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Sanchini, V. "FACILITATE DELIBERATION. TOWARDS A PROFESSIONALIZATION OF THE BIOETHICAL EXPERT IN THE PUBLIC ARENA." Doctoral thesis, Università degli Studi di Milano, 2016. http://hdl.handle.net/2434/366875.
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In an increasingly specialized world, where the production of knowledge and its acquisition have become a collective enterprise, nobody can master all the fields alone. This has led to the proliferation of a myriad of experts, each of whom is specialized in a precise domain or subdomain. Given this picture, it is not surprising that people with training in bioethics are often referred to as ‘bioethics experts’ and/or ‘bioethical experts’. However, far from being confined to a specific social dimension, in today’s society bioethicists are a commonplace presence in an ever-increasing range of domains. In recognition of this phenomenon, the aim of this thesis is to explore the so-called issue of bioethical expertise. This means first and foremost exploring two main questions: whether an expertise in the field of bioethics might actually exist and what are, if any, the skills that the bioethical expert is endowed with, in order to understand whether this figure is on a par with professionals of other disciplines. After presenting a general review of the current literature on this issue and briefly indicating the different research paths this research topic might lead to, the focus will be narrowed to dwell on the main research questions this work aims to address: is there a legitimate role for the bioethical expert within the public arena, and, if so, what is this role? Far from being a straightforward question, this issue is further complicated by a vast literature decrying the threat posed by bioethicists with respect to the broader context in which they operate: liberal democracies. In taking these considerations seriously, this dissertation aims to ‘solve the paradox’ connected with the figure of bioethical expert and to propose a normative model of bioethical expert which aims to be compatible with the tenets of liberal democracies and, in particular, their public decision-making processes. This figure will be defined here as the facilitator of deliberation, thus recognizing the debt it has towards the political theories of deliberative democracy.
This work is structured as follows: first of all the theoretical current debate concerning the topic of bioethical expertise is presented. Secondly, by narrowing the focus of investigation I concentrate on the domain in which the bioethical expert proposed here has to operate: public bioethics. The normative proposal of bioethical expert as facilitator of deliberation is then presented, remodelling the former in relation to the already existing figures occupying the public arena. Finally, the results of a preliminary experiment, designed to empirically explore this new figure, are presented and discussed.
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Durante, Christopher. "Public bioethics & the reality of religious pluralism: coping with moral diversity in bioethical methodology." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114414.
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This dissertation examines the problems that religious and moral diversity raise in public bioethics, both in the historical development of the field and in our contemporary situation, and is an attempt to develop the foundations of a bioethical methodology that is able to adequately address the issues of pluralism without losing sight of the fact that bioethics emerged out of the need for shared moral guidelines and rigorous ethical analysis of novel medical technologies. It has been my intention to contribute new insights into the processes of bioethical inquiry, deliberation and policy formation through the development of a dialogical method of public ethics that is able to quest for consensus while simultaneously maintaining a respect for, and making possible the accommodation of, incommensurable moral and ontological differences amongst religious traditions and philosophical systems. The aim is to implement modes of deliberation that can adequately cope with the reality of pluralism and to help produce bioethical policies suited for our multicultural and religiously diverse society.Cette thèse examine les problèmes que la diversité religieuse et morale soulèvent dans la bioéthique publique, à la fois dans le développement historique de la discipline et dans la situation contemporaine; de plus, elle constitue une tentative pour développer les fondements d'une méthodologie bioéthique qui est en mesure d'aborder les enjeux du pluralisme sans perdre de vue le fait que la bioéthique a émergé du besoin de lignes directrices morales partagées et d'une analyse éthique rigoureuse des nouvelles technologies médicales. Il a été mon intention de jeter un nouveau regard sur les processus d'enquête et de délibération bioéthiques et d'élaboration de politiques bioéthiques par le développement d'une méthode dialogique d'éthique publique qui puisse permettre simultanément la recherche du consensus ainsi que le respect et l'accommodement des différences morales et ontologiques incommensurables entre traditions religieuses et systèmes philosophiques différents. L'objectif est d'implémenter des modes de délibération qui puissent faire face à la réalité du pluralisme et d'aider à développer des politiques bioéthiques adaptées à notre société multiculturelle et multiconfessionnelle.
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Jones, Henry Abel. "Bioethics : a public decision? /." Title page, contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09AR/09arj761.pdf.
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Carry, Wendy M. "Public bioethics : an intermediary between public health and the media /." abstract and full text PDF (free order & download UNR users only), 2007. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1448328.
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Thesis (M.P.H.)--University of Nevada, Reno, 2007."December, 2007." Includes bibliographical references (leaves 52-54). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2007]. 1 microfilm reel ; 35 mm.
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Musse, Luciana Barbosa. "Políticas públicas em saúde mental no Brasil na perspectiva do biodireito: a experiência dos estados de Minas Gerais e São Paulo sob a égide da lei 10.216/2001 e suas implicações." Pontifícia Universidade Católica de São Paulo, 2006. https://tede2.pucsp.br/handle/handle/7170.
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Previous issue date: 2006-09-18This research was conducted with the purpose of elucidating the public policies concerning mental health care in Brazil adopted since the promulgation of the law n. 10.216/2001 and which contemplate the mental disturbance carrier attendance and his rights. In order to analyze them, as well as its implications, Biolaw was adopted as reference, considered as a dogmatic theoretical construction, aiming the standard interpretation for juridical decision taking, in order to identify the rationality criterion that surrounds them if efficiency or public ethics. Considering that, since the 1988 Federal Constitution, the whole actions and services supply concerning mental health care are conducted by state, municipal or federal institutions or by the private initiative, with complementary character, the SUS , that is organized based on the regionalism, decentralization and hierarchy principles, the experience of two federal state members was elected, specifically the states of Minas Gerais and Sao Paulo, in order to illustrate the implementation process of strategies adopted by Brazilian public policies concerning mental health care, under the aegis of the law n. 10.216/2001. The data were collected through observation and with the application of questionnaires, answered by (mental) health professionals and by users (or their legal responsible) of hospital and health care services or by mental health care of the states of Minas Gerais and Sao Paulo. Besides those two documentation techniques, this research is based on the historical method, together with the statistic and comparative methods which permits the conclusion that prevailing rationality among public policies concerning mental health care adopted by the Brazilian state is the ethics, that, meanwhile, to be effective, depends on the efficiency and creates implications for the user and mental disturbance carrier that extrapolates the standard limits of the law n. 10.216/2001 and trespasses others meanderings of its existence, especially its juridical and ethical autonomy which creates reflexes, in turn, in the fruition of its recently conquered citizenship
Esta pesquisa tem como objeto as políticas públicas em saúde mental no Brasil, adotadas a partir da promulgação da lei n. 10.216/2001 e que contemplam a assistência ao portador de transtorno mental e seus direitos. Para analisá-las, bem como as suas implicações, adota-se como referencial o Biodireito, entendido como uma construção teórico-dogmática com vistas à interpretação normativa para a tomada de decisão judicial, a fim de identificar o critério de racionalidade que as permeia - se a eficiência ou a ética pública. Tendo-se em vista que, desde a CF/88 o conjunto das ações e da oferta de serviços em saúde mental, dá-se por meio de órgãos e instituições federais, estaduais e municipais, bem como da iniciativa privada, em caráter complementar, o SUS, que se organiza de acordo com os princípios da regionalização, descentralização e hierarquização, elegeu-se a experiência de dois estadosmembros da federação, notadamente, Minas Gerais e São Paulo, para ilustrar o processo de implantação das estratégias adotadas pelas políticas públicas brasileiras em saúde mental, sob a égide da lei n. 10.216/2001. Os dados foram coletados por meio de observação e aplicação de questionários, respondidos por profissionais da saúde (mental) e por usuários (ou seu responsável legal) de serviços hospitalares e comunitários de saúde ou saúde mental de Minas Gerais e São Paulo. Além dessas duas técnicas de documentação, a pesquisa é pautada pelo método histórico, aliado ao estatístico e ao comparativo, que permitem concluir que a racionalidade predominante nas políticas públicas em saúde mental, adotadas pelo Estado Brasileiro é a ética, que, entretanto, para ter efetividade, depende da eficiência e gera implicações para o usuário portador de transtorno mental que extrapolam os limites normativos da lei n. 10.216/2001 e invadem outros meandros da sua existência, em especial a sua autonomia ético-jurídica, que reflete, por sua vez, no gozo da sua cidadania recém conquistada
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Pritchard, Kathryn. "Bioethics, public policy and the Church of England." Thesis, University of Winchester, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.698197.
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Ivarsson, Markus Linda. "Juggling with dilemmas when promoting public health : Nurses´ and physicians´ motivating strategies towards vaccine hesitant parents." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-233288.
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Background: To achieve control of a vaccine preventable communicable disease, it is of importance to establish high enough coverage to reach the threshold for herd immunity. Preventive public health interventions, such as vaccination programmes, create dilemmas between societal versus individual benefits of the programme. Vaccine providers handle this dilemma when motivating hesitant parents and vaccine providers´ own perceptions of vaccine benefits will possibly influence the parental decision. The motivating strategies need to support parental autonomy, the best interest of the child and societal benefits. By using the bioethical principles autonomy, beneficence and justice, strategies can be analyzed regarding what agents are most benefitted by the strategy. Purpose: To gain insight in how vaccine providers balance between individual, societal, parental and internal values when promoting vaccine towards vaccine hesitant parents. Method: Explorative qualitative interview study. Results: The respondents´ strategies are more or less influencing and adjusted according to the underlying reason the parents have for hesitation. An underlying strategy is to use means of social interaction to build trustful relationships. Respondents perceived reasons to vaccinate are ranging from individual to societal and are reflected in the strategies and the respondents aim to aid parents to a well informed decision. Some strategies are more persuasive than others and in rare occasions infringe on parental autonomy in a less plausible manner. Conclusions: The findings from this study reflect that the public health dilemma is indeed present in the clinical context when motivating vaccine hesitant parents. Respondents do their utmost to aid the parents to a well informed decision, regardless if the child will be vaccinated or not, or whatever reason parents have for hesitance. Since vaccination is a voluntary action that is required from many to reach herd immunity, vaccine providers need to consider the ethics surrounding motivating hesitant parents to reach best possible outcome regardless if this is benefitting the child, society or parental autonomyBakgrund: För att kunna kontrollera vaccinerbara smittsamma sjukdomar är det av högsta vikt att etablera hög vaccintäckning och uppnå nivån för flockimmunitet. Preventiva folkhälsointerventioner, såsom vaccinationsprogram, skapar dilemman mellan samhällelig och individnytta. Yrkespersoner som erbjuder vaccin måste hantera detta dilemma när de motiverar föräldrar som är tveksamma till att vaccinera sina barn. Yrkespersonernas uppfattningar om nyttan med vacciner och motivationsstrategierna kan tänkas påverka föräldrarnas beslut. Strategierna behöver stödja såväl föräldrarnas autonomi, barnets rätt och samhällets bästa. Genom användande av de bioetiska principerna autonomi, godhet och rättvisa kan strategierna analyseras utifrån vilka agenter som gagnas mest. Syfte: Att få inblick i hur yrkespersoners balanserar mellan individuella, samhälleliga, föräldrarelaterade och interna värden när de promotar vaccin till föräldrar som är tveksamma till vaccin. Metod: Explorativ kvalitativ intervjustudie. Resultat: Respondenternas strategier anpassas efter föräldrarnas bakomliggande skäl till att inte vaccinera sina barn och är mer eller mindre influerande. En underliggande strategi är att använda social interaktion för att bygga förtroende hos föräldrarna. Respondenterna uppfattade nyttan med vacciner som både individuell och samhällelig och speglades i strategierna. Respondenterna siktade på att föräldrarnas beslut ska vara välgrundat. Några strategier är mer övertalande än andra och i sällsynta fall inkräktande på föräldrarnas autonomi på ett mindre lämpligt sätt. Slutsats: Fynden speglar att folkhälsodilemmat mellan individ och samhälle är närvarande i den kliniska situationen när tveksamma föräldrar ska motiveras till att vaccinera sina barn. Respondenterna gör sitt yttersta för att guida föräldrarna till ett välgrundat beslut, oavsett om barnet blir vaccinerat eller inte, oavsett vilket skäl föräldrarna har till tveksamheten. Eftersom att vaccination är en frivillig handling som krävs av många för att uppnå flockimmunitet så behöver yrkespersoner ta hänsyn till etiken kring när föräldrar motiveras till att vaccinera sina barn. Detta för att uppnå bästa möjliga resultat oavsett om det gagnar barnet, samhället eller föräldrarnas autonomi.
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Lee, Kyung Hae. "Do not resuscitate : bioethical and nursing perspectives /." View thesis, 1995. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030807.133935/index.html.
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Pleasants, Gabriel J. "Bioethics and Human Rights: A Problem, a Proposal, and an Achievement." Thesis, Boston College, 2007. http://hdl.handle.net/2345/508.
