<p>This thesis paper defends a novel conception of the child's best interest in regard to elective pediatric surgeries (EPS). First, children's capacity for decision-making is examined, and the best decision-making model for EPS is identified as the Best Interest Standard. What follows is a discussion of the interests of children in EPS, the correlation of fundamental interests to rights, and guidelines for weighing children's competing interests. Next, the role of families is considered, especially the rights and duties of parents. Finally, a reinterpretation of the Best Interest Standard is proposed, identifying as paramount a child's ability to make elective medical decisions for herself when she reaches maturity. </p>

<p> The Doctrine of Doing and Allowing (DDA) is the ethical principle that doing harm is morally worse than allowing harm. The objective of this thesis is to show that the DDA is not a viable principle without supplementation. Deontological and consequentialist approaches to the DDA are explored in this thesis. Both approaches are rejected due to the limitations of the binary approach to harms&mdash;the binary approach to harms is the assumption that the badness of harms is best captured by two strict categories of doing and allowing. This thesis develops a sliding-scale approach to harms. This approach is developed by using axiology&ndash;value theory. Value theory is used by consequentialism to determine what goods should be maximized by action and how those goods are ranked. This thesis uses the axiological methodology of Fred Feldman to create a more complex account of the badness of harms. The final chapter of this thesis applies the sliding-scale approach to harms to three end-of-life, medical cases.</p>

Members of the biomedical community justify biomedical research on sentient beings by depicting the benign results which are regarded as necessary for scientific and medical progress, which in turn is absolutely necessary for maintaining human health, well being, and life. Rather than take for granted that the burden of biomedical research should rest only on nonhuman animals, I will explore whether or not there is a more appropriate class of sentient beings that we should conduct our biomedical research on. I will argue, based on utilitarian principles, that if we can maximize overall happiness by conducting our research on a different group of beings, then we should opt to conduct our biomedical experiments on these beings. My central proposal is that our decision to experiment on nonhuman animals is not the best alternative available; rather, if we were to experiment on violent criminals, we would increase overall happiness. Since conducting biomedical research on this particular group of prisoners would fulfill the aims of retributive punishment, deter violent crime, and procure optimal scientific results, we would produce the maximal amount of benefits by experimenting on these transgressors. Thus when faced with the choice to experiment on either violent criminals or nonhuman animals, the morally commendable decision would be to perform research on violent criminals.

<p> This study explored the lived experience of death in the hospital intensive care unit (ICU) from the perspective of surviving family members. More specifically, attention was placed on the experience of withdrawing life-support for a loved one. A phenomenological approach was adopted, and a convenience sampling technique was employed with family members in a community in Southern California. Four (4) caregivers of dying patients were interviewed to explore the lived experience of removal of life-support for a loved one. The caregiver reactions were categorized into seven themes that were common to all four participants: (a) overall experience, (b) mental perspective, (c) ambivalence about care, (d) perceptions of technology, (e) the decision, (f) aftermath, and (g) suggestions for others. The themes were discovered through implementation of transcendental phenomenology in which the researcher's past experience was bracketed out from interpretations of the interviews. Thus, the participants&rsquo; words were taken without preconception to the greatest extent possible. Even though the outcomes were identical&mdash;the death of the patient&mdash;the circumstances leading up to the decisions were each very different. Each circumstance had bioethical ramifications, including breaches in scope of practice, communication breakdown, and caregiver reactions. The results suggest several areas of improvement including those areas that were suggested by the participants themselves. The intention of this research is to shed light on this experience for mental healthcare professionals, such as psychologists and social workers who provide care for the families before, during, and/or after the experience of a loved one&rsquo;s death in the ICU. Moreover, it is hoped that this research will help mental health clinicians to better understand the needs of professional healthcare providers who are exposed to these untenable circumstances on a regular basis.</p>

<p> The purpose of this qualitative study was to discover strategies that hospital administrators can use to obtain support from physicians as they pertain to corporate compliance, while still remaining accountable and loyal to healthcare organizations. By interviewing eight physicians and eight hospital administrators, the study sample was used to gather information on behaviors that influence and affect physician participation in corporate compliance programs. Using the grounded theory design of qualitative research was most appropriate for this study. The use of purposive sampling was most appropriate for this study and produced data for a comparative analysis. The comparative analysis allowed for the generation of a grounded theory by first extracting primary themes for the collected data. Twelve primary themes emerged from the content analysis, which produced four categories, producing a grounded theory, The Hospital Compliance Leader Theory. The hospital compliance leader theory indicates that hospital administrators can engage physicians in corporate compliance programs, while maintaining physician loyalty. To accomplish this, the healthcare leaders must incorporate each of the following: (a) use appropriate training programs while understanding the challenges the physicians face; (b) bridge the artificial gap between hospitals and physicians by educating physicians on the potential consequences the hospital faces because of noncompliance; (c) training physicians on corporate compliance, emphasizing the benefits to patient care with full support from the administrative leadership team; and (d) mandating physician compliance training and focusing the training on the greatest compliance risk areas.</p>

