Bioethics and Medical Ethics Commons^™

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

The Skinny On Eating Attitudes, Body Image, And The Thin-Ideal In College Women, Lyndsay N. Greene

Undergraduate Theses and Capstone Projects

There is evidence of a link between body image and disordered eating among females, and some research that suggests exposure to the media exacerbates both body dissatisfaction and eating pathology. Despite these claims, little research has been done on the effects that exposure to photo-shopped images specifically has on body dissatisfaction and eating pathology. The present study sought to further understand the relationship between cognitive distortions of body image and eating attitudes and to examine the effects that exposure to the thin-ideal found in the media has on body dissatisfaction among college aged women. Eighty female college students answered questions …

Using Neuroscience To Create A Paradigm Shift In Addiction Treatment And Theory, Tabitha E.H. Moses

Student Works

Drug abuse has long fascinated philosophers and scientists. Many different models have attempted to elucidate the mechanism behind drug addiction and analyze whether an addict has a choice in his behavior. The problem with these models is that they seem to suggest only two ways of viewing addiction. These models suggest either that a person cannot control his addiction and is therefore deserving of treatment, or that suggest a person can control their addictions and is not deserving of treatment, and instead needs threats of punishment to stop their behavior. I believe these approaches are too simplistic and do not …

Law, Ethics, And Public Health In The Vaccination Debates: Politics Of The Measles Outbreak, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The measles outbreak of early 2015 is symptomatic of a larger societal problem–the growing number of parents who decide against vaccinating their children. This failure is causing the resurgence of childhood diseases once eliminated from the United States.

This article explores the legal and ethical landscape of vaccine exemptions. While all states require childhood vaccinations, they differ significantly in the types of religious and/or philosophical exemptions permitted, the rigor of the application process, and available review mechanisms. States with relaxed exemption policies disproportionately experience more outbreaks of vaccine-preventable disease.

Vaccine exemptions are an illustration of the “tragedy of the commons,” …

Just Compensation: A No-Fault Proposal For Research-Related Injuries, Leslie Meltzer Henry, Megan E. Larkin, Elizabeth R. Pike

Faculty Scholarship

Biomedical research, no matter how well designed and ethically conducted, carries uncertainties and exposes participants to risk of injury. Research injuries can range from the relatively minor to those that result in hospitalization, permanent disability, or even death. Participants might also suffer a range of economic harms related to their injuries. Unlike the vast majority of developed countries, which have implemented no-fault compensation systems, the United States continues to rely on the tort system to compensate injured research participants—an approach that is no longer morally defensible. Despite decades of US advisory panels advocating for no-fault compensation, little progress has been …

Ethical Perspectives Of Direct-To-Consumer Genetic Testing, Pawan Acharya, Rupesh Gautam

Journal of Health Ethics

Direct-to-consumer (DTC) genetic testing, which evolved from genomics is not free from controversies and ethical dilemmas. Conduction of genetic testing without direct communication between the users and certified medical professionals has aroused many ethical concerns. We discuss some ethical dilemmas surrounding DTC genetic testing in terms of quality assurance of the test, information communication process of the result, confidentiality of test result and the right to privacy, cost and price regulations, and user safety and harm mitigation. DTC genetic testing lies in the middle of a clash between liberal trade policies and state’s regulations as a case of extreme paternalism. …

Calling Science Pseudoscience: Fleck’S Archaeologies Of Fact And Latour’S ‘Biography Of An Investigation’ In Aids Denialism And Homeopathy, Babette Babich

Articles and Chapters in Academic Book Collections

Fleck’s Genesis and Development of a Scientific Fact foregrounds claims traditionally excluded from reception, often regarded as opposed to fact, scientific claims that are increasingly seldom discussed in connection with philosophy of science save as examples of pseudo-science. I am especially concerned with scientists who question the epidemiological link between HIV and AIDS and who are thereby discounted—no matter their credentials, no matter the cogency of their arguments, no matter the sobriety of their statistics—but also with other classic examples of so-called pseudo-science including homeopathy and other sciences, such as cold fusion. The pseudo-science version of the demarcation problem turns …

‘‘We Can Wipe An Entire Culture’’: Fears And Promises Of Dna Biobanking Among Native Americans, Roberto Abadie, Kathleen Heaney