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Thesis advisor: James F. KeenanThis study investigates the recent paradigm shift in bioethics to an approach that uses the language of human rights to work towards social justice and health equity. It follows the three stages of Kuhn's "paradigm shift": recognizing the fallibility of the first paradigm and proving its destructiveness, presenting the theoretical particulars of a new paradigm, and demonstrating how the new paradigm becomes operational. The case study of the organ trade shows the failure of the first model of bioethics, based on autonomy and non-maleficence. This model falsely depicts the true ethical challenges while shadowing the enormous harms it causes. An emerging bioethical model centered on human rights is presented as the best theoretical option to remedy the ills of the first paradigm and make sense of bioethical dilemmas across the globe. But the second paradigm cannot simply look better, it must be operational. Applying the human rights model, the Treatment Action Campaign in South Africa achieved universal access to antiretroviral treatment, thus confirming the theory of the new paradigm in action. The study concludes with a call for an ethics of implementation within the new paradigm that balances the radical ideal of health as a human right with concrete and pragmatic improvements in healthcare; an ethics of "being on the way" to the ultimate goal of justice and equity in health
Thesis (BA) — Boston College, 2007
Submitted to: Boston College. College of Arts and Sciences
Discipline: International Studies
Discipline: College Honors Program
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Maesela, Matlou Tlakale. "The analysis of public and private healthcare in South Africa." Diss., University of Pretoria, 2019. http://hdl.handle.net/2263/73473.
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The Bill of Rights enshrines the rights of all people in our country and affirms the democratic values of human dignity, equality and freedom. The state must respect, protect, promote and fulfil the rights in the Bill of Rights. Every human being on earth has the right to life. In general, the state's positive and negative duties are set out in section 7(2) of the Constitution of South Africa, which requires the state to respect, protect, promote and fulfil all human rights.
The Constitution of the Republic of South Africa adopted and in 1996 is the supreme law of the land and supersedes all other laws in the country. The main key to having a more eloquent and fulfilling governing system is to align it with the Constitution. This is empirical to developing and implementing health law and policy, which regulates in at least five important ways:
• It regulates the structure of government.
• It regulates the way in which various branches of government operate.
• It sets out the framework for raising taxes and allocating revenue.
• It guides the content of all laws and policies, primarily through the Bill of Rights.
• It regulates the role of government and non-state actors such as private corporations in realising the right of access to health care services. Furthermore, it emphasizes that every person has the right “to have access to health care services, including reproductive health care”.Mini Dissertation (LLM)--University of Pretoria, 2019.
Public Law
MPhil
Restricted
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Shane, Ruth Hardie. "Private Actions--Public Responsibilities: Reflections on West v. Atkins (1988)." Diss., Virginia Tech, 2003. http://hdl.handle.net/10919/11062.
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This dissertation explores the pragmatic implications of judicial rhetoric found in a 1988 Supreme Court decision, i.e., this is a dissertation about public administration using constitutional law to illuminate an administrative question. My viewpoint is a legal/constitutional one which uses the law as pedagogue to inform public administration and to offer a useful message for the public administration practitioner. That message deals with a legal/constitutional distinction between publicness and privateness and the implications of that distinction.
Quincy West was sentenced to prison in 1973 for armed robbery. While in prison he suffered a torn Achilles tendon for which he received inadequate medical care. After numerous attempts to obtain medical care, West filed suit against the prison physician contractor in federal courts for cruel and unusual punishment. This dissertation uses the story of West's legal efforts and the Supreme Court's decision in his case to discuss the broad implications of that decision for the public administration practitioner and government contractors. The lens is a constitutional one. The framework is John Rohr's schema for understanding a Supreme Court case: viewing that case from the institutional, concrete, dialectical, and pertinent perspectives.
The specifics of West's allegations against his physician invite discussions of bioethical topics such as informed consent and medical legal topics such as malpractice and patient abandonment. The Court's determination of state action in West v. Atkins (1988) requires discussion of the administrative areas of contracts and grants administration as well as risk management. The complex responsibilities of the public administration practitioner are examined, as is his or her need to follow and independently learn from the messages included in the courts' interpretation of the law.
This historic story illustrates that there is no bright line between law and policy. The Court's dialogue with itself is not merely interpretation and development of the law - it is policy reformulation. For this reason, among others, the conscientious administrator must monitor the Court's ongoing dialogue and listen attentively to its messages of import for our field and our practice.Ph. D.
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Maugeri, P. M. "STATES OF CANCER IMMUNITY: THE ETHICAL DIMENSIONS OF HPV VACCINATION POLICIES." Doctoral thesis, Università degli Studi di Milano, 2012. http://hdl.handle.net/2434/214786.
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Human Papillomavirus (HPV) is a sexually transmitted virus, recognized to be the necessary, yet not sufficient, cause of cervical cancer. Vaccines for individual administration targeting HPV are available today. In this dissertation I undertake a normative analysis of existing HPV vaccination programmes and evaluate how current policy alternatives put in balance competing moral concerns at stake. To this aim, I explore the ethical dimension of the different policy models, with respect to issues of respect for individual choice, expected coverage rates, and population health goals.
My goal is thus to show how the different policies - ranging from a hotly contested mandatory model to prima facie more justifiable voluntary approaches – fare with respect to the interests of individuals targeted by HPV vaccination campaigns. Differently from standard approaches in public health ethics, however, I show that concerns for individual choice in HPV contexts cannot be severed by equally important concerns for social justice. In particular, I show that an insistence on the least restrictive alternative alone leaves out of focus important concerns for social justice and the need to avoid the worsening of existing inequalities. Moreover, I argue that standard approaches in public health ethics should be widened to consider the legitimate interests of specific social groups, namely those belonging to socio-economically disadvantaged strata of society, and fair consideration of the health interests of minority groups.
In this dissertation I therefore present a rationale for adopting a capability-based approach to HPV immunization in order to cope with the most pressing ethical issues at stake in this field.
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Pelser, Adam C. "Made in the image of man the value of Christian theology for public moral discourse on human cloning /." Electronic thesis, 2007. http://dspace.zsr.wfu.edu/jspui/handle/10339/187.
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Abritis, Alison J. "An Assessment of Retractions as a Measure of Scientific Misconduct and Impact on Public Health Risks." Scholar Commons, 2015. http://scholarcommons.usf.edu/etd/5630.
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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 subsequent retractions or corrections per final ORI finding was analyzed. Out of 167 subjects who received ORI sanctions, 84 (50.3%) had no publications associated with their misconduct. Of the remaining 83 subjects, only 72 had at least one retraction associated with their misconduct, i.e., only 43.1% of the all study subjects sanctioned for misconduct had at least one retraction from misconduct. Of the 231 retractions and corrections arising from the sanctioned misconduct, only 94 notices (40.6%) gave research misconduct as a cause for the retraction or correction. Thus, the study demonstrates that research misconduct occurs at a greater rate than retractions for misconduct are published, and retraction and correction notices cannot be relied upon to convey the presence of fraudulent data within the publication.
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Kuipers, Benjamin Johannes. "Public Policy, discourse and risk: Framing the xenotransplantation debate in New Zealand (1998-2013)." Thesis, University of Canterbury. Political Science, 2015. http://hdl.handle.net/10092/10518.
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This thesis focuses on the evolution and framing of xenotransplantation (XTP) policy debate in New Zealand from 1998 to 2011. Its aim is providing a better understanding of both the science-society interface and the importance of issue framing policy debate in understanding of the scientific debate in New Zealand and its relationship with the public. A qualitative study, this thesis draws upon a variety of public science commentary and debate and poses the research question: How did xenotransplantation’s introduction and explanation to the New Zealand public inform its current status as a Restricted Procedure under New Zealand law; and what ethical implications arise from this public policy debate for public participation in bio-medical research in New Zealand?
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Essex, Ryan William. "Australian Immigration Detention: How Should Clinicians Respond?" Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20642.
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Australian immigration detention violates human rights and international law. Clinicians and professional healthcare bodies have been central to its operation, both providing healthcare within detention centres and protesting its consequences. Since its introduction over 25 years ago and despite ongoing protest the government has continued to implement increasingly opaque and punitive policy. How should clinicians respond? This thesis sets out to challenge over 20 years of thinking on this topic, calling for a shift in how clinicians and professional bodies engage with Australian immigration detention. I argue that current responses to the health and healthcare needs of those detained are inadequate. I reject a boycott but call for such action to be seen within a broader strategy aimed at bringing about social and political change. I propose a theoretical base to inform such a stance, by appealing to social movement theory and other theories of social change. I demonstrate how such theory can be applied to inform systemic, social and political change, and I argue that clinicians and professional bodies should embrace this approach which includes employing forms of political action such as protest, disruption and civil disobedience.
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Fragassi, Christopher. "SCHIZOPHRENIA AND STIGMA: AN OUTLOOK ON THE MEDICAL, LEGAL, AND SOCIAL ASPECTS OF LIVING WITH SCHIZOPHRENIA." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/488872.
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Urban BioethicsM.A.
Schizophrenia is a disease which presents many challenges. Medically, legally, and socially, afflicted individuals face obstacles that decrease their overall quality of life. Some of these are sequela of the disease and its decrease in social functioning, or symptoms of paranoia and disorganization. However, others are placed on these individuals by society. This has created a lifestyle which is marred by comorbid medical conditions and a resistance to receive treatment. It also creates frequent contact with the legal system, leading to a disorganized home life, and a significant amount of time spent behind bars, and being victimized by others. Finally, many schizophrenic patients are unable to find jobs, and report being without significant supportive relationships in their lives, creating stress both on themselves and their families and caregivers. These difficulties in life can be inseparable from their disease and place schizophrenic patients at a further disadvantage.
Temple University--Theses
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Scary, Thomas. "American Ignominy: The Incarceration of the Mentally Ill." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/501251.
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Urban BioethicsM.A.
Prisons and jails have become the de facto psychiatric hospitals of the twenty-first century. In the wake of deinstitutionalization, as mental healthcare transitioned to a community-based model, many patients with mental illness found themselves incarcerated rather than hospitalized. Strict drug laws combined with the current opioid epidemic are now forcing the government to consider treatment over punishment, lest the prison populations continue to swell. It is time to strongly consider using the involuntary commitment for severe cases of substance abuse if the patient is unwilling to undergo rehabilitation. Refusing to wait for the federal government to act, cities and states around the nation have begun to experiment with novel solutions to these issues, working within the framework of the prison system to achieve better outcomes.
Temple University--Theses
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Hason, LaiQuannah. "IF NOT NOW, WHEN?" Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/578705.
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Urban BioethicsM.A.
Maternal Health requires a bioethical evaluation to thoroughly address and reduce the troubling statistics and events of pregnancy-related complications and maternal mortality. Maternal mortality affects African American women three to four times more than any other race, therefore presenting race as a factor. Types of experienced racism and the overall scientific pathway are explored in relation to the health of African-American women. Race-related stress and its association with adverse maternal health outcomes is an important issue to consider when evaluating the maternal health complications. In addition, addressing the result of unethical inequalities in the healthcare system in combination with other societal contributions is essential when trying to recognize its impact on the experience of pregnancy. This thesis explores the impact of racism on maternal outcomes and health of African-American mothers, beyond the commonly understood influences of other socio-economic factors.
Temple University--Theses
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Zuckerman, Shlomit. "The Expansion of Newborn Screening In Israel: Ethical and Social Dimensions." Cleveland, Ohio : Case Western Reserve University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1247156923.
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Healy, Kaitlin Elizabeth. "Using Community Engagement Tools to Develop More Successful Harm-Reduction Strategies Among People Who Use Intravenous Drugs." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/503748.
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Urban BioethicsM.A.
The current opioid epidemic has had grave financial and mortal costs for our nation, and the numbers continue to climb despite our best efforts. In spite of attempts to limit the prescription of opioids and implementation of harm reduction strategies, it is clear that we are not doing enough for people struggling with drug addiction. There are many voices present in the war on drugs, however one that is noticeably absent from the conversation is that of people who inject drugs. It is clearly time to try something new which requires a fresh approach and a new point of view. Confronting the current crisis using a public health approach addresses the associated moral challenges faced in the past and provides a new lens to view potential challenges and solutions. With this new approach arises the need for a public health ethical framework to make ethically informed, community engaging, evidence based decisions on a societal, public health, and everyday level. In addition to this new public health ethics framework, the engagement of the community of people who inject drugs is no longer negotiable in order to develop more effective harm reduction interventions and policies.
Temple University--Theses
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Doyle, Jamie L. "My Experience with Oncology Clinical Research: How Clinical Trials Silently Exclude Urban Patients and What I Have Done to Make One Research Program More Inclusive." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/550374.
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Urban BioethicsM.A.
As an oncology clinical researcher at an urban hospital, I reflected on patient stories and see overlying themes: financial hurdles, treatment delays, difficulties completing treatment, ineligibility for clinical trials, and other barriers to care specific to urban patients. Delays in cancer treatment have been linked to a decrease in overall survival; consequently, reducing observed blockades could be a matter of life and death. Clinical trials provide more treatment options while researching possible standard of care therapies for future patients. As novel anticancer treatments become more biomolecule specific and low minority enrollment on clinical trials used to validate these drugs continues, I ask, “Why”? I believe urban patients are unethically excluded from participating in clinical trials by overly restrictive study eligibility criteria, high out-of-pocket costs, lengthy informed consents written either not at the patient’s reading level or not in their language, as well as other deterrents associated with low socioeconomic status. More minority representation in clinic trials is necessary to ensure drugs seeking FDA approval are more representative of the population. I argue more needs to be done to make studies more inclusive. Though challenges enrolling urban patients onto clinical trials remains, I believe there are still ways to enhance their cancer care: 1) identifying or writing treatment clinical trials that are more inclusive; and 2) developing studies with interventions that target socioeconomic barriers to care.
Temple University--Theses
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Thor, Danielle Claire. "Ethics in Emergency Medical Services: A Contextual Analysis." Master's thesis, Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/592304.
