Helping patients and their families prepare for the end of life is a privilege for physicians. Often these discussions are very sensitive; one must be able to navigate the complexities of dying while maintaining the strong, intimate relationship with a person who has entrusted the doctor with his or her final care. Many of the same principles of medical ethics still apply such as informed consent, acknowledging different degrees of health literacy, and cultural humility. With end-of-life care, physicians are responsible for providing their patients dignity in death. In doing so, it is important to decide how aggressive or intense medical treatment should be. There is evidence to suggest that early involvement of palliative care, foregoing invasive procedures or surgeries, and honest communication with families can improve the dying experience. The COVID-19 pandemic has only added more challenges to an already difficult art that physicians spend entire careers working on perfecting. Nevertheless, this provides even more reason to be proactive in determining what is most important for every individual in their final days. / Urban Bioethics

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Syftet med denna kunskapsöversikt var att sammanställa och undersöka kunskap kring BDSM kopplat till våld, samtycke och normer. Genom att samla in forskning från en bredd av olika fält introducerade denna studie olika perspektiv på BDSM till socialt arbete. För människor som arbetar med individer som misstänks vara våldsutsatta eller möter människor som utövar BDSM är det viktigt att kunna skilja på BDSM-utövning från våld och övergrepp. Analysen av de 28 relevanta källorna redovisades i tre teman. Våld och BDSM som visade att även om det finns klara skillnader gällande samtycke och syfte mellan våld och BDSM ser vissa människor BDSM som våld. Sexuella normer, samtycke och BDSM uppmärksammade att BDSM-gemenskaper både har en mer komplex förståelse och ett tydligare sätt att kommunicera kring samt förhandla fram samtycke än övriga samhället. BDSM:s stigmatisering och dess konsekvenser uppmärksammade bemötandet av BDSM-utövare och behovet av mer kunskap och förståelse, speciellt inom människobehandlande yrken. / The aim for this literature review was to compile and examine research on the topic of BDSM connected to consent, norms, and violence. By collecting research from different scientific fields, this study introduced the different perspectives of BDSM to the field of social work. It is important for people who work with individuals who practice BDSM or people that might be subjected to violence to maintain knowledge about how to differentiate abuse and violence from BDSM. The analysis of the twenty-eight studies are declared in three themes. Violence and BDSM which showed that despite the clear differences in consent and purpose between violence and BDSM there are still people who see BDSM as abusive. Sexual norms, consent and BDSM highlighted how BDSM-communities have both a more complex understanding surrounding consent as well as more clear-cut way of communicating and negotiating it compared to the rest of society. BDSMs stigmatization and its consequences  highlighted the treatment of BDSM-practitioners and the need for more knowledge and understanding especially when it comes to professions that are supposed to help people.

[pt] A dissertação tem como objeto a análise do consentimento informado do paciente no âmbito da telemedicina, especialmente na relação médico-paciente realizada em estabelecimento hospitalares. Nesse sentido, são destacadas as modalidades da telemedicina com o escopo de identificar e atribuir a responsabilidade civil pela violação do consentimento informado do paciente em cada categoria, com base nas normas deontológicas e na legislação pertinente. Com efeito, a dissertação buscará responder os seguintes questionamentos: (a) como respeitar o consentimento informado do paciente na seara da telemedicina? (b) como deve ser efetivado o termo de consentimento informado em cada modalidade da telemedicina? (c) como imputar a responsabilidade civil na relação médico-paciente oriunda da violação do consentimento informado no campo da telemedicina? (d) como provar o consentimento do paciente no âmbito da telemedicina? Para tanto, analisa-se a evolução do consentimento informado do paciente, chegando-se a conclusão de que a autodeterminação é parte integrante da dignidade humana e deve ser respeitada na relação médico-paciente, sob pena de ser imputada a respectiva responsabilidade civil. Nessa toada, discorre-se sobre o desenvolvimento do atendimento médico realizado à distância, bem como são analisadas decisões judiciais a respeito do tema a fim de demonstrar as dificuldades concernentes à consumação do consentimento informado do paciente no âmbito da telemedicina. Por conseguinte, são apresentadas proposições para inclusão no termo de consentimento livre e esclarecido com o escopo de facilitar a compreensão do paciente no atendimento telepresencial e possibilitar a concretização do consentimento informado. Enfim, considerando a dificuldade na produção probatória relacionada ao consentimento informado do paciente, é apresentada uma recomendação que visa contribuir com o aperfeiçoamento da relação médico-paciente no campo da telemedicina. / [en] The dissertation has as its object the analysis of the patient s informed consent in the context of Telemedicine, especially in the doctor-patient relationship carried out in hospitals. In this sense, it is intended to discuss the modalities of telemedicine, identifying and attributing civil liability for the violation of the patient s informed consent in each category, based on deontological norms and on the institutes of the Consumer Defense Code. Consequently, the dissertation will seek to answer the following questions: (a) how to respect the informed consent of the patient in the field of telemedicine? (b) how should the informed consent form be implemented in each modality of telemedicine? (c) how to impute civil liability in the doctor-patient relationship arising from the violation of consent in the field of telemedicine? (d) how to prove the patient s consent in the context of telemedicine? To this end, the evolution of the patient s informed consent is analyzed, reaching the conclusion that self-determination is an integral part of human dignity and must be respected in the doctor-patient relationship, under penalty of being imputed the respective civil liability. In this sense, the development of remote medical care is discussed, as well as judicial decisions on the subject are analyzed in order to demonstrate the difficulties concerning the consummation of the patient s informed consent in the context of telemedicine. Indeed, propositions are presented for inclusion in the free and informed consent form with the aim of facilitating the patient s understanding in telepresence care and enabling the implementation of informed consent. At the end, considering the difficulty in producing evidence related to the patient s informed consent, a recommendation is presented that aims to contribute to the improvement of the doctor-patient relationship in the field of telemedicine.