Department of Sociology: Faculty Publications

This paper explores Native American perceptions on DNA biobanking. A qualitative study was conducted among self-declared Native Americans living off reservation in two Midwest cities. Findings demonstrate a paradox: Informants maintain strong hopes for the transformative power of gene-based research while voicing very particular social anxieties. Emerging genomic technologies elicit concerns over the potential for genetic stigmatization or discrimination based on race, preventing access to health insurance or employment. Frequently, social anxieties adopt the narrative form of conspiracy theories which portray powerful agents exploiting or abusing a disenfranchised population. We argue that while Native Americans do not have a monopoly …

La Paradoja Hispana Epidemiológica: Investigando Las Preconcepciones Y Generalizaciones, Maya H. Sandalow

CMC Senior Theses

En los Estados Unidos, los latinos suelen tener menos acceso a la educación, el trabajo, y el seguro médico en comparación con los blancos no-latinos, pero aun así el grupo parece superar ciertos obstáculos de la salud. Las estadísticas de la población latina muestran mayor longevidad y otras tasas favorables en comparación con los blancos no-latinos. Los expertos han titulado esta contradicción “La Paradoja Hispana Epidemiológica”.

Desafortunadamente, la investigación de la paradoja está llena de generalizaciones y presuposiciones erróneas sobre la población latina diversa. Esta tesis investiga los participantes que producen generalizaciones sobre la supuesta paradoja para mostrar que estas …

Barriers To Health Care Among Laotian Americans In Middle Tennessee, Xaiyavong Saenphansiri

DNP Projects

Background. Laotian Americans have unique heath beliefs and practices. The cultural differences between Laotian American patients and American health care providers can create challenges in achieving not only evidence-based, but also culturally sensitive care. Although the current literature addresses barriers to health care for Asian Americans, there are few studies related to the Laotian-American minority.

Aim. Describing the particular barriers to preventive and curative care in the Laotian-American population in Middle Tennessee would inform strategies for successful prevention and early treatment programs for this population. The purpose of the study is to describe the health beliefs and barriers to …

An Assessment Of Retractions As A Measure Of Scientific Misconduct And Impact On Public Health Risks, Alison J. Abritis

USF Tampa Graduate Theses and Dissertations

Research misconduct has been generally considered a limited issue, occurring in a small percentage of research studies. Studies of the number of article retractions use retraction percentages to perpetuate the idea that research misconduct is not a common event, and use information in the retraction notice to quantify types of research misconduct and types or research error. However, retractions appear to be the wrong variable with which to assess misconduct rates and characteristics. Using final misconduct findings in hard science research from the Office of Research Integrity (ORI) for investigations closed from 1993 through 2013, the number of publications and …

When Harvard Said No To Eugenics: The J. Ewing Mears Bequest, 1927, Paul A. Lombardo

Faculty Publications By Year

James Ewing Mears (1838-1919) was a founding member of the Philadelphia Academy of Surgery. His 1910 book, The Problem of Race Betterment, laid the groundwork for later authors to explore the uses of surgical sterilization as a eugenic measure. Mears left $60,000 in his will to Harvard University to support the teaching of eugenics. Although numerous eugenic activists were on the Harvard faculty, and who of its Presidents were also associated with the eugenics movement, Harvard refused the Mears gift. The bequest was eventually awarded to Jefferson Medical College in Philadelphia. This article explains why Harvard turned its back …

Resolving Ethical Dilemma: An Application Of A Theoretical Model, Lubna Ghazal, Zulekha Saleem, Gulzar Amlani

School of Nursing & Midwifery

Human error can occur in any profession. Medical errors most commonly occur in a health care system, which may delay patient’s recovery and produce harm to patients. However, when a medical error occurs, it is challenging to inform the incident to patients and their family. Health care professionals follow a professional code of ethics to do well and not harm patients. Historically, many of these errors were not disclosed to patients but the trend for more open disclosure of medical errors to patients and their families is a mutually beneficial and welcomed change.

Public Health Emergencies: What Counts?, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Vaccines and drugs to prevent and treat Ebola Virus Disease that have never been tested in humans, and in scarce supply raise profound ethical challenges. What if good evidence emerged demonstrating safety and efficacy of drugs? What would be an ethical method of allocating scarce beneficial resources? The apparent preference given to foreign aid workers over West Africans provoked a firestorm. In addition to discussing the ethical allocation of scarce drugs, this article also asks a more fundamental question: Why did it take nearly 40 years after the first Ebola outbreak in 1976 to launch clinical trials?