Full textAbstract:
Urban BioethicsM.A.
The modern concept of Emergency Medical Services (EMS) has grown from its humble volunteerism origins to a multidisciplinary enterprise, outstretched into the realms of both healthcare and public service. As the American EMS community continues to assume greater responsibilities and further develop its professional standards, the moral foundations of this field open themselves to more thorough scrutiny. Upon examination, the major deficit in the ethical structuring of EMS becomes glaringly obvious: it exists as a piecemeal collection of its medical and militaristic counterparts unified by theoretical generalizations that avoid its inherently unique structure. If EMS wishes to matriculate into complete professionalism, or even continue its assumption of critical responsibilities surrounding the health and safety of others, then it must also develop and maintain its own individual ethical framework from which it operates. In doing so, an urban bioethical approach rooted in context-driven analysis and pragmatic solutions may provide the best guidance and protections for all those who interact with the EMS system while respecting the values of this distinctively prideful service.
Temple University--Theses
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Bruton, Yasmeen P. "Grandma Knows Best: Maternal Perceptions of Grandparents' Influence on Child Snacking and Parental Feeding Authority." Master's thesis, Temple University Libraries, 2015. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/351907.
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Urban BioethicsM.S.M.E.
BACKGROUND: While parents have central influence on children’s eating behaviors, an increasing number of grandparents participate in child feeding. The manner in which grandparents approach feeding young children as well as how that role is negotiated with parents is unclear. The purpose of the study was to explore maternal perceptions of grandparents’ influence on preschool aged children’s snacking and parental authority in child feeding. METHODS: Participants were 55 ethnically-diverse, low-income mothers of preschool children, aged 3 to 5 years. A qualitative design was employed where semi-structured interviews were used to examine mothers’ schemas around child snacks and the context of snacking. Interviews were recorded and transcribed verbatim. Analyses used NVivo 10 to identify major themes using a grounded-theory approach. Participant demographics and household food security were assessed by self-report. RESULTS: Three major themes emerged regarding mothers' perceptions of grandparents. First, many mothers described supportive or positive aspects of grandparents’ involvement in child feeding: 1) building bonds with grandchildren, 2) providing healthy foods, and 3) setting limits. Second, at the same time mother believed grandparents often to be unsupportive partners in child feeding by: 1) offering “junk foods” and 2) being permissive regarding the types, frequency, and portion sizes of snacks offered to children. Third, mothers’ authority in feeding was challenged by grandparents’ approach to feeding children snacks when at odds with the mothers’ the mothers approach. CONCLUSION: Findings suggest that grandparents may have important roles in family dynamics around feeding among low-income families with young children.
Temple University--Theses
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Costa, Vilcelânia Alves. "O centro de controle de zoonoses de mossoró rio grande o norte e sua relação com o bem estar animal e a comunidade." Universidade Federal Rural do Semi-Árido, 2015. http://bdtd.ufersa.edu.br:80/tede/handle/tede/24.
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Previous issue date: 2015-02-26The issues related to animal welfare (BEA) and bioethics has been the subject of much debate, especially when referring to the Zoonosis Control Centers (CCZ). That body is responsible for controlling the population of animals and, consequently, existing zoonoses in cities. In this context, can be seen problems due to a variety of factors that often affect not only public health but also animal welfare and the possibility of conflict between professionals of the institution and the population they served. Whereas, therefore, such a reality, aimed to analyze the CCZ serving Mossoró / RN, its relationship with the community and animal welfare. For this, we conducted field research on site CCZ, with observation and monitoring of the activities developed by the institution, as well as a questionnaire with open and closed questions to 36 employees of the CCZ. The research is still extended to five districts of the city, where questionnaires were applied, also with open and closed questions, the 385 residents of their neighborhoods. The data obtained after the questionnaires were subjected to statistical analysis using the R program, using the chi-square test, Fisher exact test, with a 5% significance level. From the observation of the activities developed by the local CCZ was found that this does not meet all the specific objectives set by the National Health Foundation (FUNASA), and its physical structure is not consistent with the proposed guidelines also for this, which compromises the welfare of the animals housed. Furthermore, although most professionals (78%) know what is animal welfare, only a small portion (28%) know issues related to bioethics, and 30% of those who know what bioethics has completed higher education, 10% have incomplete higher education, 50% have completed secondary level and 10% have completed secondary level. Regarding the perception of the community, the majority of respondents do not know what are the animal disease control centers, their purpose and which existing programs. Regarding the perception of the CCZ professionals about their relationship with the community conflicting data were highlighted, since they consider that their relationship is harmonious, but report that there is resistance from the population for their work. It follows that there is a perceived need on the expansion of services offered by the CCZ to the population in order to enable it to participate and collaborate in the control of zoonoses and control of stray animals. In addition, it is necessary to improve with regard to working conditions in the institution in order to ensure animal welfare and staff. However, this will only become feasible with efforts and interest of the government
As questões relacionadas ao bem estar animal (BEA) e a bioética tem sido alvo de grandes discussões, principalmente quando se referem aos Centros de Controle de Zoonoses (CCZ). O referido órgão é responsável pelo controle da população de animais e, consequentemente, de zoonoses vigentes nas cidades. Nesse contexto, podem-se observar problemas decorrentes de uma série de fatores que, muitas vezes, afetam não apenas a saúde pública, mas também o bem estar animal e a possibilidade de haver conflitos entre os profissionais dessa instituição e a população por eles atendida. Considerando, pois, tal realidade, objetivou-se analisar o serviço do CCZ do município de Mossoró/RN, sua relação com a comunidade e com o bem estar animal. Para isso, foi realizada pesquisa de campo no CCZ local, com observação e acompanhamento das atividades desenvolvidas pela instituição, bem como aplicação de questionário com perguntas abertas e fechadas aos 36 funcionários do CCZ. A pesquisa se estendeu ainda para cinco bairros da cidade, onde foram aplicados questionários, também com perguntas abertas e fechadas, a 385 moradores dos respectivos bairros. Os dados obtidos após a aplicação dos questionários foram submetidos à análise estatística com auxílio do Programa R, utilizando-se os testes qui-quadrado, exato de Fisher, com um nível de significância de 5%. A partir da observação das atividades desenvolvidas pelo CCZ local constatou-se que este não atende a todos os objetivos específicos estabelecidos pela Fundação Nacional de Saúde (FUNASA), e que sua estrutura física não condiz com as diretrizes preconizadas também por esta, o que compromete o bem estar dos animais alojados. Além disso, embora a maioria dos profissionais (78%) saiba o que é bem estar animal, apenas uma pequena parcela (28%) conhece assuntos relacionados à bioética, sendo que 30% dos que sabem o que é bioética tem ensino superior completo, 10% tem ensino superior incompleto, 50% tem nível médio completo e 10% tem nível médio incompleto. No tocante a percepção da comunidade, a maioria dos pesquisados não sabe o que são os centros de controle de zoonoses, sua finalidade e quais os programas existentes. Quanto à percepção dos profissionais do CCZ sobre a sua relação com a comunidade foram evidenciados dados conflitantes, uma vez que os mesmos consideram que a sua relação é harmoniosa, porém relatam que existe resistência por parte da população para com seu trabalho. Conclui-se que há uma necessidade perceptível quanto à ampliação dos serviços ofertados pelo CCZ à população a fim de que esta possa participar e colaborar no controle de zoonoses e no controle de animais errantes. Além disso, faz-se necessária a melhoria no que diz respeito às condições de trabalho na instituição, a fim de garantir o bem estar animal e dos funcionários. Todavia, isso só se tornará viável com esforços e interesse do poder público
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Baurer, Danielle. "Deconstructing the Teenage Pregnancy "Epidemic:" An Informed Approach to Caring for Marginalized Adolescents While Respecting Reproductive Autonomy." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/424296.
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Urban BioethicsM.A.
Teenage childbearing is considered a societal ill, despite the evidence failing to demonstrate a causative link between teenage childbearing and negative consequences for teens or their children. This thesis argues that the strongly held assertion that teenage childbearing is detrimental to teens and society is rooted in racist eugenics theories and histories of reproductive coercion. Today, social scientists, health care providers, and public health professionals develop and celebrate programs that reduce rates of teen pregnancy, particularly programs that provide Long Acting Reversible Contraceptives (LARCs) to teens in marginalized communities. While these efforts are well-intentioned, they fail to recognize their perpetuation of histories of reproductive coercion of young women of color. This paper recommends ways in which the medical community can be better informed and respect reproductive autonomy in caring for teens from marginalized communities.
Temple University--Theses
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Santos, Ellen Cristina Barbosa dos. "Judicialização do direito à saúde: acesso ao tratamento de usuários com diabetes mellitus na cidade de Ribeirão Preto e região, de 2003 a 2013." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-09022015-194034/.
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Trata-se de um estudo exploratório-descritivo do tipo documental e estatístico, de abordagem quantitativa, com o objetivo de analisar as ações judiciais individuais para fornecimento de medicamentos, insumos ou materiais, propostas por usuários com diabetes mellitus (DM) no município de Ribeirão Preto e região, no período de 2004 a 2013. A coleta de dados estudo foi realizada no Departamento Regional de Saúde XIII (DRS XIII) do estado de São Paulo e na Secretaria Municipal de Saúde de Ribeirão Preto/SP, no período setembro de 2013 a janeiro de 2014. Foi utilizado um instrumento semi-estruturado contendo variáveis relacionadas aos elementos processuais e variáveis relacionadas aos usuários com DM. Os dados coletados foram organizados, digitados em banco de dados, importados para o programa Statistical Package for Social Sciences, e submetidos à análise estatística descritiva. No período investigado foram identificados 636 processos judiciais movidos por usuários com DM, dos quais 374 (58,8%) pertenciam a mulheres. A faixa etária predominante nas ações, 372 (58,5%), refere-se a usuários com idade entre 18 e 60 anos. Observou-se que o número de processos é crescente a partir do ano de 2004, três até 2012 (111), e em 2013 medidas administrativas foram instituídas com o intuito de reduzir o número das ações, resultando em uma diminuição para 77 processos. Em 431 (67,7%) casos as instituições que conduziram as ações pertencem ao serviço público e compreendem a Defensoria Pública e o Ministério Público. 457 (71,9%) processos tinham como origem da prescrição médica o serviço prestado por consultórios particulares. 470 (73,9%) processos são movidos por usuários residentes no município de Ribeirão Preto. No que tange as solicitações de antidiabéticos orais, foi possível observar que dentre os pleiteados houve predomínio, 122(19%) das gliptinas, seguidas das glitazonas, que correspondeu a 31 (4,9%) das solicitações. Quanto às solicitações nas quais o pleito referiu-se às insulinas, as mais frequentemente solicitadas foram as de ação longa (glargina e detemir), resultando em 397(62,4%), seguidas das de ação ultra-rápida (lispro, apart e glulisina) que resultaram em 357 (56,1%) ações. Em 17 (2,7%) processos as demandas continham medicamentos já incluídos na lista federal de fornecimento gratuito de medicamentos, entretanto nos anos em que foram solicitados ainda não havia regularidade no fornecimento dos mesmos, o que pode ter suscitado a solicitação via judicial. Dos 636 processos 163 (25,6%) possuíam solicitação de materiais e/ou insumos. Desses, a maioria, 111 (17,5%), trata de materiais e insumos relacionados à aplicação da insulina através de múltiplas injeções diárias e 88 (13,8%) ações solicitaram materiais e insumos relacionados à utilização de bomba de infusão contínua de insulina. Conhecer a realidade da judicialização do direito à saúde em usuários com DM permite levantar indagações a respeito de como tal fenômeno acontece. Além disso, resulta em inquietações sobre o que têm sido relevante para as decisões finais do Judiciário, em relação a tais demandas. Por fim, tais resultados podem servir de base para uma reestruturação dos serviços em questão a fim de que novas propostas sejam apresentadas para solucionar as situações detectadas, além de promover a reflexão sobre o que de fato se entende por direito à saúdeThis is an exploratory-descriptive study, documental and statistical, quantitative approach, aiming at analyzing individual lawsuits for providing medicines, supplies or materials proposed for patients with diabetes mellitus (DM) in Ribeirão Preto and region in the period 2004-2013. Data collection was performed at the Regional Department of Health XIII (XIII DRS) of the state of São Paulo and the Municipal Health Department of Ribeirão Preto / SP in the period September, 2013 to January, 2014. A semi-structured questionnaire containing items related to procedural elements and variables related users with DM. The collected data were entered into the database, imported into the Statistical Package for Social Sciences and subjected to descriptive statistical analysis. In the period investigated, 636 lawsuits filed by users with DM, of which 374 (58.8%) belonged to the women. The predominant age group in actions, 372 (58.5%), refers to users aged between 18 and 60 years. It was observed that the number of processes is increased from 2004 (three) until 2012 (111). In 2013 there is a reduction in the number to 77 cases, due to the implementation of administrative measures to this end. In 431 (67.7%) cases the institutions that conducted the shares belong to the public sector and comprise the Public Defender and the Public Ministry. 457 (71.9%) of cases had their origin in the private offices prescription. 470 (73.9%) of the cases are filed by residents of the city of Ribeirão Preto. Regarding requests for oral antidiabetics, it was observed that among those pleaded, there was predominance, 122 (19%) of gliptinas, followed by glitazones, which corresponded to 31 (4.9%) of the requests. Regarding the requests in which the election referred to insulins, the most frequently requested were the long-acting (glargine and detemir), resulting in 397 (62.4%), followed by those of ultra-rapid-acting (lispro, apart and glulisine) which resulted in 357 (56.1%) of the actions. In 17 (2.7%) cases the demands contained medicines already included in the federal list of free supply of drugs; however in the years in which they were requested, there was no regular supply of them, which may have raised the request via court. Of the 636 cases, 163 (25.6%) had a request for materials and / or supplies. Out of these, the majority, 111 (17.5%) comes to materials and supplies related to administering insulin through multiple daily injections and 88 (13.8%) actions requested materials and supplies related to the use of continuous infusion pump of insulin. Knowing the reality of the legalization of the right to health in DM, allows users to collect data about how this phenomenon occurs. Moreover, results in concerns about what has been relevant to the decisions of the judiciary. Finally, these results can serve as a basis for a restructuring of the services in question for new solutions to be presented to resolve the situations detected, besides promoting reflection on what actually is meant by the right to health
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Santos, Ellen Cristina Barbosa dos. "Direitos dos usuários com Diabetes Mellitus: do conhecimento à utilização dos benefícios na saúde." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-18082009-130259/.
