Healthcare ethics consultation has had a place in healthcare for many decades yet the nature of the work is not well understood by many of its critics as well as its defenders. Practicing healthcare ethicists (or PHEs) have been described as compromised and ineffectual; politicised and undemocratic; and their promise to offer sound advice has been deemed irredeemably incoherent in the context of value pluralism. I tease out what is instructive in these critiques and argue that they may be answered by reviewing the conflict of interest literature and by exploring what is distinctive about the PHE role. The most challenging aspect of any PHE’s role is to provide support for the management of so-called hard cases, therefore I introduce a typology of hard cases. Emphasis is placed on what I call (borrowing from the legal theoretical literature) penumbral ethical cases. Legal theory, especially that part of legal theory that deals with what H. L. A. Hart called penumbral cases, can help PHEs (and others) to appreciate the fact that theoretical disagreement need not signal that the field has little to offer, nor need it imply that all answers are equally defensible in the hardest of cases. Finally, I argue that legal theory can provide a jumping-off point for the study of insufficiently explored topics related to PHE professionalization. Legal theorists have long attended to the relationship between law and morality, the problem of obedience in wicked legal systems, and the supposed tension between democracy and the role of an expert judiciary. An appreciation that these debates are not unique to the practice of healthcare ethics may help PHEs to engage critics with a renewed confidence and some fresh approaches to perennial, and hitherto unproductive, arguments. / Dissertation / Candidate in Philosophy / Ethics consultation has had a place in healthcare for decades, however the nature of the work is not well understood by many critics and defenders. Practicing healthcare ethicists (PHEs) have been described as compromised and ineffectual; politicised and undemocratic; and their promise to offer sound advice has been deemed irredeemably incoherent in the context of value pluralism. I tease out what is instructive in these critiques and argue that they may be answered by reviewing the conflict of interest literature and by exploring what is distinctive about the PHE role. I introduce a typology of hard cases with an emphasis on penumbral ethical cases, and contend that legal theory, especially that part which deals with H. L. A. Hart’s penumbral cases, can help PHEs to describe theoretical disagreement in hard cases. I also argue that jurisprudence can be useful in the exploration of topics related to the professionalization of PHEs.

Healthcare visits fall into the category of either Emergency or scheduled visits. Post-pandemic, a significant number of people are avoiding their scheduled and routine healthcare visits due to perceived risk of infection. Any delay in treatments could potentially lead to their condition worsening. The demographic of people avoiding their healthcare include people with reduced mobility ( wheelchair or crutch users) - who experienced a shortage of accessible transportation, people with per-existing conditions who were in-fact the most susceptible to contagious diseases, and lastly unpaid adult care takers. Our current mobility options, which include private vehicles, shared services such as Uber and public transport fail to cater to the unique accessibility and hygiene requirements of patients. This lead me to ask if it was possible to address this gap and create a new solution for a very specific purpose ? My research included understanding the pain points of users with a varying degree of mobility, such as the elderly, who found it challenging to enter vehicle with low ceiling and wheelchair user, who found transferring to the car seat tiring or sometimes impossible without assistance. Users also described how frequently touched surfaces, small enclosed areas with poor ventilation and crowding present in shared/public transportation was a cause of concern and lead to anxiety. During my process, I had used a combination of 3D models, tape drawing and projection mapping to ideate, validate and arrive at the final result. The end product was Neon- a non emergecy on demand mobility service designed to bridge the gap between home and healthcare. It is designed to have a minimal footprint on the road (smaller than a compact car), without compromising comfort of the passengers. Neon has a high ceiling and low floor, so that it’s easy for people with limited mobility to enter and exit the vehicle. In the interior, seats are designed to face each other, in order to provide comfort and security for the patient and also enable the caregiver accompanying them. Neon is wheelchair accessible, with an ejecting ramp that meets at curb height. At the center of the vehicle, a rotating pedestal orients the wheelchair user to their seats, and an innovative locking mechanism secures them in place. During their journey to the healthcare center, patients can have an on-route check up with the medical staff. Depending on the condition of the patient, the medical staff can activate the ‘Emergency mode’, where a blue cross illuminates on the exterior. With its many hygiene and accessibility features, Neon provides a seamless experience for the first mile of healthcare.

