Bioethics and Medical Ethics Commons^™

Dementia And The Fragility Of Self: Navigating Ethical Considerations In Medical Decision-Making, Grace Sauers

Scripps Senior Theses

As the global population ages, the incidence of degenerative memory disorders such as Alzheimer's and dementia is expected to rise. The frequency of complex medical decision-making challenges for these patients will subsequently increase. It is now common practice for patients to provide advance directives outlining the care they wish to receive; in the case they are deemed incompetent to perform adequate decision making. However, patients with dementia occasionally express wishes contrary to those stated in their advance directives. This divergence creates ambiguity about which wishes should be honored and for who those wishes are being honored for. I aim to …

Exploring Moral Permissibility Of Nurse Participation In Limited Resuscitation, Felicia Stokes

Electronic Theses and Dissertations

This dissertation offers a novel approach to support nurses when they face conflict between clinicians and families or alternate decision-makers over potentially inappropriate end-of-life goals of care. This dissertation will provide a normative analysis of the moral permissibility of limited resuscitation, with arguments supported by analyses of families’ and nurses’ perspectives and actions in the EoL decision-making process. Limited resuscitation is a cardiopulmonary resuscitation effort where full pharmacologic and mechanical intervention is not used, or the length of the resuscitative effort is shortened. It is typically associated with deception because it is performed without the knowledge of patients and families. …

Medical Ethics: From The Perspective Of Undergraduate Pre-Health Students, Hannah Im

Theses/Capstones/Creative Projects

The burden of ethical decision-making is a significant contributor to compassion fatigue in healthcare professionals. Due to the impact of moral conflicts, it may be beneficial to reassess the effectiveness of current ethics education and training. While previous studies have surveyed a range of medical professionals and students, it remains unclear if exposure to ethics topics during undergraduate education could better prepare future healthcare workers. Thus, there is a need to identify the necessity of introducing ethics courses into the required pre-health curriculum. The following study took the first step to gauge this by surveying undergraduate pre-health students on their …

The Ethics Of Masking During A Pandemic, Mason Bennett

Philosophy Undergraduate Honors Theses

The COVID-19 pandemic has been disastrous, approaching a million deaths in the United States alone, and has demonstrated the world’s lack of preparation for a severe airborne virus. Countermeasures to infection are important to implement in order to lessen loss of life, but also must be justified and shown to be ethical. A countermeasure which is especially viable is wearing masks because of their high efficacy in preventing disease transmission compared to their relatively low restriction of liberty; studies have shown that mask wearing effectively impairs the spread of airborne pathogens and creates little physical or social harm. I argue …

Public Goods From Private Data: An Effectiveness And Justification Dilemma For Digital Contact Tracing, Andrew Buzzell

The Journal of Sociotechnical Critique

Debate about the adoption of digital contact tracing (DCT) apps to control the spread of COVID-19 has focussed on risks to individual privacy. This emphasis reveals significant challenges to ethical deployment of DCT, but generates constraints which undermine justification to implement DCT. It would be a mistake to view this result solely as the successful operation of ethical foresight analysis, preventing deployment of potentially harmful technology. Privacy-centric analysis treats data as private property, frames the relationship between individuals and governments as adversarial, entrenches technology platforms as gatekeepers, and supports a conception of emergency public health authority as limited by individual …

Ethics Of Euthanasia And Physician Assisted Suicide, Kathryn Halloran

Honors Senior Capstone Projects

No abstract provided.

A New Directive: An Ethical Analysis Of The Ethical And Religious Directives And Catholic Healthcare Mission To Promote And Sustain Catholic Healthcare, Noah Dimas

Graduate Student Research Symposium

At the heart of all Catholic healthcare is the mission and duty to further the healing ministry of Jesus Christ and care for one’s neighbor to uphold human dignity. However, some in Catholic healthcare may not fully know nor understand these foundational Catholic teachings. As such, these healthcare professionals can turn to a simple but rich guide in giving direction to these healthcare professionals, the USCCB’s Ethical and Religious Directives. This document acts as both a primer and set of guidelines regarding Catholic doctrine, the Catholic moral tradition, and how both inform the Catholic response to common ethical concerns. However, …

Ethical Ramifications Of Xenotransplantation Research And Justification For Potentially Deadly Study Participation, Scott Dyer

Graduate Student Research Symposium

Recent leaps in medical technology now allow humans to utilize organs of animals, specifically pigs, in xenotransplantation procedures. As this science advances, ethical quandaries that must be grappled with will arise while additional clinical trials must be done. Due to the infancy of this technology, science must be cautious in how it moves forward. However, I also argue that anyone, as long as they are of sound mind and deemed to be of proper decision-making capacity, can justifiably participate in any research they want, no matter how deadly the potential consequences. A participant in such research may be getting much …