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Trata-se de um estudo exploratório-descritivo de abordagem qualitativa, com o objetivo de analisar o conhecimento do usuário com diabetes mellitus acerca dos direitos e benefícios em saúde advindos da legislação vigente. O estudo foi realizado no Centro de Pesquisa e Extensão Universitária do interior paulista com 12 usuários com diabetes mellitus, vinculados ao Grupo de Educação em Diabetes. A coleta de dados ocorreu no período de setembro a dezembro de 2008, através de entrevista semi-estruturada, norteada pela questão relacionada ao conhecimento do usuário com diabetes mellitus e percepção dos benefícios em saúde advindos da legislação vigente. Utilizou-se também, um questionário contendo variáveis sóciodemográficas, variáveis clínicas e variáveis relacionadas ao monitorização da glicemia capilar para caracterização dos participantes da pesquisa. A análise dos temas foi fundamentada nos documentos oficiais identificados através do levantamento acerca dos direitos do usuário em diabetes e dos princípios da Bioética. Os dados obtidos foram agrupados em três temas: a não-consciência dos usuários com diabetes mellitus acerca dos seus direitos; a co-responsabilidade em saúde no que diz respeito ao fornecimento de informações e à efetivação dos direitos dos usuários e, a qualidade da interação profissional-usuário nos serviços de saúde. Apesar dos avanços legalmente alcançados pelas políticas públicas, os usuários com diabetes mellitus em sua maioria desconhecem seus direitos, mas utilizam de maneira não-consciente os benefícios advindos da legislação, tais como, a aquisição gratuita de medicamentos, glicosímetros e tiras para a monitorização da glicemia capilar em domicílio. No entanto, eles percebem o benefício como um favor ou doação. Assim, é de suma importância que haja informação sobre os direitos dos usuários com diabetes, uma vez que, sem a necessária e suficiente informação, torna-se difícil o usuário ser capaz de reivindicar e/ou lutar pelos seus direitos. O desconhecimento dos usuários com diabetes sobre seus direitos resulta na falta de efetivação do exercício de autonomia. As dificuldades apontadas, tais como o acesso a consultas médicas, a impessoalidade da relação entre profissionais de saúde e usuários, apontam para o desejo de humanização no atendimento nos serviços de saúde. Esperamos que os resultados aqui apresentados sobre o conhecimento dos usuários com diabetes mellitus acerca dos seus direitos e benefícios da legislação vigente possam contribuir para a assistência de Enfermagem e dos profissionais da saúde. Para tanto, a necessidade de informação adequada aos usuários dos serviços de saúde nos remete ao papel social que a Enfermagem possui, como um elo entre os usuários e os atuais modelos de saúde vigentes.This is an exploratory-descriptive study of qualitative approach, aiming to analyze the user\'s knowledge with diabetes about the rights and benefits in health resulting from legislation. The study was conducted at a Center for Research and Extension University of São Paulo with 12 users with diabetes mellitus, related to the Group for Education in Diabetes. Data collection occurred during September-December 2008, through semi-structured, guided by the question related to the user\'s knowledge with diabetes mellitus and perception of health benefits derived from the law. It also used a questionnaire containing socio-demographic variables, clinical variables and variables related to the capillary blood glucose monitoring to characterize the participants in the research. The analysis of the themes was based on official documents identified by the survey about user rights in diabetes and the principles of bioethics. The data were grouped into three themes: the non-conscious users with diabetes about their rights, the co-responsibility in health as regards the provision of information and the realization of the rights of users and the quality of interaction professional-user in health services. Despite legal advances made by public policies, users with diabetes mellitus in the majority know their rights, but use of a non-aware of the benefits arising from legislation such as the acquisition of free medications, glucometers and strips for monitoring the capillary blood glucose at home. However, they perceive the benefit as a favor or gift. Thus, it is critical that there is information on the rights of users with diabetes, since without the necessary and sufficient information, it becomes difficult for the user to be able to claim and / or fight for their rights. The unfamiliarity of users with diabetes on their rights results in the lack of effective exercise of autonomy. The difficulties pointed out, such as access to medical consultations, the impersonality of the relationship between health professionals and users point to the desire of humanization of care in health services. We hope that the results presented here on the knowledge of users with diabetes about their rights and benefits of the legislation can contribute to the assistance of nursing and health professionals. Thus, the need for adequate information to users of health services refers to the social role that nursing has, as a link between users and the current existing models of health.
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Gouch, Ayanna D. "Stress, Coping Strategies, and Cardiovascular Disease in African American Women - With Ethical Considerations for Health Care Practitioners." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/492593.
Full textAbstract:
Urban BioethicsM.A.
African American women have the highest rates of hypertension, cardiovascular disease (CVD) and mortality rates related to CVD of all ethnic and racial groups in America. Understanding the factors contributing to these health disparities will be crucial to closing the gap in health outcomes. This thesis proposes that stressors and stress coping strategies are contributing as independent risk factors for CVD, thus leading to health disparities. Studies have shown that stress has a direct relationship to neuroendocrine processes in the body leading to elevated blood pressures and increased inflammation. Examining common stress factors among African American women and developing strategies to help relieve the burden of these stress factors will be an important ethical step toward eliminating the CVD health disparity between African American women and other ethnic groups. In addition, developing systemic support for coping with stress through health systems and health centers will be imperative for improving CVD health outcomes and agency among African American women.
Temple University--Theses
30
Huang, Diana. "Education as a Path to Health Equity: Lessons for Medical Education in the Development of a High School Health Careers Curriculum." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/432930.
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Urban BioethicsM.A.
Compared to other developed countries, the United States has healthcare spending that far outpaces other nations, but achieves below-average life expectancy. In urban cities, this disparity is most striking among predominantly black and Latino communities. There is increasing recognition that the reason for this is improper allocation of resources; we have a system that funds clinical services which contribute to only 20% of health outcomes, while providing inadequate support for social and environmental factors which account for 80% of the impact. When one considers the history of the United States, it becomes clear that such a system is not only inefficient, but also fundamentally unjust. African American patients have been used (often without consent) to obtain much of our current medical knowledge, but suffer most from healthcare disparities. Medical school is a fascinating lens from which to view this healthcare system, as students stand at the threshold between layperson and physician. Medical students, who predominantly come from backgrounds of privilege, benefit from access to institutions of medical knowledge. They often practice their fledgling skills on urban underserved patients who are disproportionately cared for in academic medical centers. Medical students also participate in service projects in the surrounding community, with common projects involving schools, churches, and free clinics. As a medical student, I spent nearly 100 hours with a class of ninth grade students at a Philadelphia public high school as I developed and implemented a health careers elective program. Through this experience, I gained a firsthand appreciation for the incredible barriers that prevent urban underserved students from equal representation in our medical schools and health care workforce. Here, I reflect on my experiences over the course of medical school, review relevant literature in the fields of ethics, medicine, education, and history, and present recommendations to move us closer to a just healthcare system by increasing investment in underserved communities and instilling in medical students a moral imperative to reduce health disparities, as well as the tools to do so effectively.
Temple University--Theses
31
Gouguet, Maia. "L'encadrement juridique de la libre disposition de soi." Thesis, Limoges, 2019. http://www.theses.fr/2019LIMO0015/document.
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La libre disposition de soi doit-elle accueillir des limites imposées par le Droit ? Une première approche, instinctive,est de répondre par la négative car le Droit n’aurait pas vocation à s’ingérer dans les rapports intimes que l’on entretient avec soi et qui ne concernent en conséquence pas la société. Il faut pourtant se rendre à l’évidence : le Droit est légitime à intervenir dans la libre disposition de soi car l’intimité est poreuse, et laisse passer entre ses mailles la présence d’autrui, ce qui autorise les pouvoirs publics à intervenir ponctuellement dans ce domaine a priori dédié à la vie privée. C’est à l’aune de l’ordre public que le législateur ou les juges déterminent si la libre disposition de soi peut s’épanouir sans danger pour autrui ou pour l’intérêt général. Cet ordre public, dans ses composantes classiques de direction et de protection, paraît néanmoins actuellement à la peine pour contenir les volontés individuelles qui s’expriment avec force conviction. Tant le juge que le législateur se sont en conséquence tournés vers un autre instrument juridique de nature à encadrer la libre disposition de soi. De facture plus récente, la dignité de la personne humaine vient soit protéger la libre disposition d’individus en situation de faiblesse ; soit au contraire limiter la libre disposition de soi, protégeant la personne contre son gré. La deuxième acception de la dignité est celle qui prédomine entre les mains du législateur et des juges, laissant la libre disposition de soi à la merci d’un instrument peu nuancé.Il faut donc rechercher un instrument juridique qui permette d’assurer la cohésion sociale sans pour autant éteindre les aspirations individuelles. C’est un équilibre particulièrement délicat à trouver en ce que ces deux objectifs sont le plus souvent diamétralement opposés. La recherche doit s’orienter vers l’ordre public car celui-ci est un concept éminemment évolutif. C’est un ordre public qui doit être de direction, eu égard aux faits qu’il accompagne, avec toute la fermeté requise, les individus dans la découverte des options qui leur sont les plus favorables et qu’il n’a pas vocation à protéger à tout prix la libre disposition de soi. Son adaptabilité aux circonstances de l’espèce est rendue possible grâce à l’application du principe de proportionnalité in concreto. Ce nouvel ordre public ne serait enfin qu’une coquille vide, sans l’objectif du Bien commun, qui permet de discriminer entre les usages licites et illicites de la libre disposition de soi. Encadrée par l’ordre public de direction de la personne, cette dernière peut s’exprimer sans verser dans des extrêmes dommageables à l’individu ou à la sociétéMust free self-determination accept limits imposed by law? A first approach, instinctive, is to answer in the negative because the Law would not have vocation to interfere in the intimate relations that one maintains with oneself and which consequently does not concern the society. However, we must face the obvious: the law is legitimate to intervene in the free disposition of oneself because the intimacy is porous, and leaves between the meshes the presence of others, which authorizes the public authorities to intervene punctually in this area a priori dedicated to privacy. It is on the basis of public order that the legislator or judges determine whether free self-determination can flourish without danger for others or for the general interest. This public order, in its classical components ofleadership and protection, nevertheless appears to be struggling to contain the individual wishes that express themselves with conviction. Both the judge and the legislator have accordingly turned to another legal instrument ofa nature to regulate the free disposition of oneself. More recent, the dignity of the human person comes to protect thefree disposition of individuals in situation of weakness; or on the contrary, to limit the free disposition of oneself,protecting the person against his will. The second meaning of dignity is the one that predominates in the hands of thelegislator and the judges, leaving the free disposition of oneself at the mercy of a little nuanced instrument. We musttherefore look for a legal instrument that will ensure social cohesion without extinguishing individual aspirations. Itis a particularly delicate balance to find in that these two objectives are most often diametrically opposed. Research must be oriented towards public order because it is an eminently evolving concept. It is a public order that must beof direction, given the facts that it accompanies, with all the firmness required, individuals in the discovery of the options that are most favorable to them and that it is not intended to to protect at all costs the free disposition ofoneself. Its adaptability to the circumstances of the case is made possible by the application of the principle of proportionality in concreto. This new public order would finally be nothing but an empty shell, without the objectiveof the common good, which makes it possible to discriminate between the licit and unlawful uses of free self determination.Framed by the public order of direction of the person, the latter can express himself without endangering the individual or the society
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Vouleli, Vasiliki. "Sources et construction du principe de dignité humaine en droit allemand." Thesis, Strasbourg, 2014. http://www.theses.fr/2014STRAA032.
