarded as the most important research result in biotechnology of the year. In the prestigious American journal Science, he claimed that he had succeeded in cloning a human

In 2004, the South Korean geneticist Woo-Suk Hwang published what was widely regarded as the most important research result in biotechnology of the year. In the prestigious American journal Science, he claimed that he had succeeded in cloning a human blastocyst, an embryo in its early stages (Hwang et al. 2004). A year later, in a second Science article, he made the earth-shattering announcement that he had derived eleven embryonic stem cell lines using his cloning technique (Hwang et al. 2005). The international scientific community was stunned. American scientists publicly fretted that President George W. Bush‘s 2001 executive order limiting federal funding for stem-cell research in the United States had put American bioscience behind the Koreans‘ (Paarlberg 2005). These breakthroughs offered potential solutions to immune system rejection of transplanted organs and possible cures for diseases such as rheumatoid arthritis, Parkinson‘s, Down‘s syndrome, and paralysis (Svenaeus 2007). However, within a year, Hwang was exposed as a fraud who had faked his results and pressured his female colleagues to donate eggs without informed consent. Despite protests against his methods from Korean religious and nongovernmental organizations, Hwang had used his prestige to ignore his ethical obligations. The Korean government, too, was slow to investigate Hwang and to subject his work to appropriate regulation.

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2012-12

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Science and Social Governance: Lessons from the Human Genome Editing Debate

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This thesis responds to the question, "Can Science Make Sense of Life?" through a structural lens of the Human Germline Genetic Editing debate. I explore who is absent from the table, and how the ways of thinking that dominate marginalize

This thesis responds to the question, "Can Science Make Sense of Life?" through a structural lens of the Human Germline Genetic Editing debate. I explore who is absent from the table, and how the ways of thinking that dominate marginalize and exclude alternative frameworks and considerations. This analysis is centered around an examination of several perspectives from the disability community and an in-depth study of how the Orthodox Jewish community contends with genetic disease. These perspectives illuminate several lessons that prove to bring insight not merely to questions of permissibility on genetic editing, but also offer reflections on the larger relationship between science, technology, and society. I then return to the mainstream genetic editing debate to show how the culture it is born out of and the structures it has ingrained prevent lessons such as these from impacting the conversation. In light of such structures that continuously reproduce the assertion that it is science, not humanity, that is able to make sense of life, my final argument is that though science tends to gatekeep questions of emerging technologies by centering conversations on highly advanced and methodological considerations, public individuals need not feel as if they are irrelevant or unessential. Though science may offer one solution, it is the individuals and communities, not results from a lab, that are equipped to determine if it is the best solution.

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2021-05

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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