The opioid epidemic is a public health crisis. How the crisis developed, how to mitigate its effects, and how to prevent it from spreading is less transparent. The practice of pain management poses a myriad of ethical challenges. The following essay will examine ethical dilemmas that arise during the decision-making process with regards to pain management in the context of addiction after a brief history of pain management and discussion of the corresponding legal and medical regulations.

Thesis (M.C.S.)--Regent College, 2007. / Abstract and vita. Includes bibliographical references (leaves [148]-154).

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.

Discussions of autonomy at the end of life in health care contexts is no new phenomenon. However, what seems to have changed in issues of autonomy is cases where patients want to refuse a treatment to cases where patients are demanding more treatment when medical professionals may not agree or be able to provide them with the medical treatment. Some key competing interests impacting patient autonomy include beneficence-doing what is in the best interests of the health or well-being of the patient- and resource limitations. Here, I will explore distributive justice theories that impact the end of life and how they constrain autonomy.

Nurses may share a commonality of issues which can affect their willingness and ability to respond as post-disaster emergency care providers. Guided by expectancy, locus of control, and chaos theory, a systematic literature review was conducted to identify the barriers which affect nurses' willingness and ability to report to their unit after a disaster occurs. Briggs methodology guided this systematic review, and Fineout-Overholt's and Melnyk levels of evidence were used to evaluate the reliability of information and effectiveness of their interventions. Fifteen articles meeting the inclusion criteria (addressed nurses' willingness to report to their unit or to contact the incident command center for mobilization, published in 2005 or after, and written in English) were reviewed. Twelve were systemic reviews of descriptive and qualitative studies (Level 5), one was a cohort study (Level 4), one was a report of expert committees (Level 7), and one reported findings from a pilot study. Five articles reported personal barriers related to the nurses' home caregiver responsibilities and four articles reported personal barriers related to nurses' concern for personal and family safety. Three articles reported institutional barriers related to unsure availability of necessary safety equipment and two articles reported lack of disaster preparedness. Developing a disaster plan that includes emergency phone numbers, a prepared backpack of basic survival gear, and a plan for emergency child and elder care arrangements, as well as providing disaster training for nurses was recommended. Understanding health provider needs and willingness to respond to emergency situations contributes to positive social change by contributing to disaster risk reduction and ensuring safer and more resilient communities.

Medical Academia Conflict of Interest Policy and Potential Impact on Research Funding by Michael K. Maahs MPA, Troy University, 1993 BA, Ripon College, 1990 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University July 2015 The partnership between medical academia and the pharmaceutical industry has been scrutinized for issues associated with research bias. As a result of this scrutiny, the Institute of Medicine (IOM) issued policy recommendations in 2009 directing academia to adopt comprehensive conflict of interest (COI) policies. During the same time, a slowdown of funded research into academia occurred, and it is not clear whether the IOM recommendations contributed to this problem. The purpose of this case study was to determine the extent to which compliance with the IOM policy resulted in a reduction in funded research. The Advocacy Coalition Framework (ACF) was the theoretical lens used for study. COI policy statements (n = 15) were analyzed from American Association of Medical Colleges member schools that engage in medical research. In addition, in-depth interviews were conducted with 4 medical academic researchers. Data were inductively coded and organized around key themes. Key findings indicated that medical academia is compliant with IOM recommendations and COI policies did not appear to have a direct effect on research placement by industry. Interestingly, a possible explanation for reductions in industry funding relate to inefficient institutional review board processes. Additionally, the ACF construct was validated via an observed complex and slowly evolving COI policy process. The positive social change implications of this study include recommendations to academia to continue to monitor and report on COI and explore efficiency improvements related to IRB oversight in order to support important pharmaceutical research that ultimately improves the health and wellbeing of people.

The partnership between medical academia and the pharmaceutical industry has been scrutinized for issues associated with research bias. As a result of this scrutiny, the Institute of Medicine (IOM) issued policy recommendations in 2009 directing academia to adopt comprehensive conflict of interest (COI) policies. During the same time, a slowdown of funded research into academia occurred, and it is not clear whether the IOM recommendations contributed to this problem. The purpose of this case study was to determine the extent to which compliance with the IOM policy resulted in a reduction in funded research. The Advocacy Coalition Framework (ACF) was the theoretical lens used for study. COI policy statements (n = 15) were analyzed from American Association of Medical Colleges member schools that engage in medical research. In addition, in-depth interviews were conducted with 4 medical academic researchers. Data were inductively coded and organized around key themes. Key findings indicated that medical academia is compliant with IOM recommendations and COI policies did not appear to have a direct effect on research placement by industry. Interestingly, a possible explanation for reductions in industry funding relate to inefficient institutional review board processes. Additionally, the ACF construct was validated via an observed complex and slowly evolving COI policy process. The positive social change implications of this study include recommendations to academia to continue to monitor and report on COI and explore efficiency improvements related to IRB oversight in order to support important pharmaceutical research that ultimately improves the health and wellbeing of people.

An estimated 300,000 people contract Lyme disease in the USA every year, 10-20% of whom will experience long-term symptoms even after antibiotic treatment. These patients are said to have Chronic Lyme Disease (CLD). However, diagnostic guidelines, treatment protocols, and the etiological existence of CLD have been the subject of much controversy in the biomedical field, leading to negative mental and physical health outcomes for of patients with CLD. Patient support networks focused on illness experience, known as biosocialities, have formed in response to this controversy. CLD biosocialities create opportunities for patients to participate in biomedical activism and the scientific research process. A historical precedent for biosocial impact on biomedical knowledge and improved health outcomes has been established from patient activists with HIV/AIDS, breast cancer, and PTSD. The impact of CLD patients’ biosocial activism on a scientific and sociological level is evaluated through an examination of the publications of CLD support networks and biomedical research publications. CLD biosocial activism has resulted in more patient-centered research endeavours, etiological proof of CLD, improved diagnostic technologies, and new treatment protocols. These biomedical results have implications for improved CLD patient health outcomes and credibility for CLD as a legitimate disease on a biological and sociological level.

With advancements in CRISPR-cas9 broadening the potential paths for clinical usage of genetic editing, conversations about genetic editing have grown to outside simply scientific communities and into mainstream conversations. This study focuses specifically on Christian discourse of genetic editing and locates four major tensions for many Christians when they think about genetic editing: beginning of life, Creator-human relationship, imago Dei, and stewardship. With these major concerns in mind, I identify epigenetics, somatic cell genetic editing, and in vivo genetic editing research as important research paths to pursue as they can potentially produce techniques that more Christian individuals would feel comfortable using. I pursue one of these paths and conclude with an experimental proposal for an analysis of in vivo and in vitro CIRSPR-Cas9 efficiency in regards to on- and off-target rates.

In the recent political climate, the debate regarding undocumented immigrants and what, if anything, they are entitled to in the US has been incredibly contentious. In the bioethics portion of this thesis, I examine two of the major frameworks for distributive justice, cosmopolitanism and the political conception, address the criminal aspect of undocumented immigration, and suggest a switch from a focus on criminality to focusing on the forces that incentivize undocumented immigration to determine the type of claim undocumented immigrants have to health resources. In the biology portion, I examine three case studies: respiratory tract infection, HIV/AIDS, and tuberculosis to illustrate health disparities among undocumented populations. I conclude that based on their participation in shared social cooperation and the unspoken shadow contract of companies incentivizing undocumented immigrants to come to the US to provide cheap labor, undocumented immigrants do have a right to access healthcare in the US. However, we should account for risk factors such as other marginalized identities, country of origin, and rate and methods of disease transmission when determining exactly what that care should look like.