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Le principe du respect et de la protection de la dignité de l’être humain est consacré dans l’article premier de la Loi fondamentale allemande. L’emplacement tout à fait symbolique de cet article témoigne de l’attachement profond du droit allemand à cette valeur, la seule à bénéficier d’une protection absolue en toutes circonstances. La notion de dignité humaine n’est pas inconnue du droit français ; il n’existe pourtant en France aucune construction théorique cohérente du principe constitutionnel de la dignité de la personne humaine. Cette thèse propose de reprendre le thème de la dignité, de sa définition et de sa fonction dans un système juridique et constitutionnel, à partir de l’expérience allemande. En interrogeant spécialement le droit allemand, à partir de ses sources et dans le contexte européen qui est le sien, la thèse vise donc à contribuer à une théorie juridique générale de la dignitéThe first article of the Basic Law for the Federal Republic of Germany guarantees the respect and the protection of human dignity. The principle of human dignity has a particular significance in German law, since it is the only value therein to enjoy absolute protection under any circumstances. The concept of human dignity is not unknown to French law ; however, contrary to the German legal system, there is not, in French law, a coherent and unified theory of human dignity as an element of constitutional law. The present doctoral dissertation aims to study the concept of human dignity, its definition and its function within a legal and constitutional system by concentrating on the German paradigme. Though this core value of German constitutional law is currently under a lot of strain, as it is faced with new challenges such as those presented by the progress of biotechnology and the fight against terrorism, a study of human dignity in German law is indispensable in order to understand the importance – and the difficulty – of constructing a coherent constitutional theory of human dignity
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Quintanas, Feixas Anna. "Salut i poder en la gènesi de l'home contemporani." Doctoral thesis, Universitat de Girona, 1997. http://hdl.handle.net/10803/7815.
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Amb aquesta investigació, que s'emmarca dins l'àmbit de l'Antropologia Filosòfica, el que ens proposem és escriure un capítol per a una genealogia de l'home contemporani, intentant respondre a la pregunta: com hem arribat a ser el que som? No pretenem descriure els principals factors que han influït en la manera de ser de l'home contemporani, sinó que l'objectiu d'aquest treball és molt més limitat: dibuixar algunes de les principals relacions entre el saber i el poder que s'han donat en el si de la medicina contemporània, i més concretament en l'àmbit de la Salut Pública, i que han contribuït a subjectar els individus d'una determinada manera, creant un model: l'home saludable.
Volem mostrar com el discurs i la pràctica mèdica que es van començar a perfilar entre el segle XVIII i el segle XIX moment en què es solidificaren els fonaments de l'art de guarir tal com ara l'entenem , a part d'aportar un conjunt de tècniques de curació, també van oferir una determinada visió de l'home, la qual va tenir importants repercussions en la manera de ser de l'individu contemporani.
Ens interessa mostrar de quina manera la medicina, a partir de la Salut Pública, ha intervingut en la gestió de l'existència humana, prenent una postura normativa que l'ha autoritzat a governar la vida de les persones.
L'objectiu de la nostra investigació és respondre les qüestions: quin tipus de subjectivació implica la medicina contemporània? Quin tipus de subjecte ha ajudat a crear, incitant l'home a establir unes determinades maneres de relacionar-se amb si mateix i amb els altres? En definitiva, desciure algunes de les principals estratègies dibuixades des de la Salut Pública que han actuat com a poders de normalització, en tant que han fomentat un determinat tipus d'home.
Tal com veurem, la nostra medicina, almenys des del moment en què es va poder parlar d'una salut pública, ha anat lligada al projecte d'una determinada tecnologia de la població. Entre els segles XVIII i XIX, la medicina va anar desenvolupant una nova política de la salut en la qual les malalties van passar a ser considerades com un problema polític i econòmic que afectava les col.lectivitats i que demanava solucions globals. El que va aparèixer en el segle XVIII no es pot resumir només en el fet que l'estat va començar a intervenir d'una forma constant en la pràctica mèdica, sinó que el que va passar va ser que la salut i la malaltia, vistes com a problemes que exigien algun tipus de gestió col.lectiva, van ser considerades des de múltiples llocs del cos social. És a dir, la política de la salut que s'inaugura en el llindar de l'època contemporània, més que una iniciativa vertical, va prendre la forma d'un problema amb orígens i direccions múltiples.
Pretenem mostrar aquesta política mèdica que es va posar en joc al voltant de l'origen de la nostra Salut Pública, fent sortir a la llum el que podríem anomenar l'«ètica de la bona salut» que es va potenciar i que va servir no solament per elaborar algunes indicacions per prevenir o curar les malalties, sinó que també fabricà prescripcions que feien referència a la forma de vida en general (des de l'alimentació i la vestimenta fins a la procreació, la sexualitat, el comportament, les relacions familiars, etc.). És a dir, es tractaria de veure com a l'interior del discurs i de les pràctiques de la nostra Salut Pública, s'ha anat contruint un cert espai de la normalitat, en el qual ha estat possible associar Salut i Raó, Malaltia i Desraó.
This thesison Anthropological Philosophy studies the relationships holding between Knowledge and Power tha were originated in the domain of Public Health so as to prove the great influence of these relationships in the building-up of the contemporary man's identity.
Besides furnishing a set of healing technics, contemporary Medicine has also promoted a certain view of Man (the Healthy Man) which has worked as a normalizing power of populations, clearfing the way for the associations Heakth and Reason, Illness and Unreason to be made.
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Lucio, Bonilla Carlos Ernesto. "Aspectos bioéticos de la regulación de medicamentos en Colombia." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/664061.
Full textAbstract:
El problema del suministro eficiente y transparente de medicamentos en Colombia es un tema de la Bioética. Seguramente el problema es más grave en otros países del mundo, parece que la situación en Venezuela en relación a la escases de medicamentos es insostenible. Sin embargo, en Colombia, por su condición de país de ingresos medios con décadas de crecimiento económico sostenido, que el problema del suministro eficiente y trasparente de medicamentos no sea ampliamente abordado desde la academia parece inconcebible.
Pero el problema del suministro eficiente de medicamentos tiene un espectro global, casi todos los países del mundo afrontan grandes retos en sus sistemas de salud, que deberían avivar el debate público. La limitación de recursos, el crecimiento exponencial de los costos sobre las nuevas tecnologías en salud y la creciente demanda de servicios por parte de la población mundial, traen consigo, importantes preguntas sobre justicia distributiva. ¿Qué proporción de recursos públicos se debe destinar a la salud y como establecer su utilización? o ¿Como limitar los estándares de atención a las enfermedades huérfanas?. Estas preguntas requieren un debate para establecer los métodos para la asignación justa de los recursos públicos en la búsqueda de la cobertura universal (Organización Mundial de la Salud, 2010).
Para la cobertura universal del sistema de salud se requiere un método de priorización en la utilización de recursos. Uno de los grandes problemas para la eficiencia del sistema, se encuentra en el uso de medicamentos costosos, cuando se cuenta con opciones con mejores precios e igualmente eficaces. Este problema teóricamente puede ser solucionado de manera adecuada a través de la regulación del sistema. Sin embargo, el tema tiene una alta complejidad, además, hay que tener en cuenta dos factores en la regulación: el aumento desbordado en el precio de algunos medicamentos sofisticados y la crisis de la evidencia sobre su efectividad terapéutica (Kantarjian, Fojo, Mathisen, & Zwelling, 2013).
El espectro más amplio de nuestra investigación tiene que ver con la bioética y el derecho. Resulta de gran importancia para los abogados en el mundo actual reflexionar sobre los puntos de contacto y separación entre la ética y el derecho, tradicionalmente analizados desde la filosofía del derecho y de manera especial desde la teoría general del derecho.
En la bioética, como parte de la ética aplicada, encontramos la necesidad de trasformar los acentos de la ética tradicional desde los fundamentos de la norma hasta los problemas más prácticos de la sociedad contemporánea (Escríbar Wicks, 2004). Para entrar en el estudio de la bioética iniciamos nuestra investigación en las primeras definiciones del término. Para esto, se toman los dos autores que primero utilizaron el neologismo de conformidad con la bibliografía especializada. Ellos son, Hans Fritz y Rensselaer Van Potter.
La Macrobioética ha buscado nuevos estados de aplicación en las sociedades contemporáneas. Como parte de la ética aplicada, la bioética pretende adaptarse a los retos prácticos de las nuevas comunidades sociales eminentemente pluri-etnicas y pluri-culturales, con extraños morales y distintas concepciones sobre la buena vida. Por esto, la concepción de la bioética que utilizamos en este escrito es laica, amplia y flexible, alejada de dogmatismo pero basada en el desarrollo de los derechos humanos.
La nueva juridicidad que argumentamos tiene importantes puntos de encuentro con la bioética. Ambas están sincronizadas con los documentos legales que realzan los derechos humanos como el elemento indispensable de la organización en sociedad. Aquí se encuentran varios tratados sobre derechos humanos y bioética que resaltan la relación de esta nueva concepción de lo jurídico, menos preocupada por las formas y los derechos patrimoniales y más consciente de los derechos humanos y colectivos.
Claramente se evidencia esta situación en la acción de tutela o acción de amparo constitucional. Aquí se ponderan derechos encontrados en casos típicamente bioéticos como lo pueden ser la interrupción voluntaria del embarazo y la eutanasia, pero también en todos los casos en general. La misma naturaleza de la tutela nos dice que se acude a ella precisamente cuando nos encontramos ante un caso de vulneración de los derechos fundamentales donde se requiere una acción sumaria y extraordinaria de protección para evitar un daño irreparable.
Sin embargo, esta premisa tiene en el caso colombiano de la tutela en salud profundas particularidades por el número elevado de tutelas, en el año 2015 se interpusieron “151.213 tutelas que invocaron el derecho a la salud”(Defensoría del Pueblo 2016, pág. 145) y por la incidencia de estas sobre la regulación general del sistema de salud. Aunque la tutela se aplica para casos particulares, las deficiencias regulatorias en el caso colombiano han hecho que el juez constitucional se convierta en un determinante de la política pública en salud. Esta situación concibe importantes riesgos que son objeto de este estudio, con profundas consecuencias sobre la equidad del sistema de salud.
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Moreira, Edna Corrêa. "O acesso ao tratamento da Doença de Fabry no Sistema Único de Saúde e os pressupostos da Bioética Principialista." Universidade do Estado do Rio de Janeiro, 2014. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7551.
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O acesso ao tratamento da Doença de Fabry (DF) no sistema público de saúde nacional. Trata-se de uma pesquisa exploratória de corte transversal, centrada em elementos qualitativos, realizada com os profissionais e os pacientes portadores da DF, no Ambulatório de Genética Clínica do Hospital Universitário Gaffrée e Guinle - HUGG. Utilizou-se como coleta de dados a entrevista aberta e semiestruturada. Seu objetivo maior é identificar os aspectos bioéticos envolvidos no acesso ao tratamento da DF no SUS, e para tal buscamos tornar manifestos os argumentos morais dos profissionais do ambulatório, acerca da existência de uma política pública para o tratamento das doenças raras no SUS. A Bioética Principialista de Beauchamp e Childress, em seus princípios prima-facie: o respeito pela autonomia; a não maleficência; a beneficência e a justiça, é tomada como fundamentação teórica deste estudo. O tratamento dos dados se deu por meio do método de análise de conteúdo, de Bardin. A pesquisa contempla o percurso histórico das principais política
públicas de saúde, e seus movimentos em direção à criação do SUS, e a integração dos hospitais universitários ao sistema público de saúde, em seus marcos legais. Ela também enfoca a mobilização da sociedade política e organizada em busca da materialização política pública de atenção às Doenças Raras. O estudo constatou que os princípios de Justiça e da Beneficência emergiram espontaneamente, e por vezes implicitamente, na fala do sujeitos da pesquisa, em suas justificativas morais para a criação de uma política pública para Doenças Raras. Ademais, é delineado o curso da doença na família, haja vista tratar-se de doença hereditária. Assinala-se de que modo a DF chegou do acaso a estas pessoas, e como estas chegaram ao diagnóstico e tratamento.The access to the treatment of Fabry Disease (FD) in the national health public system. Explanatory cross sectional research, centered on qualitative elements, performed with the professionals and patients that carry the FD, at the Clinic Genetics Ambulatory of the Gaffrée and Guinle University Hospital HUGG. An open and semi-structured interview was used as data collection. Its greatest objective is to identify the bioethics aspects involved in the access to the treatment of FB at Unified Health System, in order to do so, we intend to become the moral arguments of the ambulatory professionals manifest, regarding the existence of a public policy to the treatment of rare diseases at SUS. The Beauchamp and Childress Principialist Bioethics, in its prima-facia principles: the respect for the autonomy; the non-maleficence; the beneficence and justice, is taken as theoretical fundament for this study. The data was treated by means of Bardins Content Analysis Method. The research contemplates the historical background of the main health public policy and its movements towards SUS formation, and the integration of the university hospitals in the health public system, in its legal frameworks. It also emphasizes the mobilization of the political and organized society seeking the materialization of the public policy concerning the Attention to Rare Diseases. The study found that the Justice and Beneficence principles emerged spontaneously, and occasionally implicitly, in the investigation subjects speech, in their moral justifications to the creation of a public policy to Rare Diseases. Moreover, it is outlined the course of the disease within the family, due to it being a hereditary disease. It is noted how the FD reached by chance these people, and how they accessed the diagnosis and treatment.
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Granja, Gabriela Ferreira. "Equidade no SUS: uma abordagem da teoria fundamentada." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/7/7137/tde-06052009-102822/.
