In this thesis, I examine traditional philosophical arguments concerning the disabled body. I contribute to disability theory by focusing on disabled individuals who employ the use of advanced prosthetics, and by looking at the implications of said prosthetics on disabled individuals’ lived experiences and the ideology of disability. I join other thinkers in finding current disability theory inadequate in its attempts to accurately describe disability and aid disabled individuals to flourish and resist discrimination and marginalization. I suggest that advanced prosthetic use by disabled persons results in the overt cyborgification of the disabled body. Furthermore, I suggest that the cyborgification of the disabled body requires us to re-evaluate the binary of ability vs. disability, and requires us to stop essentializing the disabled body as disabled. I suggest therefore, that these new technologies should be considered morally permissible, and respond to possible objections from the standpoints of fairness and from concerns more broadly regarding transhumanism. Ultimately, questions remain as to any regulatory schemes that should possibly be put in place regarding advanced prosthetics to either limit or promote access to advanced prosthetic technologies for various groups, and to what degree disabled persons should be able to draw on medical resources to access advanced prosthetics. / Thesis / Master of Arts (MA) / In this thesis I aim at unpacking the ways in which traditional theories about disability fail to view the disabled body in an accurate way. I examine the advance of prosthetic technologies as they relate to disability and suggest that in this way the disabled person is a very good example of a cyborg. I then apply cyborg ideologies to ideas of disability and suggest the cyborgification of the disabled body is beneficial both from a flourishing and an ideological standpoint. I finally consider and respond to some objections against advanced prosthetics and transhumanism more broadly.

Classified for decades as a “least risk medical device,” surgical staplers have been recently associated with at least 41,000 injuries and 360 deaths in the last ten years (FDA Letter to Healthcare Providers, 2019). This shocking development has generated calls for a broad investigation into the errors involved in surgical stapler use and reform of the regulatory protocol for medical devices. Current regulatory infrastructure and framework operate with understandings that combine risk inherent to the device and that which is born by the operator (FDA Classification Call, 2019). This thesis explores the aforementioned classification error and its adverse outcomes from an epistemological standpoint. Social epistemic analysis is applied to FDA regulation and to the comparison of two scenarios in reference to the current status-quo classification and to the proposed risk reclassification of surgical staples. Expert versus novice error avoidance surgical performance capabilities are discussed under these two different classificatory scenarios and epistemic social roles.

Health literacy is not only the ability to read, but also the ability of an individual to obtain, process, and understand the basic health information needed to make appropriate health decisions. Over time the concept of health literacy has evolved from considering it a risk factor to be managed to considering it an asset which can be continually built upon. With this in mind health professionals should continue to communicate in simple language, but should also provide their patients with high-quality educational materials and aid them in making the best choices about their health. One way to do this could be with the use of symptom-checking and decision-aiding smartphone apps. In this study, the primary caretakers of children aged 30 months and younger with publicly funded health insurance will be randomized to receive a pediatric symptom-checking smartphone app or a developmental milestone smartphone app. Caretaker health literacy will be measured, and data will be collected on emergency department and primary care office sick visits. It is hypothesized that the use of the pediatric symptom-checking smartphone app will decrease non-urgent visits to the pediatric emergency department. / Urban Bioethics

The thesis begins by examining the history of the newborn screening (NBS) process in the United States and why it is the way it is today. The next section explores why certain genetic conditions, such as Long QT Syndrome (LQTS), do not fulfill requirements for the recommended uniform screening panel (RUSP). Lastly, ethical considerations of expanded NBS in the age of genomic technology are examined by highlighting the principles of autonomy, beneficence, equity, cost-effectiveness, privacy and trust. Overall, the NBS process benefits children by identifying serious rare diseases and intervening early to prevent harm; however, a deeper ethical analysis highlights some of the concerns with expanding mandatory, universal NBS in the age of precision medicine. The focus must be on educating the public and healthcare professionals about the NBS process and using evidence-based protocols for adding new conditions to the panel. / Urban Bioethics