I medier har det larmats om att allt fler unga tjejer som besöker ungdomsmottagningar uppvisar skador efter samtyckt samlag. Studiens syfte var att undersöka fenomenet genom att besvara två frågeställningar om hur ungdomsmottagningar arbetar med unga tjejer (13–25 år) som misstänks ha- eller uppvisar skador till följd av samtyckt sex, samt vilka orsaker de tillskriver skadorna. Detta gjordes genom en kvalitativ ansats utifrån semistrukturerade intervjuer med sex yrkesverksamma på olika ungdomsmottagningar i Sverige. Intervjuerna analyserades genom tematisk analys. Resultatet visade på att skador kan uppstå till följd av fysiologiska besvär som förvärras av penetrerande sex eller av bristande förberedelser inför samlag. Däremot framhävde resultatet gråzoner i ungas samtyckesutövning såsom att ungas samtycke kan undermineras av bristande kommunikation, psykisk ohälsa eller av att sex används i självdestruktivt syfte. Sexualiserade medier och pornografi kan också socialisera unga i skeva föreställningar om sex, och könade sexuella manus kan utgöra en påtvingande drivkraft på unga tjejer att samtycka till samlag. Respondenterna arbetar med fenomenet (1) förebyggande och normativt genom kunskapsspridning, (2) individanpassat med fysiska undersökningar, samtalsstöd och remittering till specialistvård, samt (3) sonderande för att fånga upp sexuellt utsatta ungdomar. Studiens slutsatser är att fenomenets omfattning är svår att avgöra, likaså att urskilja skadornas orsaker som kan grunda sig i samverkan mellan individuella riskfaktorer och strukturella eller normativa samhällsbetingelser. / In the media it has been brought to attention that more and more young girls that visit youth clinics show injuries after having consensual intercourse. The purpose of the study was to investigate the phenomenon by answering two questions relating to how youth clinics work with young girls (13-25 yrs) who are suspected of having or showing injuries after consensual sex, and what causes they attribute these injuries. This was done through a qualitative approach based on semi-structured interviews with six professionals who work at various youth clinics in Sweden. The interviews were analyzed through thematic analysis. The results showed that physiological disorders can be exacerbated by penetrating sex or by lack of preparation before intercourse. On the other hand, the result emphasized gray areas in young people's practice of consent, such as that young people's consent can be undermined by lack of communication, mental illness or by sex being used self-destructively. Sexualized media and pornography can also socialize young people in skewed notions of sex and gendered sexual scripts can be a coercive force for young girls to consent to intercourse. The respondents work with the phenomenon (1) preventively and normatively through the dissemination of knowledge, (2) individually adapted through physical examinations, counselling and referral to specialist care, and (3) probing to reveal sexually vulnerable young people. The study's conclusions are that the extent of the phenomenon is difficult to determine, as well as to distinguish the causes of the injuries that seem to be based on the interaction between individual risk factors and structural or normative societal conditions.