Righting Health Policy: Bioethics, Political Philosophy, And The Normative Justification Of Health Law And Policy, D. Robert Macdougall

Publications and Research

In Righting Health Policy, D. Robert MacDougall argues that bioethics needs but does not have adequate tools for justifying law and policy. Bioethics’ tools are mostly theories about what we owe each other. But justifying laws and policies requires more; at a minimum, it requires tools for explaining the legitimacy of actions intended to control or influence others. It consequently requires political, rather than moral, philosophy. After showing how bioethicists have consistently failed to use tools suitable for achieving their political aims, MacDougall develops an interpretation of Kant’s political philosophy. On this account the legitimacy of health laws does …

Sexual Minority Rights Are Not Just For The West: Health And Safety Considerations In Africa, Robert Scott Stewart Ph.D., Dionne Van Reenen Ph.D., Richard Watuwa Ph.D.

Journal of Health Ethics

In a recent article, C.O. Akpan argues that it is “unnatural for a man to sleep with a man as with a woman, and the idea of marriage in this sense is an abomination” (“The morality of same-sex marriage: How not to globalize a cultural anomie,” Online Journal of Health Ethics, 13(1), 2017, p. 9). Arguments in favor of same sex marriage, he claims, are “driven and motivated by the human right fad” (p. 9) that is inappropriate for African countries.

We argue that the specific arguments Akpan employs against the morality of homosexuality and same-sex marriage are flawed. Our …

Is There A Doctor In The House? Medical Ethics And The Doctoral Honorific, Kenneth R. Pike, M. Scott Moore

Journal of Health Ethics

The proliferation of professional doctorates has reinvigorated debate over the use of the doctoral honorific. Doctorate holders are often addressed as “doctor” in academic contexts, but idiomatic American English associates “doctor” with physicians—licensed clinicians with doctoral degrees in medicine. The possibility of patient confusion has historically justified proscription of the doctoral honorific by others, including nurses, but recently such proscriptions have been withdrawn. An examination of history, language, and ethical reasoning leads us to conclude that, in the context of patient interaction, clinicians should eschew the doctoral honorific entirely. We think it appropriate for professionals to rely on training-pathway titles …

Informed Consent: Foundations And Applications, Joanna Smolenski

Dissertations, Theses, and Capstone Projects

Since its advent in the 20th century, informed consent has become a cornerstone of ethical healthcare, and obtaining it a core obligation in medical contexts. In my dissertation, I aim to examine the theoretical underpinnings of informed consent and identify what values it is taken to protect. I will suggest that the fundamental motivation behind informed consent rests in something I’ll call bodily self-sovereignty, which I argue involves a coupling of two groups of values: autonomy and non-domination on the one hand, and self-ownership and personal integrity on the other. I will then go on to consider two 'case …

Must Consent Be Informed? Patient Rights, State Authority, And The Moral Basis Of The Physician's Duties Of Disclosure, D. Robert Macdougall

Publications and Research

Legal standards of disclosure in a variety of jurisdictions require physicians to inform patients about the likely consequences of treatment, as a condition for obtaining the patient’s consent. Such a duty to inform is special insofar as extensive disclosure of risks and potential benefits is not usually a condition for obtaining consent in non-medical transactions.

What could morally justify the physician’s special legal duty to inform? I argue that existing justifications have tried but failed to ground such special duties directly in basic and general rights, such as autonomy rights. As an alternative to such direct justifications, I develop an …

Covid-19 And Challenges To The Traditional Understanding Of Individual Medical Autonomy, Callon A. Green

Honors Theses

Throughout history, vaccines have provided the human population with the ability to combat dangerous illnesses and avoid preventable suffering. Despite the benefits vaccines provide to the public health of the United States, anti-vaccination sentiment and resistance to vaccine uptake are still prevalent in the modern day. As the COVID-19 pandemic has developed into a major public health crisis that can be controlled through vaccination, the issues underlying vaccine resistance are becoming more critical to return to normal life. Using COVID-19 as a case study, it is evident that the individual choice to deny vaccination can have consequences on the health …

A Literary Analysis Of The Origin Of Human Embryonic Stem Cells, Its Advancements, Philosophical, Ethical, Sociocultural, And Political Aspects; An Investigation Of The Underlying Attributes That Affect One’S Views On Hesc Research To Resolve Turkey And Brazil’S Hesc Policy, Religious, And Cultural Conflicts, Haleema Shamsuddin

