We think of the lobotomy as utterly primitive and brutal; we shudder at the idea of it. The archetypal image of creepiness, violence, and unnecessary brutality was expressed in the book and movie One Flew Over the Cuckoo’s Nest. This procedure weighs heavy on America’s conscience but in 1945 the procedure was characterized as being as gentle as ‘cutting through butter’ and the therapeutic effect was described as ‘cutting out worry’. How did the lobotomy gain such widespread acceptance? One part of the answer is that Walter Freeman advocated for it not just among his colleagues, but through the popular media outlets of his day as well. In this thesis I will claim that, starting in 1936, Walter Freeman influenced the positive portrayal of lobotomies in the American press. He participated in visual culture that promoted a convergence between medical culture and the popular press by cultivating a representation of the procedure that could appeal to both. His tools included narrative accounts, images, and a public dramatization of himself that was hard to resist. I will show how these efforts were quite successful in the beginning, but that by 1947 he started to lose control of the perceptions and narrative he had worked so hard to construct.

Human dignity is an enunciated ethical principle in many societies, and it has elicited a great deal of interest, not least because it is central in health care. However, it has also been the subject of criticism. Some have argued that it is sufficient to rely on a principle of autonomy, and that dignity is a redundant principle or concept in health care. Other discussions have focused on the precise meaning of dignity, and how a principle of dignity should be interpreted and applied. This dissertation discusses questions on the principle of dignity and the meaning of the concept. In addition to a theoretical analysis of these questions, a qualitative research study has been carried out, based on interviews with physicians in palliative and neonatal care, and hospital chaplains, looking at dignity at the beginning and end of life. This dissertation can be categorised as empirical ethics because of its methodological approach. Based on a narrative analysis of the interviews, the results from the study shed light on the theoretical discussion on dignity. Through the history of ideas, dignity has often been linked to human abilities such as autonomy and rationality. However, autonomy is only one of the aspects which emerged from the qualitative research in this dissertation. Other aspects introduced into the discussion on dignity include human vulnerability, interdependence and the responsibility to face vulnerability in others. Some theoretical perspectives on dignity are criticised in the light of the empirical results. Furthermore, the dissertation includes a theological perspective where a Christological view – connected to Bakhtin’s ethics of responsibility – forms a critique to both the Kantian deontological perspective and dignity acquired by virtue. The dissertation also considers how the results can be applied to medical practice.

ABSTRACT Background: For patients with life-limiting illnesses, having adequate knowledge of prognosis can strongly impact the choice between curative and supportive treatment. Objectives: The purpose of this research study is to explore patient understanding of prognosis and to illuminate the experience of having or not having prognostic information in people diagnosed with life-limiting illnesses. This study aims to investigate the patient's understanding of the term "prognosis", the significance of the term "prognosis" to the patient, and how prognosis may or may not affect future treatment choices. In addition, this study aims to further understand the experience of prognostic communication between provider and patient. The over-arching goal is to capture the personal perspectives of participants with a view to exploring their experiences around knowledge of their prognosis. Methods: A qualitative research design using a phenomenological approach was employed to examine how people experience prognosis. An invitation to participate in the study was publically announced via local newspapers, social media venues, and word of mouth. Participants who responded to study advertisements and who met inclusion criteria were asked to participate in one interview answering open-ended questions aimed at examining their experience with and knowledge of their prognosis. In addition, questions about prognostic communication between patient and health care provider were explored. All interviews were recorded, transcribed verbatim and analyzed using phenomenological methods. Results: Three study participants met the study criteria and were interviewed. Several themes emerged from the data including 1) patients have need for information about their illness, 2) prognostic data inform treatment choices, 3) patient experiences are unique and 4) patients feel a connection to nurses involved in their care. Conclusions: This study illuminated the patients' desire and need for information during their illness, the desire for patient autonomy, the difficulty of starting and having prognostic conversations, the downstream impact of having prognostic information, and the important role that nurses play for patients facing serious health issues. It is hopeful that the themes identified during the course of this research ultimately contribute to the knowledge base by informing healthcare providers on the importance of conveying prognostic information in a timely, direct, and sensitive manner.