This study is a two-phase examination of the desegregation of the 16-campus University of North Carolina system. The first phase involved obtaining and analyzing copies of letters, books, journal articles, newspaper articles and annual reports concerning the court-mandated desegregation plan and its implementation and voluntary continuation after the mandate was rescinded. Reports of black and white student enrollment in historically black institutions (HBIs) and historically white institutions (HWIs) were analyzed for the years 1980, 1988, and 1999. The study found that very substantial increases in minority enrollments occurred in all HBIs and HWIs between 1980 and 1988 and, there were further increases from 1988 to 1999. In absolute numbers, white student enrollments in HBIs increased from 1,801 in 1980 to 3,009 in 1988 (for an increase of 67.1%) and to 3,421 in 1999 (which represented a 13.7% increase from 1988 and a 90.0% increase from 1980). black students in HWIs increased from 7,481 in 1980 to 10,186 in 1988 ( 36.0% increase) and to 14,489 in 1999 ( an increase of 42.2% from 1988 and 87.7% from 1980). black employment in HWIs in faculty and executive/administrative positions increased even more dramatically over the same period. black faculty members in HWIs increased from 138 in 1980 to 206 in 1988 to 310 in 1999, for a total increase of 124.6%. black executive/administrative employment in HWIs rose from 43 in 1980 to 76 in 1988 to 139 in 1999, for a 19-year increase of 223.2%. The second phase of this study involved interviewing the former president and other top-level University of North Carolina system administrators and other principal actors in desegregation planning, implementation and evaluation in the 1970s and 1980s. A second round of interviews was conducted with selected chancellors and directors of admissions in several HBIs and HWIs. The conclusions based upon the responses of both the former and current administrators are that the greatest impediments to increasing black enrollment on HWI campuses were geographic locations of the institutions and the greatest obstacles to increasing black faculty members in HWIs were geographic locations and the lack of new black Ph.D. graduates.

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This thesis report explores and talks about my different experiences, thoughts, ideas, designs and field trips that I took in order to make my project happen. For my project, I created a 3D graphic book and I wanted to educate, empower and start conversations with young teen girls in India about consent and victim blaming through it. I have explored how to talk about a serious topic such as rape without triggering people, given a detailed insight as to how I discovered my visual style for my book, explored how people in India react to my project, sex education level taught in India, collaborated with different people in Sweden and India that helped make my project work and used a metaphorical story of Medusa to communicate my message.

BACKGROUND: The Emergency Department is a quick-moving environment in which rapid identification of illness and prompt treatment is the mainstay of care. Obtaining informed consent from a patient for a high-risk or invasive procedure is required both legally and ethically regardless of the setting. However, informed consent in the Emergency Department is routinely inadequate. LITERATURE REVIEW: Research thus far has identified several of the barriers to obtaining proper informed consent; a few including language barriers, gaps in intellectual levels, fragmented care of different emergency providers, vulnerability of patients in the ED, and the complexity of the informed consent forms. Investigation into improving the informed consent discussion and patient comprehension has shown promise in implementing patient centered modalities that aid in communication. Such modalities include repeat-back mechanisms, easy-read documents, and implemented multimedia presentations. PROPOSED PROJECT: In this proposed study, we will focus on a pre-intervention (control) group and an intervention group. The intervention to be implemented will be a paracentesis informed consent video and a provider checklist including procedure, diagnosis/intervention, risks, benefits, and alternatives all to be checked off after being discussed with and repeated back by the patient. Patient understanding will be analyzed using a post-discussion questionnaire completed by all participants. We hypothesize that this intervention will improve overall comprehension of the informed consent discussion regarding the paracentesis procedure. CONCLUSION: Patient comprehension of the informed consent discussion in the Emergency Department is often lacking in meeting both legal and ethical standards. Reviewing the data for a significant change between the control and intervention group will allow us to determine if enhancing the informed consent discussion to a more patient-centered process will improve patient understanding of all aspects of the informed consent discussion. In the end, this will guarantee ED patients their lawful right to truly informed consent. SIGNIFICANCE: This informed consent video and checklist will allow for an informed consent process that remains standardized but is more patient focused to improve patient comprehension of the process and protect the rights of all parties involved.

Geochemical samplers carry out manual labour in difficult and dangerous conditions while largely unsupervised. This paper explores questions regarding the labour effort provided by these workers which often goes above and beyond the level necessary to maintain employment and at times endangers their personal safety. This extra effort is provided despite relatively high levels of worker autonomy, low levels of supervision, and little apparent economic incentive. Analysis of worker-level interviews using a number of possible theoretical frameworks indicates that more coercive factors such as direct managerial control and employment insecurity are unable to fully explain sampler behaviour and, instead, participant accounts indicate a form of active worker consent to increased labour effort and risk taking. This is a gendered worker consent based on a form of contingent upon the specific context of geochemical sampling. These specific contingent factors are: a working class masculinity derived from the hard manual labour of the work; the wilderness context that facilitates tropes of ‘man versus nature’ reinforcing the masculine workplace culture and obscuring the appropriation of surplus by more easily allowing the workplace to be interpreted as non-capitalist; and a fraternal masculinity resulting from the crew-based workplace organization and highly male dominated workforce composition, intensified by the conforming pressure of isolated camp life. This specific masculinity forms a basis of consent by which the autonomy afforded to workers by the labour process of geochemical sampling helps rather than hinders the imperative of management to encourage workers to exert the maximum effort. / Thesis / Master of Arts (MA)