Honors Scholars Collaborative Projects

Human embryonic stem cells (hESCs) are cells derived from 5-day human embryos and are self-renewing cell lines that change into any type of cell in the body, a trait called pluripotency. hESCs have almost unlimited clinical and medical research potential. Despite the great therapeutic promise of hESC research, it comes with a controversial ethical debate due to its involvement with the destruction of the human embryo. The central argument revolves around the question of whether or not these human embryos should be ascribed equal moral status to fully developed humans. This thesis aims to analyze the origin and advancements of …

Catholic Terminal Sedation-A New Framework For Providing Terminal Palliative Sedation As A Requirement In Catholic Healthcare Organizations, Noah Dimas

Graduate Student Research Symposium

The present attitudes surrounding death and dying in the United States have been trending toward the acceptance of so-called “Assisted Death” interventions at the end-of-life (EoL), specifically Physician-Assisted Suicide. The acceptance of these interventions is rooted in the notion of autonomy within the American culture of medicine that generally states a patient is allowed to request whatever medical interventions they wish. As such, legislative bodies around the United States have begun to legalize Assisted Death in response to the regularly cited desire to die peacefully and without pain from an expected terminal illness. However, for Catholic healthcare organizations, there is …

Three Roles Of Narratives In The Treatment Of Chronic Pain, Nina Atanasova

Philosophy and Religious Studies Department Faculty Publications

In this paper, I discuss the roles narratives play in the diagnostics, treatment, and recovery of chronic pain patients. I show that the successes of this narrative approach to the treatment of chronic pain support the biopsychosocial model of disease. The central example of narrative interventions discussed in the paper is pain neuroscience education. This is an intervention which aims at helping chronic pain patients reconceptualize their pain experiences so as to align them with neuroscientific knowledge of pain. Multiple clinical trials have established the success of these interventions in pain reduction. This shows that neuroscience pain education is in …

Dentistry And The Principle Of Justice: How Ethics Informs Oral Health Policy, Michael G. Maihofer Dds

Journal of the American College of Dentists

The article defines the dental professional’s ethical principle of Justice and discusses the obligations that come with adherence to this principle with an emphasis on that portion of the ADA Code’s definition which states “that the dental profession should actively seek allies throughout society on specific activities that will help improve access to care for all.

It examines this principle to better understand its relevance and importance to both clinical practice, dental education and emerging oral health policy. Also discussed is how dentistry’s ethical code intersects the realm of social justice making a persuasive argument for adopting strong policies on …

Ethical Price For Essential Pharmaceuticals?, Sang T. Truong

Student Research

Azidothymidine or AZT is an antiretroviral medication used to prevent and treat HIV/AIDS. Nowadays, AZT remains to be the primary active drug that can elongate the life of infected patients. Without treatment, patients can live for 5 to 10 years after infected. With the treatment, their life expectancy approaches the norm.

However, it is important to note that AZT is a life-saver for HIV patients only if they can afford it. An HIV patient needs to spend about $17,000 for AZT every year until the end of his life. Therefore, the estimated lifetime cost of HIV will be $600,000. This …

An Ethical Market For Kidney?, Sang T. Truong

Student Research

The kidney performs several vital functions that maintain our general health condition, including filtering waste chemicals out of our blood. Kidney failure is a condition where patients’ kidneys lose their ability to filter the waste from their blood, leading to accumulating toxin in their body. Without any medical care, a patient with kidney failure has a couple days to a couple of weeks to live. One way to elongate the life of the kidney-failure patient is through kidney transplant, where another kidney is implanted into the patient’s body.

In the U.S, it is illegal to trade a kidney for money. …

Heeding The Call Of Covid-19, David Wiebers, Valery Feigin

Animal Sentience

We are grateful to all of our commentators. They have provided a wide range of valuable perspectives and insights from many fields, revealing a broad interest in the subject matter. Nearly all the commentaries have helped to affirm, refine, expand, amplify, deepen, interpret, elaborate, or apply the messages in the target article. Some have offered critiques and suggestions that help us address certain issues in greater detail, including several points concerning industrialized farming and the wildlife trade. Overall, there is great awareness and strong consensus among commentators that any solution for preventing future pandemics and other related health crises must …

