It is often remarked that we are entering into a biotech age that will afford us with the unprecedented means to remake human biology. The question is: should we use our imminent techno-scientific powers to ‘enhance’ and even ‘transcend’ our ‘natural’ limitations or remain human ‘as we have always been’? But is this the right question? This dissertation critically examines the human enhancement debate in bioethics and bioethics-adjacent literature. More specifically, it mobilizes a wide range of disciplinary tools to reflexively explore the discursive resonances, effects, and shortcomings of human enhancement as a conceptual framework. Through this exploration, I demonstrate that the well-established therapy/enhancement distinction depends upon deeply humanist ontologies that are insufficient for understanding and addressing the biotechnological ‘crisis’. In turn, I provide a posthumanist approach to thinking human nature, which highlights the relational, embodied, and differential character of subjectivity. Such an approach implies that we have always been cyborgs and, therefore, never been human as such. In doing so, I take a small step towards constructing post-enhancement frameworks for doing bioethics in our posthuman moment.

Thesis advisor: Katie Rapier / Through the years, people began to breed their dogs and cats with the intention for the pets to be useful in a certain skill. However, that has shifted to focus on their looks rather than their skills thanks to kennel clubs imposing standards on each breed. This has led irresponsible breeding practices to occur which in turn caused breeds to evolve negatively as breeds began to suffer from preventable genetic disorders and negative physical changes. Genetically manipulating soon shifted from pets to humans with PGD/IVF and CRISPR-Cas9. At first, there was a focus to use these methods to help cure and prevent genetic disorders. That has since shifted to people wanting to create the perfect child. In this thesis I will argue that designer breeds help lead the way to designer babies, and that any genetic manipulation to embryos should only be done if a medical reason is present. / Thesis (BA) — Boston College, 2020. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Philosophy.

This dissertation argues that the unstable category of the parasite was used to debate the limits of humanism during the modernist period (approximately 1890 to 1945). I show how the most marginalized individuals and organisms are deemed “parasitic” and positioned at the core of social issues, such as tropical disease, poverty, and racism. Authors from Virginia Woolf and Nella Larsen to John Steinbeck and George Orwell reveal how parasitism occupies a liminal space between categories of sickness/health, human/animal, and production/exploitation. This project contributes to developing debates in modernist studies about the relationship between nature and culture, and it builds on animal studies, disability studies, and the history of medicine to demonstrate that aesthetics shapes our evaluation of various forms of life.

Future health professionals are often educated with other students of their same discipline when, in practice, they will be working with professionals from other backgrounds to provide care for the patient. Complex issues of ethical concern are common to health professionals due to modern technology. This paper describes the evolution of an interprofessional bioethics course that had a unique combination of students and faculty. Innovative teaching methods were utilized and continuously refined based on student evaluations. Students commonly cited the interprofessional interactions as the most enjoyable part of the learning experience. Establishing a patient-centered focus and an appreciation of the contributions of other disciplines, students learned how to apply ethical decision-making to real cases. At the conclusion of the course, students reported improved attitudes toward interprofessional teamwork. This course format and teaching techniques may be applied at other universities looking for linkages to encourage consistent interprofessional collaboration across disciplines.

Nurses may share a commonality of issues which can affect their willingness and ability to respond as post-disaster emergency care providers. Guided by expectancy, locus of control, and chaos theory, a systematic literature review was conducted to identify the barriers which affect nurses' willingness and ability to report to their unit after a disaster occurs. Briggs methodology guided this systematic review, and Fineout-Overholt's and Melnyk levels of evidence were used to evaluate the reliability of information and effectiveness of their interventions. Fifteen articles meeting the inclusion criteria (addressed nurses' willingness to report to their unit or to contact the incident command center for mobilization, published in 2005 or after, and written in English) were reviewed. Twelve were systemic reviews of descriptive and qualitative studies (Level 5), one was a cohort study (Level 4), one was a report of expert committees (Level 7), and one reported findings from a pilot study. Five articles reported personal barriers related to the nurses' home caregiver responsibilities and four articles reported personal barriers related to nurses' concern for personal and family safety. Three articles reported institutional barriers related to unsure availability of necessary safety equipment and two articles reported lack of disaster preparedness. Developing a disaster plan that includes emergency phone numbers, a prepared backpack of basic survival gear, and a plan for emergency child and elder care arrangements, as well as providing disaster training for nurses was recommended. Understanding health provider needs and willingness to respond to emergency situations contributes to positive social change by contributing to disaster risk reduction and ensuring safer and more resilient communities.

Distributive justice is a bioethical principle concerned with the fair distribution of resources and benefits in society. In the context of orthopaedic surgery management, distributive justice is an important consideration in ensuring that all patients have equal access to the resources and care in the treatment of their injuries. The literature well documents demographic and socioeconomic factors in the allocation of elective orthopaedic surgeries, but unfortunately a similar analysis is lacking when it comes to orthopaedic trauma surgeries. This study examines fundamental philosophical perspectives that underly healthcare delivery specifically pertaining to orthopaedic trauma. In doing so, the influence of race, socioeconomic status, insurance status and other factors on access to care and allocation of resources are described. Findings for various orthopaedic trauma surgery cases suggest decreased allotment to those of black race, lower socioeconomic, educational, and non-insurance status. Although the reason is multifactorial and complex, I suggest a shift in focus to the equity and fair distribution of surgical resources by considering the role of population health, understanding multidisciplinary interactions, improving research methodology, and community partnership. / Urban Bioethics