Commissions, comités, conseils, les instances spécialisées dans les questions d’éthique des sciences de la vie prennent de nombreuses dénominations et forment une nébuleuse extrêmement diverse. Riche est la littérature qui s’est donné pour objectif de différencier ces organes. Les diverses tentatives de typologie semblent s’accorder sur l’existence de deux comités d’éthique-types : les comités d’éthique clinique ou hospitaliers et les comités d’éthique de la recherche biomédicale. C’est à partir de ces catégories que seront créés de nombreux comités exerçant des compétences variées et agissant au niveau local, national, régional et international. S’agissant de leurs caractères principaux, la doctrine dégage trois éléments fondamentaux : l’indépendance, la pluridisciplinarité et le pluralisme. En dépit d’une évolution plus tardive dans le domaine des technologies, du progrès médical et plus généralement des sciences de la vie, l’Amérique Latine a pleinement pris part au phénomène dit d’institutionnalisation de la bioéthique ; non sans quelques spécificités. L’établissement des instances d’éthique dans cette région est caractérisé par la priorité accordée aux principes de justice et d’accès aux services de santé en raison de la prééminence des problèmes socio-économiques. / The organizations and authoritative entities specialized in evaluating the ethical issues raised by recent developments in the life sciences take on extremely diverse denominations and forms such as commissions, committees, and boards that all form acomplex nebulous. Research focusing on differentiating these bodies is very rich. Various attempts at categorizing these organizations agree on the existence of two main types ofethics committees, hospital ethics committees, and biomedical research ethics committees. On the basis of these categories numerous sub-committees are then created and exercise a variety of skills at the local, national, regional and international levels. As for their main characteristics, consensual research identifies three basic elements: independence,interdisciplinarity and pluralism. Despite a relatively late development in the general field of the life sciences and more particularly in the realm of technology and medical progress, Latin America has fully participated in the phenomenon now known as the institutionalization of bioethics, and has done so with specific characteristics to its region. Indeed, the establishment of ethical review boards in this region is above all preoccupied by the priority given to the principles of justice and access to health services due to the predominance of socio-economic issues.