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A equidade é um dos pilares do Sistema Único de Saúde, entretanto, seu conceito é polissêmico e assume diversas interpretações, determinadas pela construção histórica, política e social do Brasil. O objetivo da pesquisa foi propor uma teoria de médio alcance para equidade no SUS, a partir dos sentidos e da percepção da operacionalização deste princípio. Na metodologia, utilizou-se a abordagem qualitativa, através da Teoria Fundamentada em Dados proposta por Streubert e Carpenter (1999). Na análise das entrevistas, junto a usuários, profissionais e gestores do SUS, através do Discurso do Sujeito Coletivo proposto por Lefèvre e cols (2000) foram encontradas três categorias centrais a respeito do conceito de equidade: tratar todos igualmente; tratar os desiguais de forma desigual, segundo o critério clínico e tratar os desiguais de forma desigual, segundo critério epidemiológico. A análise da literatura científica de Saúde Coletiva e Bioética demonstrou que os especialistas a respeito da equidade descrevem em suas produções os mesmos sentidos encontrados nas entrevistas com os atores do SUS. Na busca de compreender as bases políticas e ideológicas desses discursos foi realizada a análise de documentos oficiais da Política Pública de Saúde do Brasil. Ficou demonstrada uma estreita relação entre as concepções de equidade e a Promoção da Saúde. Na integração dos resultados das entrevistas, da literatura e dos documentos emergiram quatro variáveis principais para equidade: justiça social, igualdade, acesso universal e priorização dos que mais precisam para redução das iniqüidades. Estas variáveis representam critérios que devem ser respeitados pelos gestores na efetivação da equidade e do direito à saúde e podem contribuir para que os profissionais e pesquisadores construam coletivamente uma equidade justa para todos os brasileiros no SUSThe equity is one of the pillars of the National Health System, however, the concept is polysemic and assume many interpretations, determined by historical ,political, and social construction in Brazil. The objective of the research was to propose a theory of medium range for equity in the SUS, from the senses and perception of the operationalization of this principle. In the methodology, was utilized the qualitative approach, through the Theory Based on Data proposed by STREUBERT and Carpenter (1999). In the interviews analysis , along with users, professionals and managers of SUS, through the Collective Subject\'s Discourse proposed by Lefèvre and cols (2000) were three central categories with respect to the concept of equity: treat all equally, to address the unequal way unequal, according to clinical criteria and process for the unequal unequally, according epidemiological criteria. The analysis of the scientific literature of Public Health and Bioethics showed that the experts about equity describe their products in the same way found in interviews with actors of SUS. In the quest to understand the political and ideological discourse principals was done the official policys analysis of Public Health of Brazil. It was demonstrated a close relationship between the concepts of equity and Promotion of Health .In integrating the results of the interviews, literature and documents emerged four variables key to equity: social justice, equality, universal access and prioritization of those who most need to reduce inequities. These variables represent the criteria that must be respected by managers in the realization of equity and the right to health and may contribute to the professionals and researchers collectively build an equity fair to all Brazilians in the SUS
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Sibley, Amanda Nicole. "Child assent to clinical research participation : how to determine a child's ability to assent." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:c0de25b2-12ca-46a6-8442-7b1eaf559389.
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Assent, currently defined as “a child’s affirmative agreement”, is a way in which some children are included in the decision-making process regarding their participation in clinical research. Current guidelines for paediatric research do not provide clear directions for how assent should be handled, resulting in confusion among researchers. The goal of this research project was two-fold: to examine the ethical arguments for assent with a view to developing concrete moral justification for its being required, and to develop a framework of significant issues for an investigator to consider when deciding whether to gain assent from an individual child. After an in-depth analysis, it was determined that the ethical justification for assent arises from the researcher’s dual obligations to the child and his parents. A child’s parents are responsible for determining when and how he will develop his decision-making ability. The researcher has an obligation to engage with the child in a manner that complements their pedagogical style, while also treating the child as a being of moral worth. As a child’s family context has an influence on his participation in medical decision-making, further research on children’s daily decision-making within their families is needed. To this end, a three-phase research agenda was designed: a qualitative focus group study, a quantitative questionnaire study, and a discussion panel with paediatric experts. The children in these studies clearly desired to make decisions but did not express an interest in having complete control. They expected their parents to provide them with decision-making guidance in most aspects of their lives. Data collected from parents illustrated that they often tried to involve their children in decisions by providing them with limited options from which to choose and encouraging family discussion. Participants in the discussion panel stated that they did not expect children to make an independent decision regarding medical care, but they might attempt to give children smaller decisions, such as the arm used to provide a blood sample. These results indicate that the definition of assent should be revised, emphasising the child’s involvement in the overall decision making process, without an expectation of an “affirmative agreement”, likely mimicking a familiar decision-making setting from his family context. This could then be documented in the child’s clinical notes through a brief description of all relevant interactions and/or discussions with the child, resulting in an accurate portrayal of the entire assent process.
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Prior, Tamara. "Hereditariedade, progresso e decadência no pensamento médico-eugenista de Renato Kehl." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-02052016-113111/.
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Resumo: Ao longo da história, o tema da hereditariedade apresentou-se sob interpretações variadas. O desenvolvimento das ciências biológicas permitiu, por um lado, maior conhecimento sobre seus mecanismos; por outro, tornou imprescindível a reflexão sobre determinismos teóricos que parecem recair, principalmente, sobre o campo das ciências da Saúde. A história do movimento eugenista é um evento que permite importantes reflexões sobre o passado e o presente. O termo \"eugenia\" foi criado por Francis Galton em 1883 para nomear uma ciência que visava o melhoramento do patrimônio biológico da humanidade. Para tanto, deveria oferecer teorias e métodos rumo à perfectibilidade física e mental. Renato Kehl (1889-1974), médico e farmacêutico paulista, foi um dos principais expoentes da eugenia brasileira, tomando para si, com afinco, a tarefa de publicista e articulador das sociedades eugênicas que aqui se formaram nas primeiras décadas do século XX. Algumas noções de progresso versus decadência contidas em suas obras em prol do movimento médico-eugenista - publicadas majoritariamente entre 1917 e 1940 - são tratadas nesta dissertação. Fizeram parte da campanha eugenista brasileira os debates acerca da esterilização dos \"indesejados\", das restrições matrimoniais e imigratórias e do confinamento dos chamados \"denegerados\". Nesse contexto o movimento eugenista foi apresentado pelos seus defensores como solução contra a supostamente inevitável e alarmante decadência que acometia o país que se formavaThroughout history the subject of heredity showed up in varied interpretations. The development of life sciences has greater insight into its mechanisms; on the other hand, it becomes indispensable to reflect on theoretical determinisms that appear to fall mainly on the field of Health Sciences. The history of the eugenics is an event that allows important reflections on the past and present. The term \"eugenics\" was coined by Francis Galton in 1883 to name the science of the improvement of the biological heritage of humanity. It should offer theories and methods towards mental and physical perfectibility. Renato Kehl (1889-1974), brazilian physician and pharmacist, was one of the main exponents of Brazilian eugenics, publicist and articulator of eugenic societies formed in the early decades of the twentieth century. Some notions of progress versus decay contained in his works - mostly published between 1917 and 1940 -are treated in this dissertation. Part of the Brazilian eugenics campaign debates about the sterilization of \"unwanted\", about marriage and immigration restrictions and confinement of so-called degenerate. In this context the eugenics movement was presented by its enthusiasts as a solution against the supposedly inevitable and alarming decay that affected the nation
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Maher, Patricia. "Florida Adult Trauma Scorecard Methodology and Scene Transportation Choice." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7694.
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Prehospital management of patients who are traumatically injured within the state of Florida starts with the use of the Florida Adult Trauma Scorecard Methodology. The scorecard methodology may indicate that a patient is a Trauma Alert based on applied physiological and other judgment criteria. However, patients may be transported via Helicopter Emergency Medical Services (HEMS) without justified physiological needs. Rawls’ theory of justice posits that a fair and equal distribution of social resources is essential to public wellbeing. To evaluate this premise regarding prehospital trauma transports, archival 2015 data from the Florida Department of Health Trauma Registry was obtained. Using logistic regression, each trauma scorecard assessment criteria was individually and collectively evaluated regarding its predictive likelihood of a scene responder requesting HEMS versus ground ambulance transport. Controlling for trauma center locations, all five of the triage classifications illustrated a significant likelihood (p = 0.000) of HEMS transportation requests. Category 4 (EMS Judgment) predicted the highest likelihood of HEMS transport requests (b = 2.39, Wald X2(1) = 2026.88, OR = 10.9, p = .000, CI [9.83, 12.09]). Categories 4 (14.7%) and 6 (Local Criteria; [25.8%]) illustrated unexpectedly high percentages of emergency department discharge when Trauma Alert patients were HEMS transported. Over triage of patients to HEMS without meeting physiologic criteria provides less than an equal and fair distribution of public and private resources. State-level social change can be realized through HEMS transport criteria modifications applying more stringent application of physiologic patient condition scoring when determining the mode of prehospital scene response transport.
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Tomc, Nicolas Antoine. "Mourir à l’hôpital : entre droit privé et droit public : approche pratique, théorique et philosophique." Thesis, Bordeaux 4, 2012. http://www.theses.fr/2012BOR40065/document.
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Il est quasiment devenu un lieu commun aujourd’hui de mourir à l’hôpital. Et s’il fallait traiter ce sujet, le plus souvent c’est la perspective médicale qui tenterait d’en percevoir les enjeux. C’est au tournant du milieu du XXème siècle, au lendemain d’un énième génocide, marquant l’esprit de l’humanité certainement pour l’éternité, qu’un nouveau langage bioéthique va se faire le vecteur d’une considération renouvelée de la personne. L’homme devient personne humaine dans les textes internationaux proclamant dès lors d’inédits droits de l’homme. C’est en prenant la bioéthique comme objet de réflexion qu’un certain droit de la santé, largement inspiré par la production de comités d’éthiques, a émergé d’une doctrine privatiste en premier, afin de cerner de premiers droits définissant celui qu’il serait convenu d’appeler alors le mourant. Toutefois, l’établissement public de santé confronté à la technologisation médicale, permettant alors un allongement de la fin de vie, s’est rapidement trouvé être un lieu de conflit entre ceux qui furent considérés comme des usagers de service public, et les commettants médecins de l’Etat. La primauté du droit privé de la personne semblait alors menacée, le droit administratif prenant le pouvoir afin d’indemniser les victimes de l’hôpital. Cependant, à force de réductions systématiques ne regardant la personne mourante que sous un angle génériciste, relevant d’un droit public, celle-ci s’est progressivement retrouvée parfaitement ignorée en son essence première que le droit privé parvenait à percevoir. Les formes les plus récentes de déresponsabilisation attesteraient d’une consécration de l’indemnisation finissant d’objectiviser l’être sous-jacent à la personne mourante, allant jusqu’à justifier l’acte euthanasique. L’approche réitérée de ce difficile objet d’étude trouverait à générer une réflexion que le philosophe du droit engagerait, réintroduisant la personne irréductible se manifestant comme point de départ et d’arrivée, de telle sorte que se pourrait être harmonisée la rencontre inévitable des domaines public et privé, juridique et politique, afin de rendre toute sa vérité onto-axiologique aux droits premiers du sujet mourantToday, dying at hospital is the most curently idea agreed in order to protect people. That’s maybe the reason why medical studies took this as an issue more than lawyer studies. It’s around the middle of the twentieth century, after one more genocide, marking the spirit of the humanity certainly for all eternity, that a new bioethical language is going to be made the vector of a consideration renewed by the person. The man becomes a human-person in the international texts, proclaiming from then on of unpublished works human rights. While taking the bioethics as object of reflection a certain health law, widely inspired by the production of committees of ethics, emerged from a privatiste doctrine in the first one, to encircle first rights of the one that it would have been advisable to call then the dying. However, the public institution of health confronted with the medical technologisation, allowing then an extension of the end of life, quickly was to be a place of conflict between those who were then considered as users of public service, and principals doctors of the State. The superiority of the private law of the person seemed then threatened, the administrative law taking the power to indemnify the victims of the hospital. However, by means of systematic reductions looking at the dying person only under an angle génériciste, recovering from a public law, this one gradually found itself perfectly ignored in the first essence which the private law succeeded in perceiving. The most recent forms of deresponsabilisation would give evidence of a consecration of the compensation stopping an objectivisation the underlying being to the dying, going person to justify the euthanasic act. The approach repeated by this difficult object of study would find to generate a reflection which the philosopher of the right(law) would engage, reintroducing the person inflexible as point of departure and arrival, so that could be harmonized the inevitable meeting of the public and private, legal and political domains, to return all its onto-axiological truth to the first rights of the dying subject
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Gaudenzi, Paula. "Um olhar da bioética sobre o cuidado com a própria saúde no contexto da Saúde Pública e do exercício do biopoder na atualidade." reponame:Repositório Institucional da FIOCRUZ, 2009. https://www.arca.fiocruz.br/handle/icict/2493.