The Unseen And Untold Issues Of Clinical Trials And Research Ethics In Pakistan., Shahan Waheed, Emaduddin Siddiqui

Department of Emergency Medicine

No abstract provided.

Review Of Ourselves Unborn: A History Of The Fetus In Modern America, By Sara Dubow, Rose Holz

Women's and Gender Studies Program: Faculty Publications

With the publication of the Bancroft Prize-winning Ourselves Unborn, Sara Dubow offers a long overdue analysis and historicization of what has become a central feature in battles over reproductive rights: the fetus. Drawing upon legal and legislative records as well as educational tracts, museum exhibits, medical textbooks and journals, personal memoirs, and the popular press, Dubow traces what she calls “fetal stories” (4) in America from the late nineteenth century through the early twenty-first. In so doing, she persuasively reminds her readers the following: First, that our understanding of the fetus is not simply a product of biology or theology. …

Diffusion Of Polst Education In Maine: Successes, Challenges, And Opportunities, Mary Lou Ciolfi

Muskie School Capstones and Dissertations

POLST, Physicians Orders for Life Sustaining Treatment originted in Oregon in the 1990's and is a vehicle for recording patient health care choices near the end of life as actionable physician orders so choices are honored with greater clarity and frequency at the point of care. This capstone is about educating and encouraging clinicians and the public to engage in conversations surrounding POLST.

Tobacco Endgame Strategies: Challenges In Ethics And Law, Bryan P. Thomas, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

There are complex legal and ethical tradeoffs involved in using intensified regulation to bring smoking prevalence to near-zero levels. The authors explore these tradeoffs through a lens of health justice, paying particular attention to the potential impact on vulnerable populations. The ethical tradeoffs explored include the charge that heavy regulation is paternalistic; the potentially regressive impact of heavily taxing a product consumed disproportionately by the poor; the simple loss of enjoyment to heavily addicted smokers; the health risks posed by, for example, regulating nicotine content in cigarettes—where doing so leads to increased consumption. Turning to legalistic concerns, the authors explore …

Industry’S Colonization Of Psychiatry: Ethical And Practical Implications Of Financial Conflicts Of Interest In The Dsm-5, Lisa Cosgrove, Emily E. Wheeler

Counseling, School Psychology & Sport Faculty Publication Series

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), scheduled for publication in May 2013 by the American Psychiatric Association (APA), has created a firestorm of controversy because of questions about undue industry influence. Specifically, concerns have been raised about financial conflicts of interest between DSM-5 panel members and the pharmaceutical industry. The authors argue that current approaches to the management of these relationships, particularly transparency of them, are insufficient solutions to the problem of industry’s capture of organized psychiatry. The conceptual framework of institutional corruption is used to understand psychiatry’s dependence on the pharmaceutical industry and …

Carrots, Sticks And False Carrots: How High Should Weight Control Wellness Incentives Be? Findings From A Population-Level Experiment, Harald Schmidt

Frontiers in Public Health Services and Systems Research

Employers are increasingly using wellness incentives, including penalties for unhealthy behavior. Survey data suggests that people are willing to accept the principle of penalizing those perceived to take health risks, but the equally relevant question of the magnitude of acceptable penalties is unclear.

While the principle of penalizing overweight and obese people has some support, findings from a population-level experiment (n=1,000) suggest that the acceptable size of penalties is comparatively small, around $50: more than 10-fold below levels favored by advocates. Reward-based incentives are favored over penalty-based ones by a factor of 4. Of two different ways of framing penalty …

Enhancing Communication Between Scientists, Government Officials, And The Lay Public: Advancing Science And Protecting The Public's Welfare Through Better Multi-Stakeholder Interfacing, Clark J. Lee, Patrick P. Rose, Earl Stoddard Iii

Homeland Security Publications

No abstract provided.

Astrue V. Capato: Forcing A Shoe That Doesn't Fit, Courtney Hannon

Journal of Health Care Law and Policy

No abstract provided.