INTRODUÇÃO: A importância da bioética tem uma demanda importante na prática médica e é muito pouco discutida na psiquiatria. Antes de se pensar o panorama bioético do paciente e do contexto de tratamento, deve-se avaliar a postura bioética do profissional envolvido na relação médico-paciente. Como em outras áreas da psicologia e da psiquiatria, o uso de instrumentos de avaliação de atitudes tem se mostrado útil na discussão de várias situações e comportamentos. No campo da relação médico-paciente na psiquiatria, o Questionário de Sensibilidade Moral (QSM), uma escala dimensional com respostas tipo Likert sobre questões éticas (divididas em 6 dimensões propostas para a sensibilidade Moral) na enfermagem e na psiquiatria, mostra-se como um instrumento específico e útil na investigação das atitudes morais do médico. OBJETIVOS: Conhecer a estrutura da sensibilidade moral dos médicos psiquiatras do Brasil. Descrever o panorama das variáveis epidemiológicas e demográficas da população estudada. Investigar as relações de algumas variáveis epidemiológicas (demográficas e culturais) com a estrutura da sensibilidade moral dos médicos psiquiatras do Brasil. MÉTODOS: Comparar estatisticamente os resultados das dimensões da escala com as variáveis epidemiológicas colhidas no momento da avaliação. RESULTADOS: Foram avaliados 522 médicos psiquiatras do Brasil. As variáveis epidemiológicas investigadas foram: a idade, com média de 49 anos, a raça (brancos, 91,60%), o sexo (homens, 65,70%) e o estado civil (casados, 64,00%). Os psiquiatras também foram avaliados com relação a outros aspectos, a saber: religião (católicos, 44,40%), ter feito ou não residência médica (sim, 75,10%), tipo de prática na psiquiatria (mais que 1 atividade, 86,20%) e tempo de prática profissional (21,3 anos). DISCUSSÃO: Houve a concordância total com as dimensões da Sensibilidade Moral como autonomia, respeito pela integridade e relacionamento interpessoal; concordância parcial na benevolência e respeito às regras, e forte discordância na experiência de conflitos éticos. As variáveis demográficas que tiveram relação estatisticamente significativa com as dimensões e questões da escala foram: idade, cor da pele, sexo, estado civil, religião, residência médica como formação profissional, tempo de experiência profissional e tipo de prática na psiquiatria. CONCLUSÃO: O QSM mostrou ser útil como escala de avaliação moral da prática médica psiquiátrica no Brasil. A estrutura da sensibilidade moral dos médicos psiquiatras brasileiros sofre múltiplas influências em sua relação com elementos epidemiológicos, demográficos e culturais / INTRODUCTION: Despite the importance of Bioethics in all fields of medical sciences, it does not receive enough attention, mainly in psychiatry. Before considering the most appropriate approach to treatment, any physician must focus on its bioethical medical-patient relationship. Like other neuroscience areas such as psychology, the use of instruments that evaluate the phenomenology of attitudes have proved to be necessary in many discussions that involve behavior. In regard to the relationship between physician and his patient, the Moral Sensitivity Questionnaire (MSQ), a Likert-type scale with 30 questions concerning 6 dimensions of moral sensitivity in psychiatric practice, has shown itself to be a specific and good self-evaluation instrument that can be used in the investigation of psychiatrists\' moral sensitivity attitudes. OBJECTIVE: To know the Brazilian Psychiatrists\' Moral Sensitivity framework; and to describe the epidemiology and demographics of the population studied and to investigate some relations within these variables with the Psychiatrists\' Moral Sensitivity. METHODS: The results and scale domains were compared statistically using the epidemiological variables mentioned in the questionnaire. RESULTS: A number of 522 Brazilian psychiatrists were evaluated. The epidemiological variables were age (average of 49 years old), race (91,60% were white), sex (65,70% were men), and marital status (64,00% were married). The psychiatrists were also evaluated concerning other aspects, namely: religion (44,40% were Catholic), status of medical residency as field of training (75,10% had academic residency training), type of professional practice (86,20% had more than one practice field in psychiatry) and length of professional practice (average 21,3 years). DISCUSSION: There was a total agreement in the moral dimensions mentioned in autonomy, respect for integrity and interpersonal relationship. A partial concordance was achieved in benevolence and rules. A strong disagreement was shown in experiencing medical conflicts. The epidemiological variables that were strongly related to the scale dimensions were age, religion, medical residency, length of professional experience and the type of psychiatric practice. CONCLUSION: The QSM has shown to be useful as a bioethical tool in the field of investigation of Brazilian Psychiatrists\' Moral Sensitivity. It was also viewed that the Brazilian Psychiatrists\' Moral Sensitivity framework can be influenced by epidemiological, demographic and cultural factors

abstract: Medical policies, practices, and definitions do not exist solely in the clinical realm; they show up in the lived experiences of patients. This research examines how people with the chronic illness called myalgic encephalomyelitis (ME) define their own illness experiences. They have situated knowledge about their illness onset, search for care, and clinical encounters. Their knowledge complicates and challenges the existing norms in clinical practice and medical discourse, as the experience of searching for care with ME reveals weaknesses in a system that is focused on acute care. Patient narratives reveal institutional patterns that obstruct access to medical care, such as disbelief from clinicians and lack of training in chronic illness protocols. They also reveal patterns in physician behavior that indicate the likelihood of receiving effective care. These patient narratives serve as a basis for continued examination of ME as well as further reconstruction of medical practice and procedure. / Dissertation/Thesis / Masters Thesis Social Justice and Human Rights 2019

