This licentiate thesis is comprised of a “kappa” and two articles. The kappa includes an account of personal autonomy and informed consent, an explanation of how the concepts and articles relate to each other, and a summary in Swedish. Article 1 treats one problem with the argument that a patient’s consent to treatment is valid only if it is authentic, i.e., if it is “genuine,” “truly her own,” “not out of character,” or similar. As interventions with a patient’s life and liberties must be justified, the argument presupposes that the authenticity of desires can be reliably determined. If the status of a desire in terms of authenticity cannot be reliably determined, discarding the desire-holder’s treatment decision on the basis that it is inauthentic is morally unjustified. In the article, I argue that no theory of authenticity that is present in the relevant literature can render reliably observable consequences. Therefore, the concept of authenticity, as it is understood in those theories, should not be part of informed consent practices. Article 2 discusses the problem of what it is to consent or refuse voluntarily. In it, I argue that voluntariness should be more narrowly understood than what is common. My main point is that a conceptualization of voluntariness should be agent-centered, i.e., take into account the agent’s view of her actions. Among other things, I argue that an action is non-voluntary only if the agent thinks of it as such when being coerced. This notion, which at first look may seem uncontroversial, entails the counterintuitive conclusion that an action can be voluntary although the agent has been manipulated or coerced into doing it. In defense of the notion, I argue that if the agent’s point of view is not considered accordingly, describing her actions as non-voluntary can be alien to how she leads her life. There are other moral concepts available to describe what is wrong with manipulation and coercion, i.e., to make sense of the counterintuitive conclusion. Voluntariness should be reserved to fewer cases than what is commonly assumed. / <p>QC 20170821</p>

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Racial and ethnic minorities in the United States experience health disparities and poor health outcomes at a disproportionate rate in comparison to other groups. One of the many social determinants of health that contributes to these poor health outcomes is mistrust in the medical community. Mistrust is a consequence of a too-long history of unethical experimentation in African American and Latino communities, and has resulted in decreased use of preventive services and screening tools, lack of adherence to medical treatments, and minimal participation in clinical trials. These patterns of minimal utilization of healthcare services have resulted in poor outcomes for numerous health conditions, poor understanding of different diseases and their impact on minority groups, as well as a lack of evidence-based treatments which will benefit these populations. The purpose of this thesis is first to address the historical origins and contemporary consequences of mistrust in medicine within the African American and Latino communities. Second, I address the ameliorating impact that patient-physician racial and language concordance has on both trust and clinical outcomes. Throughout, I reference the ethical principles which warrant the need for greater patient-physician race and language concordance, and I present pipeline programs as a tool to increase the diversity in the medical field, all with the ultimate goal of improving health outcomes in the African American and Latino community. / Urban Bioethics

The Healthy People 2020 initiative recognizes how the physical, emotional and mental toll of incarceration causes poorer health outcomes because of the health risks and exposures individuals face in the prison environment. However, incarceration in the urban setting is more than the social determinant of health. The social, political, and economic consequences of mass incarceration have disproportionately affected urban communities. By reviewing the research on the health and socio-economic status of incarcerated population prior, during and after imprisonment, I make the argument that prisoners have a predisposition to be incarcerated due the negative social determinants of health present in their natal neighborhoods. I illustrate how the evolution of mass incarceration is in part due to the United States (US) government imprisonment of many non-violent offenders by criminalizing drug abuse in part due to racial discrimination towards men of color, primarily African-American men. I examine how drug abuse as a mental illness has been disregarded by the US Criminal Justice System, and how racism has contributed to this factor. Furthermore, as the drugs policies have disproportionately affected these communities, additional consideration should be given to how the criminalization and demonization of drug abuse and addiction has impinged on the bioethical rights of the members of urban communities. I explain how mass incarceration in the urban setting violates each bioethical principle and how the racial disparities in mass incarceration is a reflection and is an extension of the problems of racism inherent to the US. Ultimately, I conclude that any new legislation passed to end mass incarceration should include policies that help to rehabilitate and to rebuild lives of those affected most by mass incarceration. / Urban Bioethics