Automating Autism: Disability, Discourse, And Artificial Intelligence, Os Keyes

The Journal of Sociotechnical Critique

As Artificial Intelligence (AI) systems shift to interact with new domains and populations, so does AI ethics: a relatively nascent subdiscipline that frequently concerns itself with questions of “fairness” and “accountability.” This fairness-centred approach has been criticized for (amongst other things) lacking the ability to address discursive, rather than distributional, injustices. In this paper I simultaneously validate these concerns, and work to correct the relative silence of both conventional and critical AI ethicists around disability, by exploring the narratives deployed by AI researchers in discussing and designing systems around autism. Demonstrating that these narratives frequently perpetuate a dangerously dehumanizing model …

“How Could You Even Ask That?”: Moral Considerability, Uncertainty And Vulnerability In Social Robotics, Alexis Elder

The Journal of Sociotechnical Critique

When it comes to social robotics (robots that engage human social responses via “eyes” and other facial features, voice-based natural-language interactions, and even evocative movements), ethicists, particularly in European and North American traditions, are divided over whether and why they might be morally considerable. Some argue that moral considerability is based on internal psychological states like consciousness and sentience, and debate about thresholds of such features sufficient for ethical consideration, a move sometimes criticized for being overly dualistic in its framing of mind versus body. Others, meanwhile, focus on the effects of these robots on human beings, arguing that psychological …

Proceeding Without Consent: The Ethics Of Disregarding Patient Preference For Paternalistic Reasons, Nicholas Munsey

Undergraduate Theses and Capstone Projects

Within the last few decades, modern medical regulations have brought the practicing medical community to an unprecedented level of accountability. Laws and regulations governing the practice of medicine were once, at best, loosely enforced guidelines; practices such as experimental surgeries, dangerous health testing, end of life care, and treatment of mental illness were left comparatively unregulated. The introduction of patient rights and new standards for practicing have left the medical community with a novel dilemma: how might one approach a patient who, according to medical advice, is in need of treatment if that patient is unable to express preference or …

Ethical Considerations Regarding Paternalism In Medicine, Lola Holcomb

Richard T. Schellhase Essay Prize in Ethics

Paternalism and autonomy are typically conceptualized as opposing theoretical frameworks. With respect to medical ethics, autonomy is practiced by the patient when he/she has liberty and control over his/her own medical matters, and his/her opinions supersede those of the physician. Paternalism is practiced by the physician when he/she restricts the patient’s autonomy (sometimes against the patient’s will) to promote health and well-being while discouraging undesirable behaviors. This paper details and analyzes a number of cases of medical paternalism in practice, both from the past and in the present day, with the purpose of examining associated ethical considerations. Attention is given …

The Ends Of Medicine And The Experience Of Patients, D. Robert Macdougall

Publications and Research

The ends of medicine are sometimes construed simply as promotion of health, treatment and prevention of disease, and alleviation of pain. Practitioners might agree that this simple formulation captures much of what medical practice is about. But while the ends of medicine may seem simple or even obvious, the essays in this issue demonstrate the wide variety of philosophical questions and issues associated with the ends of medicine. They raise questions about how to characterize terms like “health” and “disease”; whether medicine’s goals should be extended to include enhancement beyond normal human function; and whether the ends of medicine are …

Immunotherapy: Therapy Vs. Enhancement, Mariah Daly

Honors Program Theses

The battle against cancer is a long-standing struggle that has resulted in new information and the development of novel medical technologies. Current research aims to figure out a way to reprogram cells and bodily mechanisms to eliminate those cells that are cancerous without destroying healthy cells in the process. Methods which use the body’s own mechanisms, such as immunotherapy, have shown and continue to show potential for specifically targeting cancer cells. Adoptive T cell therapy is one form of immunotherapy that has gained significant attention and focus in the field. Therapies improve conditions up to the normal state of being, …

Introduction To Biomedical Ethics, Katherine Mendis

Open Educational Resources

This course introduces students to issues in the field of biomedical ethics, the theoretical tools bioethicists use to analyze them, and methodology for resolving clinical ethical dilemmas.

Intervention Principles In Pediatric Health Care: The Difference Between Physicians And The State., D. Robert Macdougall

Publications and Research

According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or by the harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies …

Exploring Parental Wishes And Personhood In The Grey Zones Of Neonatal Resuscitation, Alison Lindsay

Honors Projects

The intense societal debate churning around the moral status of fetuses includes topics such as qualifications for personhood, the role of the autonomous decisions of a fetus’ mother, and the obligations of society to protect fetuses. This paper analyzes extending this discussion to newborns in five sections. The first section presents a literature review of responses to a philosophical paper about the respective interests of parents and fetuses and newborns, elaborating on aspects of personhood and parental decision-making. The second section presents a literature review of medical and nursing discussion around resuscitation for extremely premature newborns, focusing on similar evaluations …