Marijuana is the most frequently used illegal substance in the United States and is most widely used among young people aged 12 to 21 years. Accurate screening and monitored issuance of medical cannabis recommendations have been shown to decrease abuse rates of the substance, create fewer deaths from opiates, reduce crime rates, reduce marijuana use in youths, decrease car crash deaths, and lessen prevalence of suicide in young men. The purpose of this project was to explore whether multiple screening methods for depression and anxiety in patients who seek medical cannabis referrals for anxiety and depression would improve screening and cannabis referral accuracy. A comprehensive review of the literature was conducted, and 2 screening tools were identified. The tools identified were the Zung self-rating anxiety scale and the Diagnostic and Statistical Manual of Mental Disorders 5 scale. The medical director at the project site reviewed the tools and approved them. These tools were then included in an education program for 12 staff members and providers with a pretest given to the participants prior to the staff education program. A posttest was then administered to the same group after the staff education program was completed and the new screening measures implemented. Results showed that referrals for cannabis were at 85% before the 2-step screening process was implemented; referrals for cannabis decreased to 60% with implementation of the dual screening method, suggesting increased accuracy in screening for depression and anxiety for cannabis referrals. This project might promote positive social change by increasing accuracy for cannabis referrals and reducing the risk of cannabis abuse.

This dissertation examines the political economy of HIV biomedical prevention research—largely designed in the global North but conducted in the global South—and its implications for people of diverse genders and sexualities. As a recognized global leader in HIV biomedical prevention research among people categorized as men who have sex with men (MSM) and transgender women, Peru offers a key site in which to explore the increasing focus on gender and sexual identity as a strategic area for extractive research practices. This phenomenon has become particularly visible in the epidemic’s 4th decade, which has emphasized the pursuit of biomedical prevention strategies. Building on nine years of previous experience working inside HIV biomedical prevention studies, this project involved 24 months of ethnographic research, including participant observation; 110 interviews with scientists, study staff, and research subjects; 10 focus groups; and analyses of relevant scientific publications. This study presents four key findings. First, US and Peruvian researchers’ historical and continued entanglement primed Peru to become a hotbed of HIV biomedical prevention research. In this context, population categories imported from the global North have served as powerful tools to sustain a booming local research market, which produces data that aligns with the global demands of the HIV industry. Second, on the ground, research begets more research rather than institutionalized HIV prevention technologies, creating a sustained enterprise in which issues of compensation, value, and labor shape the science. The commodification of gender and sexually diverse identities operates here in two ways: as a mechanism to access particular kinds of bodies and associated HIV risk data, and as a mechanism by which to claim expertise in the HIV prevention research industry for both researchers and community members. Third, Peruvians classified as MSM and transgender women are afforded only temporary access to cutting-edge strategies to prevent HIV, limited to study participation. The result is a sustained pool of people in need of HIV care primed to support the HIV biomedical research economy. Finally, this project illuminates a key paradox within the industry’s contemporary focus on gender and sexual diversity in HIV prevention science. This focus creates the impression that progressive health politics marked the field, while obscuring and absolving ongoing forms of exploitation and unequal gains embedded within it.

This dissertation aims to determine what should be the appropriate base ethical limits of health care markets in the United States. I argue that because we do not value health care goods and services as commodities, treating them as commodities available for market sale can only be ethical when health care markets accord with at least the principles of honesty, respect for autonomy, and increased access to essential health care goods and services. I begin by establishing the theoretical foundation of my argument by expositing three theories of commodification and ethical markets that critically examine the relationship of goods to the market. Each theory shows how commodification often fails to account for the non-market value(s) we attribute to many goods. I then apply these theories to health care goods and services to show how they are not properly valued merely as commodities, and to lay the foundation of my argument regarding the ethical limits of health care markets. I then argue why honesty, respect for autonomy, and increased access to essential health care goods and services should be considered the base ethical limits of health care markets by examining how each ideally applies to both health care and the market. Lastly, I apply my argument to two health care markets: the pharmaceutical industry and a possible legal organ market. For the former, I show how many of the practices of the pharmaceutical industry violate what I argue should be the base ethical limits of health care markets. For the latter, I show the extent to which a legal organ market in the United States could or would violate these limits.

In this paper, I seek to determine whether the current ban on performance-enhancing drugs (PEDs) in professional sport is justified. I look at two of the most common categories of arguments in favor of the ban, which I term the Harm Category and The Nature of Sport Category, and ultimately determine that neither is strong enough to justify the current ban. I determine, however, that a third and less common category of arguments, which I term the Dehumanization Category, provides good reason to justify the ban by appealing to our intuitions about why the use of PEDs in professional sport is wrong.