Correctional populations account for about 2% of persons in the United States, who have a unique right to health care guaranteed by the Constitution per court decisions. However, the quality and breadth of this care is not standardized, and incarceration itself creates risk factors for one’s health. A review of the literature was done to evaluate the health and access to care of prison populations. Prison populations are largely minorities from poor neighborhoods with low socioeconomic status who usually have limited engagement with health services prior to incarceration; there is a large amount of morbidity of chronic diseases in prisons, and prisoners are at increased risk for communicable diseases, substance abuse and mental illness. Former inmates are also at increased risk of death following release. While advances such as telemedicine help to bridge the gaps in correctional health, more research needs to be done to assess the needs of this population, and more education and linkage to care should be accomplished to do right by these populations and ensure they get the care they need. This will in turn lead to better health outcomes in this population and may have a beneficial effect on the communities from which these prisoners come. / Urban Bioethics

While death is surely inevitable, the timing and circumstances of our deaths may vary widely and are likely to be negotiable in response to the changing needs of patients and families for physical, emotional and spiritual support as their diseases and illnesses evolve. Patients and families need to become aware of specific care options and supports that are available for them so they can be accessed in order to achieve their own “good death”. The professional health care team is obliged to assist patients and families become knowledgeable about potentially appropriate resources to assist them to become more comfortable with their roles thus more effectively supporting the patient as well as each other. Through literature review and interviews with diverse stakeholders, I will explore what a good death means from the divergent perspectives of patients, families and the clinicians who provide care for hospitalized dying patients. / Urban Bioethics

Research has long shown that breastfeeding provides many concrete health benefits for both mothers and infants that other forms of infant feeding do not. As such, unsurprisingly, breastfeeding has been deemed the preferred infant feeding method by the national and global medical communities and widespread initiatives promoting breastfeeding have followed. However, despite being well-intentioned, messaging around breastfeeding has left some people who cannot or choose to not breastfeed feeling othered and inadequate. While the health benefits of breastfeeding should not be understated, there are other experiences and perspectives that deserve to be in the conversation when thinking about breastfeeding and breastfeeding promotion. This thesis seeks to analyze breastfeeding and breastfeeding promotion from a bioethical perspective, providing an alternative lens through which to think critically about the way breastfeeding recommendations and initiatives are impacting real people. In this thesis, I will discuss the history of breastfeeding in the United States, why breastfeeding has come to be the gold standard of infant feeding, and real-life experiences of breastfeeding. I will also analyze breastfeeding, breastfeeding messaging, and current breastfeeding initiatives through the four principles of bioethics: beneficence, maleficence, autonomy, and justice. Lastly, I will offer my view and recommendations on how to incorporate bioethical perspectives into breastfeeding promotional strategies to create a more effective, inclusive, and supportive breastfeeding culture at the individual, community, and national level. / Urban Bioethics

Neonatal intensive care is an ambiguous and anxious medicine with troubling un/intended consequences. The causes and increasing prevalence of premature birth, available histories and the establishment hospital-based neonatology are presented, with a particular focus on American and Canadian contexts. The thesis traces neonatal medicine’s unlikely swerve through early-American freakshow culture, considers the influence of the eugenics movement, and spans decades of haphazard clinical experimentation with premature babies. Of particular interest is the complex nexus between neonatology and disability and what new technologies reveal about deep-rooted human desires and fears about life, death and disability. Incorporating statistical data, policy analysis and clinical trends with personal, parent and practitioner narratives leads to provocative ethical questions about neonatology’s growing powers. This thesis draws on critical disability theory and contemporary critical theories concerning technology, and builds towards a conception of disability that is separate from the medical paradigm, somewhat unorthodox, and certainly post conventional. / Graduate