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Previous issue date: 2009No momento atual, marcado tanto pelas incertezas em relação ao futuro de cada um e de todos quanto pela busca de segurança, vê-se surgir uma noção de risco vinculada a um ideal de saúde que, ao responsabilizar cada indivíduo pelos comportamentos, considerados suscetíveis de garantir ou prejudicar sua saúde pessoal, pode ser visto como uma potente tecnologia de biopoder sobre a vida tanto individual como coletiva. Pode-se dizer, então, que o discurso dominante sobre a saúde e os comportamentos que estariam colocando-a em risco tem, hoje, um enfoque que pode ser considerado reducionista da difícil dialética entre o individual e o coletivo, que acaba por afirmar tão somente a responsabilidade de cada indivíduo pela gestão dos riscos aos quais se expõe, sem considerar as determinações às quais ele está submetido quando interage com a coletividade e o mundo. Neste contexto, o trabalho parte do pressuposto de que presenciamos, com relação à saúde pública, a uma transição paradigmática em ética referente aos cuidados com a saúde, pois estes estão deixando de ser considerados um direito da cidadania para se tornarem um dever de todos e cada um, supostamente em prol do bem-estar de todos. Nosso trabalho analisa, a partir das ferramentas da Bioética da Proteção, o movimento atual de responsabilização individual pelo cuidado com a própria saúde, o qual foi realizado a partir de pesquisa bibliográfica e documental, que tiveram por finalidade identificar a conflituosidade que perpassa o campo das práticas em saúde e as abordagens teóricas e práticas adotadas nos campos da saúde e da bioética para enfrentá-las. Em particular, a pesquisa documental visou identificar a forma como são expostas a noção de direito em saúde, sobretudo, nos documentos produzidos a partir do Relatório Lalonde do Canadá, de 1974, que representou o marco inicial para o debate contemporâneo sobre Promoção da Saúde, campo, este, que identificamos como o de maior relevância para a discussão sobre os direitos e deveres em saúde a serem pensados numa dialética entre a dimensão individual e coletiva do bem-estar pessoal e social. Os objetivos específicos desta pesquisa foram: (a) apresentar os principais argumentos que vêm sendo adotados para justificar tal responsabilização e aqueles contrários a ela; (b) apresentar o conceito de biopoder de Michel Foucault e a reinterpretarão do mesmo conceito a partir de dois autores contemporâneos: Giorgio Agamben e Paul Rabinow; e (c) apresentar as principais implicações éticas decorrentes da grande ênfase da noção de risco na atualidade, a consequente responsabilização pelo cuidado com a própria saúde e as implicações que surgem a partir das interpretações das atualizações do biopoder pelos dois autores.
In the present age of uncertainty with regard to the future of anyone seeking security, a notion of risk has arisen that is linked to an ideal of health, which, in so far as it holds each individual responsible for behavior beneficial for or detrimental to personal health, can be seen as a form of biopower technology that holds sway over both the individual and the collective. It can thus be said that the dominant discourse regarding health and behavior that puts it at risk currently focuses on a reduction of the difficult dialectic between the individual and the collection, which holds that the individual alone is responsible for managing the risks to which he or she is exposed, heedless of the determining factors to which one is submitted when interacting with the collective and the outside world. This study thus starts out from the presupposition that the field of public health is going through a “paradigm shift” in the ethics of health care. The latter is no longer seen as a civil right but as a duty of each and every citizen, supposedly for the sake of the well-being of all. This study uses the Bioethics of Protection to investigate the current trend towards holding the individual responsible for his or her health. The investigation was carried out using bibliographical and documentary research, with a view to identifying the onflicts that pervade health care practice and the theories and practices adopted in the fields of health and bioethics as a means to address them. In particular, the documentary research aimed to identify the way in which these theories and practices are exposed to the notion of rights in health, especially, in documents produced for the 1974 Lalonde Report, which constituted the first step towards the contemporary debate on Health Promotion, a field that we have identified as being highly relevant for the discussion of rights and duties in health seen in terms of a dialectic between the individual and the collective, between collective and personal well-being. The specific aims of this study are: (a) to present the main 7 arguments that have been put forward to justify individuals being held responsible for health and those that have been used to oppose this; (b) to outline Michel Foucault’s concept of biopower and explore the way this is re-interpreted in the work of two contemporary scholars, Giorgio Agamben and Paul Rabinow; and (c) to lay out the main ethical implications deriving from the overarching emphasis on the notion of risk in contemporary society in so far as these impact on caring for one’s own health, along with the implications arising from the interpretations of the forms in which biopower is currently manifesting itself as put forward by the aforementioned authors.
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Escandon, Rafael Duncan. "Globalization of Clinical Research and Assessment of Global Access to Treatments Approved between 2006-2015." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7379.
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Globalization in clinical research and development has increased since the 1990s. Products approved in the United States (U.S.) and European Union (EU) include increasing numbers of research participants from low- and middle-income countries. The purposes of this quantitative correlational study were to investigate the lag time, or drug lag, between U.S. approval and the approval of selected drugs in all countries that hosted their pivotal clinical trials. The study population was limited to products approved first in the U.S. between 2006 and 2015. The health capability model and research for health justice framework were the theoretical frameworks for the study. Data were collected from public reports and websites of the U.S. Food and Drug Administration (FDA), European Medicines Agency, National Institutes of Health, local ministries of health, National Association of Securities Dealers Automated Quotations, New York Stock Exchange, the World Bank, and a subscription-based report from Springer Publications. Data were analyzed descriptively, with inferential statistics performed via Wilcoxon and chi-square tests. Independent variables were FDA approval year, drug indication, FDA review type, orphan indication, host country World Bank income category, sponsor market capitalization, and sponsor headquarters country. The dependent variable was drug lag, in months. The U.S. to EU drug lag was significantly shorter than U.S. to last host country drug lag. Lower host country income was also associated with longer drug lag. Reducing drug lag may create justice for research participants, improve health outcomes, and yield positive social changes.
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Eklöf, Jenny. "Gene technology at stake : Swedish governmental commissions on the border of science and politics." Doctoral thesis, Umeå University, Historical Studies, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1424.
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This thesis examines the Swedish political response to the challenges posed by gene technology, seen through the prism of governmental commissions. It discerns and analyses continuities and changes in the Swedish political conception of gene technology, over the course of two decades, 1980–2000. This is done by thematically following ideas of “risks” and “ethics” as they are represented in the inner workings and reception of three governmental commissions. The Gene-Ethics Commission (1981–1984), the Gene Technology Commission (1990–1992) and the Biotechnology Commission (1997–2000) form the empirical focal points of this analysis. The first two provided preparatory policy proposals that preceded the implementation of the Swedish gene technology laws of 1991 and 1994. The last one aimed at presenting a comprehensive Swedish biotechnology policy for the new millennium.
The study takes into account the role of governmental commissions as arenas where science and politics intersect in Swedish political life, and illuminates how this type of “boundary organisation”, placed on the border of science and politics, impinges on the understanding of the gene technology issue. The commissions have looked into the limits, dangers, possibilities and future applications of gene technology. They have been appointed to deal with the problematic task of distinguishing between what is routine and untested practices, realistic prediction and “science fiction”, what are unique problems and what are problems substantially similar to older ones, what constitutes a responsible approach as opposed to misconduct and what it means to let things “get out of hand” in contrast to being “in control”. Throughout a period of twenty years, media reports have continued to frame the challenges posed by gene technology as a task of balancing risks and benefits, walking the fine line between “frankenfoods” and “miracle drugs”.
One salient problem for the commissions to solve was that science and industry seemed to promote a technology the public opposed and resisted, at least in parts. For both politics and science to gain, or regain, public trust it needed to demonstrate that risks – be it environmental, ethical or health related ones – were under control. Under the surface, it was much more complicated than “science helping politics” to make informed and rational decisions on how to formulate a regulatory policy. Could experts be trusted to participate in policy-making in a neutral way and was it not important, in accordance with democratic norms, to involve the public?
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Melo, Maria da Penha Pereira de. "Análise bioética da relação médico-paciente na perícia médica da Previdência Social." Universidade do Estado do Rio de Janeiro, 2013. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7372.
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Esta dissertação apresenta e discute resultados de pesquisa desenvolvida como pré-requisito parcial para obtenção do grau de mestre em Bioética, Ética Aplicada e Saúde Coletiva junto ao Programa de Pós-graduação em Bioética, Ética Aplicada e Saúde Coletiva da Universidade do Estado do Rio de Janeiro, em regime de associação com a Universidade Federal do Rio de Janeiro, a Fundação Oswaldo Cruz e a Universidade Federal Fluminense. A pesquisa de metodologia qualitativa analisou material empírico composto por amostra de registros da Ouvidoria da Previdência Social contendo reclamações sobre o atendimento médico-pericial. A Previdência integra o campo da seguridade social e tem a vida e suas intercorrências na população de segurados como seu objeto de cuidados e
controles. O benefício auxílio-doença é o mais frequentemente concedido entre todos os benefícios da Previdência sendo devido somente a seus segurados em dupla condição de vulnerabilidade, doentes e incapazes para o trabalho. A verificação da condição de incapacidade para o trabalho é realizada pelos médicos peritos da Previdência Social como pré-requisito para acesso ao benefício e funciona como mecanismo de controle de custos. Os resultados do estudo
evidenciam que a tarefa de controle de acesso, realizada na interface com o segurado, exige um deslocamento da atividade médica da função assistencial para a pericial em decorrência da natureza da tarefa médico-pericial, onde o lugar do controle é o da exceção beneficente. Tal atribuição condiciona um risco da atividade médico-pericial que entendemos ser de ordem moral. As reclamações sobre o atendimento médico na perícia previdenciária foram compreendidas como índices de
disfunções nesta interface, assim como os registros de violência em torno desta atividade. Resultantes da prática de limites de acesso ao benefício, na forma em que estes limites estão colocados. A análise desta interface coloca em relevo o paradoxo da proteção securitária que funciona retirando da proteção partes de sua população e caracteriza a relação médico-paciente na perícia médica da Previdência Social
como moralmente conflituosa. A pesquisa na linha de uma bioética crítica, que enfatiza as políticas públicas que afetam a vida, entendeu Previdência Social como biopolítica e a atividade médico-pericial como expressão de biopoder, nos termos da filosofia política de Michel Foucault. Cabe à sociedade refletir seriamente sobre essas práticas de controle e definir o alcance e a forma da proteção securitária tendo
em vista que esta proteção tensiona necessidades individuais e coletivas. Cabe a todos e a cada um ter em mente a dimensão ética da política previdenciária.This dissertation presents and discusses research results developed as prerequisite for obtaining the masters degree in Bioethics, applied Ethics and Public Health by the graduate program in Bioethics, applied Ethics and Public Health at the University of the State of Rio de Janeiro, in association with Federal University of Rio de Janeiro, Oswaldo Cruz Foundation and the Fluminense Federal University. The qualitative methodology research analyzed empirical material composed sample records of the Ombudsman of Brazilian`s Social Security System containing complaints about the medical examinations. The Social Security System has life and its complications in the population of insured persons as object of care and controls. The sick leave benefits is the most often granted between all social security benefits being due only to its policyholders in double condition of vulnerability, disease and work disability. The verification of incapacity to work is carried out by medical experts of Social Security as prerequisite for access to benefit and serves as a cost-control mechanism. The results of the study show that the task of access control, held at the interface with insured, requires an offset of medical care function as a result of the nature of medical-legal examinations, where place of the control is the beneficent exception. Such attributions determine a specific risk to the medical-legal examinations that we understand to be of moral order. The complaints about the medical work in Social Security were understood as dysfunctions index on this interface, as well as the records of violence around this activity. As results of the limits to access the benefits, in the form in which of these limits are placed. The analysis of this interface puts into sharp relief the paradox of social security protection that works by removing parts of its population under protection and characterizes the medicalpatient relationship in Medical Social Security expertise as morally conflictive. The research, in accordance with a critical bioethics approach, that emphasizes the public policies that affect the life, understands Social Security as Biopolitics and medical expertise as an expression of Biopower according political philosophy of Michel Foucault. Its up to society reflect seriously on these control practice and define the scope and form of social security protection considering that this protection produces tension between individual and collective needs. Its up to each and every one to keep in mind the ethical dimension of the social security policy.
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Garmendia, Craig A. "Patterns of Regularity Noncompliance Identified by the U.S. Food and Drug Administration and Their Effects on Meta-analyses." FIU Digital Commons, 2018. https://digitalcommons.fiu.edu/etd/3920.
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The objective of this study was to determine the patterns of regulatory noncompliance, as identified by the U.S. Food and Drug Administration (FDA), and their effects on meta-analyses. In order to achieve these objective, three studies were undertaken: analysis of citations issued by FDA Investigators at the conclusion of an inspection; analysis of regulatory actions taken by the FDA towards clinical researchers based on the observations cited by FDA Investigators; and sensitivity analysis of meta-analyses based on the Agency’s determination of research misconduct, primarily the falsification of data. FDA Investigator citations were analyzed using Chi-Square analysis based on geographic location of the inspection, type of inspection, and type of violation. Temporal changes in the number of inspections and the violations cited were analyzed using bivariate Poisson regression models. Bonferroni correction was employed for temporal changes across the time period analyzed. Regulatory actions taken by the agency were analyzed via Chi-Square or Fisher’s exact test based on changes identified in previous publications, temporal changes, and differences between regulatory action types. Sensitivity analysis of meta-analyses identified through a systematic review were assessed both qualitatively and quantitatively for the effects of including publications of apixaban trials with significant FDA regulatory action, i.e. the comparison of odds ratio point estimate, upper and lower 95% confidence interval, both before and after consideration of falsified data.
Under the FDA’s Bioresearch Monitoring program from 2007-2015, the number of inspections increased, but the rate of citation issuance per inspection decreased. One third of the violations were related to adherence to investigational procedures followed by informed consent violations and violations involving study records. During this same time period, 194 clinical researchers received a regulatory action based on FDA’s review of inspection results. Since 2007, rates of significant deviations had decreased. Lack of researcher supervision and submission of false information were cited more frequently for disqualification proceedings. A systematic review found 99 statistical analyses from 22 different meta-analyses available for sensitivity analyses. Nearly one-third resulted in a change in the conclusions reported in the originally published statistical analyses.