<p> This dissertation provides an ethical justification of surgical weight loss interventions for the treatment of obesity. Situating obesity as not merely a public health concern but also fundamentally a problem of clinical medicine confronting individual patients and physicians, the dissertation argues that the time frame of public health interventions is too long for individuals presently facing obesity and its deleterious physical and social co-morbidities. It argues that failure to address weight loss on an individual level, and specifically to consider the clinical appropriateness of weight loss surgery (WLS), raises serious questions about failure to respect autonomy and promote patient welfare. Moreover, social skepticism or rejection of WLS as a treatment option raises concerns about fairness, as this failure indicates that obesity is not regarded in relevantly similar ways to other life-threatening and health-impairing conditions. </p><p> The dissertation examines various reasons that obesity and its myriad interventions, including WLS, are inadequately addressed in the clinical setting. It argues that considerations with cultural and ethical valence play a critical role in obesity's different and unfair treatment within clinical medicine. Gendered and theologically informed attributions of blame, self-blame, shame, and self-stigma influence the attitudes and actions of both patients and clinicians with regard to addressing obesity. Inappropriate and conceptually confused ascriptions of responsibility impede social acceptance of, and access to, WLS. The dissertation's criticism and subsequent reconceptualization of these ascriptions of responsibility from a perspective informed by feminist epistemology and ethics provide the foundation upon which to consider reform of current clinical practices surrounding treatment of obesity. This dissertation concludes that WLS is both ethically and clinically justified.</p>

<p> The images of dissected pregnant women in William Hunter's atlas <i> Anatomia Uteri Humani Gravidi</i> published in 1774 were among the first realistic, highly detailed illustrations of fetal development and pregnant female physiology. Commissioned by Hunter, the images established scientific truth about female reproductive anatomy, a previously misunderstood field, and aided in the elevation of the work of male-midwives to that of respected obstetricians. The fetal image he presented, like a Lacanian mirror, also opened the door into the psyche of William Hunter. Driven by his passion for anatomical research, Hunter pursued the uncharted territories of female anatomy and fetal development in a narcissistic path of self-aggrandizement. The thesis herein compares Hunter's images to historical images to examine Hunter's unique and innovative qualities. Hunter's images demystify the Jungian maternal archetype and reflect his desire to create artful images. The ethical use of the human body in the arts is also discussed.</p>

<p> Healthcare systems are under pressure to eliminate disparities of care. Communication methods used with Limited English Proficiency (LEP) patients was presented in the literature as an essential component to deliver quality and equal care. Several strategies have been implemented to assess and target the communication methods between patients and health care teams. The challenge for health systems workers is to address communication barriers to eliminate disparities of care and medical errors. The purpose of the present qualitative case study was to explore if communication barriers affect the understanding of LEP research participants while participating in the informed consent process during clinical trials. Communication barriers during the informed consent process may affect clinical trial outcomes. In the study, the use of a triangulation data gathering method was associated with a qualitative case study. Data regarding barriers of communication during the informed consent process were gathered by performing semistructured interviews. The study population included six principal investigators, five interpreters, and nine LEP research participants. Data analysis involved reviewing the emerging themes from participants&rsquo; responses. Results indicated four major themes supporting communication challenges. The themes included authority figure, cultural sensitivity, communication barriers, and education. The study suggested the need for further research regarding communication barriers during the clinical trials process.</p>

<p> Critical care nurses may experience burnout and stress because they are caring for an increasing number of dying patients in the intensive care setting. The purpose of the qualitative, existential phenomenological research study was to explore the experiences, perceptions, and needs of critical care nurses who provided care to dying patients receiving futile medical care and how their experiences may contribute to burnout and stress. Findings revealed that critical care nurses in the study experienced aversive memories associated with scents and sounds of death in intensive care, discomfort, ethical concerns, family issues, personal issues, and physician barriers, but burnout was not discussed. The sample consisted of four critical care nurses who worked in a hospital in Northern California. Data collection was conducted by unstructured interviews, and data analysis was accomplished using thematic analysis and additionally interpreted using NVivo 10 software. Authentic experiences when caring dying patients, barriers encountered while caring for dying patients and identifying resources for nurses caring for dying patients were three themes that emerged from the data analysis. Goodness of caring with intent to stay, meaningful engagement, death feelings/perceptions/scents/sounds, personal feelings, values neutral, advocating for patients, family issues, physician barriers, developing coping skills, colleague/communication support, and end-of-life education/training were the 11 sub-themes that were revealed during the data analysis. There is considerable need for continued research on how to develop and offer a range of supportive resources to help nurses care for themselves while caring for dying patients and their families, on integrating palliative care teams in intensive care units, and how health care organizations could benefit from developing palliative or comfort care units in their organizations.</p>

<p> This study examined hospice physicians' understanding of and attitudes toward existential suffering and palliative sedation, including their understanding of existential suffering, their responses to existential suffering, their use of palliative sedation as a treatment for existential suffering, and the influences on physicians' attitudes and behaviors about palliative sedation. Data were collected through a semi-structured, one-on-one, in-person interview conducted with five physicians employed at one hospice. Each interview was audio-recorded and lasted approximately 60 minutes. The data were examined using thematic analysis. The physicians had consistent views regarding the complex nature of existential suffering and agreed that it is difficult to define and diagnose. They explained that they alleviate existential suffering by helping patients work through it through conversation over time (usually with other hospice team members). The physicians unanimously emphasized that palliative sedation should be a last resort&mdash;and typically given only for intractable physical suffering. Examination of the influences on physicians' decisions to administer palliative sedation revealed that their background, training, and experiences, as well as their personal values and beliefs, countertransference, their assessment of patient's actual need, and ethical concerns influenced their decisions about palliative sedation. Four recommendations are offered based on the study results: Increase physicians' comfort and competence with patients' existential suffering, incorporate training in the use of self for physicians, destigmatize the intervention of palliative sedation, and revisit the terminology of palliative sedation. Limitations affecting the study include small sample size as well as possible researcher bias due to her experience as a hospice social worker and views about palliative sedation. Continued qualitative research throughout the medical field is recommended to further build the body of knowledge about physicians' understanding of and response to patients' existential suffering.</p>