Mestrado em Bioética / Master Degree Course in Bioethics / Introdução: usando como referência a área da Bioética, pretende-se delinear uma reflexão crítica no que diz respeito ao domínio da preparação dos estudantes de Enfermagem em Portugal, para a importância atribuída ao ensino da Bioética na aquisição de competências profissionais em Enfermagem. O fundamento deste estudo é traçado pela averiguação junto dos estudantes de três dimensões: a) percepção em relação às temáticas da Bioética, da Enfermagem e da Bioética em Enfermagem; b) importância/ responsabilidade atribuída à Bioética em Enfermagem e c) práticas educativas em foco no contexto do currículo formal da Licenciatura em Enfermagem. Metodologia: o questionário usado (questionário de indicadores formativos- QIF) construído de novo e validado tendo sido pré testado junto de estudantes do 1º e 2º anos da ESTSP (Escola Superior de Tecnologia da Saúde do Porto) com a finalidade de aferir a sua precisão quanto à sua estrutura formal e de conteúdo de modo a proceder à sua validação. A versão de pré-teste tinha 60 itens distribuídos pelas três dimensões acima citadas e adicionalmente duas questões de resposta aberta e duas questões de reflexão falada (esta duas últimas não constaram da versão final do instrumento de trabalho em causa). O questionário após revisão, correcção, reestruturação e reformulação de itens foi aplicado aos estudantes do 1º, 2º e 4º anos (n=565) das Escolas Superiores de Enfermagem de S. João e de Imaculada Conceição. Resultados: Os resultados obtidos apontam globalmente para uma grande valorização dos princípios orientadores da actividade do profissional de saúde assentando nos cinco pilares da Bioética e na necessidade de estratégias activas de aprendizagem, de formação prática, com discussão de casos concretos, para aquisição de competências e para a excelência do exercício profissional. Adicionalmente, é salientada a necessidade de aprendizagem ao longo da vida de profissionais de saúde em constante formação e aprendizagem contínua. Foram obtidos resultados distintos por Escola e por anos escolares tendo-se observado uma evolução da opinião dos alunos à medida que se analisaram os resultados do 1º ano ao 4º ano de escolaridade, o que é consistente com o modelo de Dreyfus embora possam ser devidos a diferentes factores, que foram discutidos. Conclusão: Sabendo que a formação dos futuros Enfermeiros é cada vez mais meticulosa, mais rigorosa e mais exigente, fruto de um processo globalizante que hoje se assiste em todas as facetas da vida, urge reflectir acerca do contributo da Bioética para a aquisição de competências profissionais na área de Enfermagem durante a formação académica, de modo a preparar, motivar e envolver os estudantes, tendo em vista cumprir cabalmente com o seu mandato social. / Introduction: using as reference the area of the Bioethics, is intended to delineate a critical reflection in what it says concerning the domain of the Nursing students preparation in Portugal, for the importance attributed to the education of Bioethics in the acquisition of professional abilities in Nursing. The bedding of this study is traced by ascertainment next to the students of three dimensions namely: a) perception regarding to Bioethics, Nursing and Bioethics in Nursing; b) importance/ responsibility attributed to the Bioethics in Nursing; c) educational practices and approaches to the items focused curriculum in Nursing. Methodology: the questionnaire used, QIF (questionnaire of formative pointers), constructed of new and validated was daily pre tested with students of 1st and 2nd years of the ESTSP (Escola Superior de Tecnologia da Saúde do Porto) with the purpose to survey its precision how much to its formal structure and of content. The daily pre version contains 60 items that are distributed amongst the three above cited dimensions and plus two open answer questions, as well as two spoken reflection questions (this two last ones had not consisted of the final version of the instrument of work in cause). The questionnaire after revision, correction, reorganization and reformulation of item was applied to the students of 1st, 2nd and 4th years (n=565) of the Escola Superior de Enfermagem S. João and Escola Superior de Enfermagem of Imaculada Conceição. Results: The gotten results point globally with respect to a great valuation of the orienting principles of the activity of the health professional seating in the five pillars of the Bioética and in the necessity of active strategies of learning, of practical formation, with quarrel of concrete cases, for acquisition of abilities and the excellency of the professional exercise. Additionally, the necessity of learning throughout the life of professionals of health in constant formation and continuous learning is pointed out. They had been gotten resulted distinct by School and per pertaining to school years having itself observed an evolution of the opinion of the pupils to the measure who if had analyzed the results of 1º year to 4º year of scholarship, what it is consistent with the model of Dreyfus even so can have the different factors, that had been argued. Conclusion: Knowing that the formation of the future nurses is each more meticulous, more rigorous and more demanding, fruit of a globalization process that today attends in all sides of life, urges to reflect concerning the contribution of Bioethics for the acquisition of professional abilities in the nursing area during the academic formation, in order to prepare, to motivate and to involve the students, in view of fulfilling perfectly with its social mandate.

Univ., Diss.--Düsseldorf, 2005. / Literaturverz. S. [387] - 423.