In approximately the last decade, the number of violations cited during inspections under the Bioresearch Monitoring program has decreased; however, significant improvements can continue to be made regarding adherence to study procedures, the consenting of human subjects, and creation of adequate and accurate study documentation. Disqualification of clinical researchers is more likely to occur when researchers fail to supervise a clinical trial or false information is submitted to the FDA. Falsified data can make its way into the exploding field of meta-analyses, a study method that provides a concise and compelling method for the dissemination of medical intervention knowledge; however, this method can be highly unstable and can provide biased results. A robust sensitivity analysis that considers data quality from available sources can help ensure calculations of the best estimates.
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Carvalho, Koichi Kameda de Figueiredo. "Saúde pública, inovação farmacêutica e propriedade intelectual: o desenvolvimento de um novo medicamento contra a malária no Brasil." Universidade do Estado do Rio de Janeiro, 2012. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7193.
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Fundação de Amparo à Pesquisa do Estado do Rio de JaneiroEsta dissertação tem como objetivo estudar a relação entre propriedade intelectual, inovação e saúde pública, com foco na análise do consórcio farmacêutico para desenvolvimento do medicamento combinação em dose fixa artesunato-mefloquina (ASMQ) contra a malária. A concepção dessa iniciativa se insere num momento histórico, final dos anos 1990 e início dos anos 2000, em que estudos apontaram a insuficiência da pesquisa e desenvolvimento para as doenças negligenciadas. Na época, o cenário da malária era particularmente preocupante, dada a disseminação de resistência aos medicamentos disponíveis e à falta de perspectiva do lançamento de novos produtos contra a doença. Para proteger a última classe de antimaláricos eficazes, a saber,os derivados a base de artemisinina, uma estratégia encontrada foi a do recurso à terapia combinada a base de artemisinina (artemisinin based combination therapy ACT). Contudo, dos 4 ACTs recomendados pela OMS em 2001, apenas 1 se encontrava disponível no mercado. O projeto FACT foi então criado, em 2002, com o propósito de desenvolver dois novos ACTs artesunato-mefloquina e artesunato-amodiaquina. O consórcio do ASMQ, por suas especificidades, em particular a produção de inovação por um laboratório público do Sul e a circulação Sul-Sul de conhecimentos e tecnologias , o tornam de interesse para estudos nos campos da bioética e da saúde pública; tendo sido, por isso, escolhido como objeto desta dissertação. O estudo se apoiou em pesquisa bibliográfica, de fundamental relevância para a compreensão dos problemas de acesso e de disponibilidade de novos produtos para doenças negligenciadas, decorrentes de um modelo de inovação farmacêutica sustentado em patentes. De forma complementar, foram feitos: i) trabalho de observação durante a 65a Assembleia Mundial da Saúde, da Organização Mundial da Saúdem, evento de importância para os debates sobre propriedade intelectual e interesse público; e ii) entrevistas com integrantes de equipes das duas principais instituições participantes do consórcio FACT (Farmanguinhos/Fiocruz e DNDi).
This thesis aims to study the relationship between intellectual property, innovation and public health, considering the case of the consortium for the development of the fixed-dose combination artesunate-mefloquine (ASMQ) for the treatment of malaria. The genesis of this initiative is part of a historical moment (late 1990s and early 2000s), when studies highlighted the crisis on R&D for neglected diseases. At that time, the scenario of malaria was particularly worrying, given the spread of drug resistance and also the fact that there was no expectation for launching new antimalarials in the market. A strategy was then developed to protect the last class of effective antimalarials (artemisinin derivatives) by establishment of the artemisin-based combination therapies (ACTs). Nevertheless, only one of the four ACTs recommended by WHO in 2001 was available. The FACT project was then created in 2002 with the purpose of developing two new ACTs - artesunate-mefloquine and artesunateamodiaquine. The ASMQ Consortium, due to its specific features (production of an innovation by a public laboratory located in the South and South-South knowledge circulation), may interest the studies in the fields of Bioethics and Public Health, and was chosen to integrate this thesis. Besides the analysis of specialized literature, which was of fundamental importance for understanding the problems of access and availability that arises from the current model of innovation adopted by the pharmaceutical industry, an observation work was conducted during the 65th World Health Assembly, World Health Organization, held in Geneva during May 2012, which was of valuable importance for the debates regarding intellectual property and public interest. Also we conducted interviews with actors belonging to the two institutions participants of the consortium FACT (Farmanguinhos / Fiocruz and DNDi) in order to better understand the initiative.
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Sandalow, Maya H. "La Paradoja Hispana Epidemiológica: Investigando las preconcepciones y generalizaciones." Scholarship @ Claremont, 2015. http://scholarship.claremont.edu/cmc_theses/1191.
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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 generalizaciones impiden un entendimiento claro. Antes de llegar a conclusiones e implicaciones, es necesario diseccionar la paradoja para poder entender esta diversidad y especificar los aspectos que realmente necesitan explicaciones. El análisis de la aparente paradoja tiene mucho que decirnos no sólo sobre la población latina, sino también sobre las maneras en que se estudia la salud y cómo se presenta información sobre la salud al público. Una examinación de las investigaciones de la paradoja puede dar luz a estos discursos generales.
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Estévez, Abad René Fernando. "Los derechos de las personas con demencia. Un estudio de casos, aproximación desde Ecuador." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/666506.
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La demencia es una enfermedad prevalente en el mundo desarrollado pero se constituye en una amenaza latente para los países en desarrollo. El caso de Ecuador es una muestra de las complicaciones que enfrenta el sistema de salud debido al crecimiento de incidencia de esta enfermedad y que para los próximos treinta años constituirá un problema severo que se sumará a las dificultades asociadas a la persistencia de enfermedades de la pobreza y subdesarrollo.
Las acciones urgentes por parte del estado, asociadas al marco constitucional de protección de derechos se ven retrasadas por la condición económica de un sistema social no cohesionado. Los determinantes sociales de la salud constituyen en Ecuador problemas persistentes y de difícil solución. La salud a pesar de constituirse en derecho fundamental protegido constitucionalmente no logra establecerse con políticas inclusivas y asertivas.
La demencia constituye desde el punto de vista biológico un complejo de enfermedades en la cual la más visible por predominio numérico es la Enfermedad de Alzheimer; sin embargo el impacto de la investigación neurocientífica ha permitido establecer un complejo de enfermedades demenciales que comparten factores genéticos y neurobiológicos pero que difieren por la topografía de afección cerebral. La investigación en neurociencia ha permitido avances no sospechados en el campo de la demencia pero también presenta situaciones de potencial conflicto para la Bioética que deben ser tratados en un marco de visión plural y apelando a la concepción contemporánea sin dejar de lado el principialismo.
Las discusiones acerca de una corriente más reciente de reflexión sobre el impacto de la investigación del cerebro y su funcionamiento suponen el aparecimiento de una nueva rama de la Bioética denominada neuroética. Esta corriente no ha estado exenta de polémica y reticencia por los seguidores de la Bioética clásica pero presenta oportunidades trascendentales para aportar a la ciencia y a los investigadores con las reflexiones necesarias para mantener el carácter moral de la ciencia, la precaución, la solidaridad y el cuidado.
Los pacientes afectados por esta enfermedad enfrentan situaciones de severa vulnerabilidad no solo por la posibilidad de estigma y discriminación asociados al diagnóstico sino por los todavía pobres avances en cuanto a la terapéutica y medidas
preventivas con carácter efectivo; estas condiciones son más severas para los pacientes de países en desarrollo por la suma de condiciones de vulnerabilidad siendo tal vez la más importante la desigualdad, no es igual tener demencia en Ecuador que en Europa.
La investigación sobre el avance de la terapéutica se ha visto limitada durante los últimos diez años y la mayor esperanza podría surgir de la identificación en etapas previas a la enfermedad para establecer medidas preventivas primarias, aunque también presenta el riesgo potencial de generar discriminación y estigma por el manejo inadecuado de la información. El trabajo de los médicos, sustentado en la relación médico-paciente, el profesionalismo, la transparencia y la actuación libre de conflictos de interés permitirá establecer condiciones de protección y acompañamiento necesarios para una patología que produce severa afectación al ser humano.La demència és una malaltia prevalent al món desenvolupat però es converteix en una amenaça latent per als països en desenvolupament. El cas de l'Equador és una mostra de les complicacions que enfronta el sistema de salut a causa del creixement d'incidència d'aquesta malaltia i que per als pròxims trenta anys constituirà un problema sever que se sumarà a les dificultats associades a la persistència de malalties de la pobresa i subdesenvolupament. Les accions urgents per part de l'estat, associades al marc constitucional de protecció de drets es veuen endarrerides per la condició econòmica d'un sistema social no cohesionat. Els determinants socials de la salut constitueixen a Equador problemes persistents i de difícil solució. La salut tot i constituir-se en dret fonamental protegit constitucionalment no aconsegueix establir-se amb polítiques inclusives i assertives. La demència constitueix des del punt de vista biològic un complex de malalties en la qual la més visible per predomini numèric és la Malaltia d'Alzheimer; però l'impacte de la investigació ha permès establir un complex de malalties demencials que comparteixen factors genètics i neurobiològics però que difereixen per la topografia d'afecció cerebral. La investigació en neurociència ha permès avenços no sospitats en el camp de la demència però també presenta situacions de potencial conflicte per a la Bioètica que han de ser tractades en un marc de visió plural i apel·lant a la concepció contemporània sense deixar de banda el principialisme. Les discussions sobre un corrent més recent de reflexió sobre l'impacte de la investigació del cervell i el seu funcionament suposen una nova branca de la Bioètica anomenada neuroètica. Aquest corrent no ha estat exempta de polèmica i reticència pels seguidors de la Bioètica clàssica però presenta oportunitats transcendentals per aportar a la ciència i als investigadors amb les reflexions necessàries per mantenir el caràcter moral de la ciència, la precaució, la solidaritat i la cura . Els pacients afectats per aquesta malaltia s'enfronten situacions de severa vulnerabilitat no només per la possibilitat d'estigma i discriminació associats al diagnòstic sinó pels encara pobres avenços pel que fa a la terapèutica i mesures preventives amb caràcter efectiu; aquestes condicions són més severes per als pacients de països en desenvolupament per la suma de condicions de vulnerabilitat sent potser la més important la desigualtat, no és igual tenir demència a l'Equador que a Europa. La investigació sobre l'avanç de la terapèutica s'ha vist limitada durant els últims deu anys i la major esperança podria sorgir de la identificació en etapes prèvies a la malaltia per establir mesures preventives primàries, encara que també presenta el risc potencial de generar discriminació i estigma per el maneig inadequat de la informació. El treball dels metges, sustentat en la relació metge-pacient, el professionalisme, la transparència i l'actuació lliure de conflictes d'interès permetrà establir condicions de protecció i acompanyament necessaris per a una patologia que produeix severa afectació a l'ésser humà.
Dementia is a prevalent disease in the developed world but constitutes a latent threat to developing countries. Ecuador`s case is a sample multiple threat for a weak health system, for the next thirty years it will constitute a severe problem added to the difficulties associated with poverty and underdevelopment associated diseases. Urgent state actions are needed, within the constitutional framework for rights protection. These actions seems delayed due to the labile economic and social condition. Social determinants of health in Ecuador are persistent problems and difficult to solve. Health, despite considered as a constitutionally protected right, fails to establish itself with inclusive and assertive policies. Dementia constitutes from the biological point of view a complex of diseases in which the most visible by numerical predominance is Alzheimer's Disease; however, the impact of neuroscientific research has allowed to establish a complex of dementing diseases that share genetic and neurobiological factors but differ by the topography of cerebral lesions. Research in neuroscience allowed unsuspected advances in the field of dementia but presents situations of potential conflict for Bioethics. Must be treated in a plural vision framework appealing to the contemporary conception without neglecting principlism. Discussions about the impact of brain research involve the new branch of Bioethics called neuroethics. This current full of controversy and reticence by classical Bioethicists supports transcendental opportunities to contribute science and researchers about special consideration to maintain the moral character of science, precaution, solidarity and care. Patients face situations of severe vulnerability related to stigma and discrimination, they also show concerns about poor progress in terms of poor effect in therapeutic and preventive measures. These conditions worse for patients in developing countries due to the sum of the called multiple layer vulnerability. Inequality could be the heaviest one, it is not the same to suffer dementia in Ecuador as in Europe. Research and progress of therapeutics has been limited during the last ten years, greatest hope arises from early detection in order to provide primary preventive measures, although it also presents potential risk about discrimination and stigma associated to inadequate information handling. The best physicians work is related to best doctor-patient relationship, professionalism, transparency and absence of conflicts of interest. These measures allow to establish conditions of real protection and necessary support for an illness who produces severe human being hurt.
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Miller, Vail Marie. "The Role of Consumers in the Success of the Consumer Driven Healthcare Movement." Cleveland, Ohio : Case Western Reserve University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=case1259787032.
Full textAbstract:
Thesis(Ph.D.)--Case Western Reserve University, 2010Title from PDF (viewed on 2010-01-28) Department of Bioethics Includes abstract Includes bibliographical references and appendices Available online via the OhioLINK ETD Center
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Ott, Kenneth Brad. "The Closure of New Orleans' Charity Hospital After Hurricane Katrina: A Case of Disaster Capitalism." ScholarWorks@UNO, 2012. http://scholarworks.uno.edu/td/1472.
Full textAbstract:
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, took advantage of the mass internal displacement of New Orleans’ populace in the aftermath of Hurricane Katrina in an attempt to abandon Charity Hospital’s iconic but neglected facility and to supplant its original safety net mission serving the poor and uninsured for its neoliberal transformation to favor LSU’s academic medical enterprise.