Ethical Challenges Of Preexposure Prophylaxis For Hiv, Jonathan S. Jay, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

On July 16, 2012, emtricitabine/tenofovir (Truvada) became the first drug approved by the US Food and Drug Administration for preexposure prophylaxis (PrEP) of human immunodeficiency virus (HIV) for adults at high risk. While PrEP appears highly effective with consistent adherence, effective implementation poses ethical challenges for the medical and public health community. For PrEP users, it is necessary to maintain adherence, safe sex practices, and routine HIV testing and medical monitoring, to maximize benefits and reduce risks. On a population level, comparative cost-effectiveness should guide priority-setting, while safety measures must address drug resistance concerns without burdening patients' access. Equitable distribution …

Under The Gun: Ongoing Assaults On Bahrain’S Health System, Richard Sollom, Holly G. Atkinson

Publications and Research

In February 2011, the Government of Bahrain began targeting health professionals who treated protesters. In April 2012, PHR's Richard Sollom, Deputy Director, and Holly Atkinson, MD, FACP, past President of PHR's Board and volunteer expert, authored a report showing the devastation on Bahrain's health system that have resulted from the Government of Bahrain’s continued assault on doctors, patients, and the healthcare system.

The Closure Of New Orleans' Charity Hospital After Hurricane Katrina: A Case Of Disaster Capitalism, Kenneth Brad Ott

LSU New Orleans Theses and Dissertations

Abstract

Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, …

Book Review: Dream Of Ding Village By Yan Lianke, Mike Frick

China Beat Blog: Archive 2008-2012

Unsurprisingly, the Chinese government levied a “three nos” ban—no sales, no distribution, and no promotion—against Dream of Ding Village after its publication in 2005. Though the storytelling relies heavily on dream sequences, Yan takes little poetic license when exposing the depth of the state’s culpability in spreading HIV among poor, medically-naïve farmers. He is just as uncompromising when detailing how officials denied responsibility for the ensuing AIDS epidemic, even as they profited from its human tragedy. No one in Ding Village receives medical care, mental health counseling, food assistance, or a chance to hold the blood heads legally accountable. Cast …

The End Of Nowhere: The History Of Tuberculosis In Ri, Emma G. Sconyers

Senior Honors Projects

The World Health Organization estimates that approximately one third of the word's current population had been infected with tuberculosis. Prior to the 1940's TB was considered an incurable, chronic affliction. Historically, many people were forcibly detained in tuberculosis sanatoria to lessen the spread of the disease; my great granfather being one of them. In 1939, without warning, he was taken from his pregnant, jobless wife and one-year-old daughter, who were left to fend for themselves for two years without government planning or assistance. He spent those two years at Wallum Lake Sanitorium in northern Rhode Island, a place my great-grandmother's …

Sorry Buddy, But Your Name Isn't On The List: Fear And The Ethics Of Organ Donation In Film, Ted Callis

Annual Undergraduate Conference on Health and Society

The fear of death and illness is a powerful motivator. When taking into account the ethical reasoning that drives organ transplantation and procurement practices, it is persuasive enough to sway minds and corrupt pure reason. And so this paper will uncover how fear of illness and death shape answers to the ethical questions that arise in transplant debates and how these debates are in turn raised in the ethical dilemmas portrayed by popular American films. This paper will examine recent films such as The Island, and Never Let Me Go to illustrate how the ethical dilemmas associated with organ …

Culture Ontogeny: Lifespan Development Of Religion And The Ethics Of Spiritual Counselling, Glen Milstein, Amy Manierre

Publications and Research

The counsellor has an ethical obligation to treat the whole person. Humans are cultural beings and the foundation of most cultures is religion. Religion and culture are received from our early relation~ ships and modified through later relationships across the lifespan. The paper introduces the term "culture ontogeny" to emphasize that this is a biological process wherein abstract ideas of culture and religion become material in the developing neurophysiology of each brain. A framework and methods are offered to examine the changing roles of religion in clients' emotional self~ structure, inclusive of those who describe themselves as spiritual, not religious. …

Aids/Hiv Denialism: Patients’ Privacy Rights, Fadia Abdullah, Guadalupe Medrano

Festival of Communities: UG Symposium (Posters)

HIV is a sexually transmitted disease that develops into AIDS. There is no cure for it, only treatment. In this poster, we look at the pros and cons of disclosing this type of information. People who decide to disclose their HIV status may have various reasons for doing so, but most do it for emotional support and for prevention of spreading the disease. Those who decide to keep it private primarily do it to not face rejection, discrimination, degradation, and loss of respect. (Petronio Page 72) The problem with creating a public database is that many organizations are against the …