Lifetime incarceration within the United States has an incidence of 6.6%, thehighest globally. Within the United States, individuals experiencing incarceration are among the few citizens who have a protected right to healthcare, as outlined by the Eighth Amendment of the United States Constitution. Yet, despite the promise for adequate care, patients who are currently incarcerated or have previously experienced incarceration continue to be included in the most vulnerable and underserved populations. When bioethical principles, specifically autonomy and agency, are considered, it becomes clear that there is a convoluted relationship between the healthcare system, the correctional system, and the patient who must traverse both sides. Incarceration itself is often associated with poor short- and long-term health outcomes, and patients who currently or previously experienced incarceration can face bias when attempting to navigate the healthcare system. It is imperitive to evaluate healthcare provided in the prison systems as well as the associated outcomes because of the significant proportion of the U.S. population affected by incarceration. This thesis explores the current status of healthcare provided to individuals who are currently or previously incarcerated. In addition, this thesis aims to identify disparities that exist within the provision of this care. Lastly, it suggests potential solutions that would result in more ethical and humanistic care provided to this vulnerable population. / Urban Bioethics

When it comes to inclusion of social support as a criterion for kidney transplantation, there is lack of standardization and understanding of what it truly means to staff, clinicians, even patients and their families. Despite the variability in what “social support” means to many kidney transplant teams and centers, studies (mostly through survey studies) have shown that inadequate social support serves as an exclusion for patients awaiting kidney transplantation. With inadequate social support serving as an exclusion criterion and without it being properly addressed, inequities currently present in the kidney transplant considerations may be perpetuated. This thesis aims to tangibly define this social support criterion within an urban setting – North Philadelphia. Through REDCap survey administration to practitioners and support staff that handle candidacy for kidney transplantation, we will get a sense of how social support defined by wealth, marriage relationship and parental relationship affect views on the ethics of kidney transplant considerations. Discussions will also be applied to pediatric settings. This thesis will be a commentary on whether the current transplant system fulfills the standards of urban bioethics principles. This will present a framework for social support referrals to be implemented as a necessary resource if a patient on the transplant list presents with inadequate social support. I will argue support of the urban bioethical principles of social justice and solidarity for the purpose of helping healthcare systems, government and insurance understand that such resources should be funded by them to support candidates who truly need it. / Urban Bioethics

Vaccines are a scientifically proven method of preventing disease. Immunization has eradicated and continues to protect individuals from life-threatening and fatal diseases. However, as a public health measure, trust in efficacy and safety of vaccines has not been unanimous since their inception. Historically, acceptance of vaccination as a method for disease prevention has been debated since development of the smallpox vaccine. Vaccine hesitancy exists on a spectrum with the advent of each new vaccine but has been amplified in the present day COVID-19 pandemic across the United States. Higher vaccination rates have been associated with lower COVID-19 caseload, a miracle for special populations such as pregnant, pediatric, and older patients at higher risk for COVID-19 complications. This thesis seeks to explore, through a bioethical lens, the factors that contribute to the growth of today’s vaccine hesitancy movement. I highlight previous vaccine hesitancy movements and hesitancy today by examining multiple themes present in literature. I argue that describing a patient as an “Anti-Vaxxer” further ostracizes them from the healthcare institution, politicizes a healthcare issue, and generates inequitable healthcare. I use the example of Philadelphia’s own COVID-19 vaccination response through interviews with involved individuals. In terms of solutions, I propose open and persistent conversation between healthcare institutions and community, public education, and structural reform. The key concern of this thesis is to explore how to navigate a complex healthcare ecosystem regarding vaccination and strategies to ensure patient safety while maintaining the bioethical principles of autonomy and agency. / Urban Bioethics

This thesis uses the four principles of biomedical ethics as put forth by Beauchamp and Childress to address the issue of the criminalization of sex work in contemporary national and international settings. Though a controversial subject, the existence of sex work has been a constant for centuries worldwide. However, the criminalization of sex work in contemporary society has been largely predicated on the conflation of sex work and a number of social ills, particularly human trafficking and sexual exploitation. This uncritical and inappropriate conflation of terms has enabled discourse, legislation, and even health care policy that is unethical, ineffective, and explicitly harmful to both sex workers and victims of human trafficking alike.Medical professionals have a unique set of moral obligations to which they must hold themselves in their practice of medicine, both with their individual patients as well as with the society in which they live. This thesis argues that the criminalization of sex work is fundamentally incompatible with contemporary health care ethics, reviewing each of the four fundamental pillars of biomedical ethics as it applies to policies that criminalize sex work. Each chapter will outline the many ways in which criminalization violates each of these fundamental principles, causing immense and largely preventable harm in the form of human rights violations and poor public health outcomes. At the same time, this thesis will introduce the alternative policy of decriminalization, discussing its features and implications for public health, and highlighting the ways in which the decriminalization of sex work results in improved health, safety, and human rights outcomes for both sex workers and victims of sex trafficking, exemplifying a viable, ethical, and evidenced-based alternative to criminalization. Given the gross bioethical and humans rights violations associated with the criminalization of sex work, this thesis concludes that there exists evidence of a substantial ethical imperative on the part of the medical community and its constituent professional societies to formally condemn policies that criminalize any and all aspects of sex work and issue formal recommendations for its urgent decriminalization, as both a public health issue and an issue of human and patients’ rights. / Urban Bioethics