Healthcare-associated infections (HAIs), especially those caused by different antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and multidrug resistant Pseudomonas aeruginosa are of growing concern in healthcare facilities. Since 1995, overall incidence rates of MRSA in Canadian hospitals have increased 19-fold, leading to unnecessary suffering by patients and increasing costs to hospitals. There have been many reports that link pathogen-carrying hospital textiles and cases of infections. The development of effective, durable and rechargeable antibacterial healthcare textiles is expected to impede the transmission of infectious microorganisms, and act as an additional prevention measure to infection control. N-chloramines have been proven to be one of the most suitable antimicrobial agents to be immobilized onto healthcare textiles to impart them with potent and rechargeable antimicrobial functions. However, the majority of the hospital used medical textiles are synthetic fibers which are chemically inert and hard to be chemically modified with N-chloramine functions. This study focuses on developing an industry scalable process to durably immobilize N-chloramine onto poly (ethylene terephthalate) (PET), a common synthetic fiber used in healthcare textiles. Many techniques have been reported till now to activate the chemically inert PET surface with reactive functional groups. Among all the techniques, aminolysis and plasma treatments have attracted great attention due to their easy process to introduce functional group onto PET and can be set up for large production. However, aminolysis suffers from polymer degradation and plasma treatments suffer from less deposition which hinders these two processes to produce commercial antibacterial textiles. In this study, a new combined process was introduced by combining aminolysis and plasma treatments in a specific way that not only minimize the problems associated with these two processes but also can create more N-chloramine precursor functional groups onto the surface of PET. The covalently bonded N-chloramine precursor groups can be easily converted to N-chloramine by dilute sodium hypochlorite solution. The presence of nitrogen on the PET substrates after the modification was confirmed by CHNS/O elemental analyzer and ATR/FTIR analysis showing a successful incorporation of N-chloramine precursor. The morphology of the treated fibers was kept relatively similar with a slight decrease in their diameter. Moreover, the tensile strength of the treated fabric was also acceptably maintained. The N-chloramine modified PET presented highly effective antimicrobial properties, even after 50 home launderings the rechargeable treated fabric demonstrated 100% reduction of both MRSA and P. aeruginosa within a contact time of 5 min. / May 2016

Bakgrund: I Sverige genomförs 30 000–38 000 aborter varje år, främst genom medicinsk metod. Lagstiftningen tillåter abort fram till vecka 18 och möjligtvis fram till vecka 22 vid särskilda skäl. Kvinnors lidande, både under och efter aborten, är komplex och kräver ett gott bemötande och individanpassad vård från vårdpersonalen. Syfte: Belysa kvinnors upplevelse av abortprocessen och vården vid genomförande av abort i Sverige. Metod: En litteraturstudie där kvalitativa artiklar valts ut för att besvara syftet. Resultat: Studiens resultat kom fram till att beslutet att genomgå en abort är en komplex situation där många känslor påverkas. Bemötandet från vårdpersonalen under hela abortprocessen påverkade kvinnornas upplevelse av vården och detta bemötande varierade. Informationen om abortprocessen var olika och många kvinnor önskade en mer individanpassad och detaljerad information. Smärtupplevelsen vid abort var varierande och bristen på effektiv smärtlindring påverkade kvinnors upplevelser. Upplevelsen av vårdpersonalens empati och engagemang efter aborten var avgörande för kvinnornas emotionella välbefinnande. Konklusion: Kvinnor upplever ett lidande när omvårdnaden brister. För att förhindra ett vårdlidande hos kvinnorna krävs en god och individanpassad kommunikation och omvårdnad. Kontinuerlig förbättring av abortvården sker genom ökad informationsgivning, förbättrat bemötande från vårdpersonal och adekvat stöd under eftervården, vilket kan optimera kvinnors upplevelser och välbefinnande inom abortvården. / Background: In Sweden, 30 000-38 000 abortions are performed each year, mainly through medical methods. The legislation allows abortion up to week 18 and possibly up to week 22 for special reasons. Women's suffering, both during and after the abortion, is complex and requires good treatment and individualized care from the healthcare staff. Aim: To illustrate women's experience of the abortion process and healthcare during abortion. Method: A literature study where qualitative articles were selected to answer the purpose. Findings: The study concluded that the decision to undergo abortion is complex, and healthcare staff significantly influence women's care experiences. Varied information about the abortion process leaves many women seeking more detailed and individualized information. Pain experiences during abortion differ. Post-abortion, the empathy and commitment of care staff play a crucial role in women's emotional well-being. Conclusion: Women experience suffering when care is lacking. In order to prevent women suffering from care, good and individually adapted communication and care is required. Continuous improvement of abortion care takes place through increased information provision, improved treatment from health care personnel and adequate support during aftercare, which can optimize women's experiences and well-being in abortion care.

Considerando a sua composição e seu risco potencial ao meio ambiente e à saúde pública, os Resíduos de Serviços de Saúde (RSS) necessitam atenção especial em todas as suas fases de manejo. Dentre os principais geradores de RSS encontram-se os hospitais, que foram o foco deste estudo devido à quantidade, diversidade e periculosidade de resíduos que geram. Estes resíduos podem representar um grave problema caso exista uma ineficiência no seu gerenciamento, constituindo um risco para a saúde da comunidade hospitalar e da população em geral. Partindo deste contexto, este trabalho teve como objetivo principal avaliar e realizar um diagnóstico do desempenho do gerenciamento dos RSS em dois hospitais localizados no município de São Carlos-SP (Hospital Universitário e Santa Casa de Misericórdia) através de uma pesquisa descritiva-exploratória com estudo de casos múltiplos. Para tanto, as duas unidades hospitalares foram avaliadas de acordo com 72 indicadores que estão inseridos em quatro esferas: 1- Manejo de Resíduos Sólidos; 2- Segurança e Saúde do Trabalhador; 3- Biossegurança; e 4- Sistema de Gestão. Já o diagnóstico ocorreu a partir da observação in loco, de relatos dos funcionários, entrevistas e da análise de documentos pertencentes aos hospitais. Ademais, foram aplicados questionários para avaliar o conhecimento dos funcionários com relação aos resíduos gerados. Foram entrevistados 43 e 87 funcionários envolvidos com a geração de resíduos do Hospital Universitário (HU) e Santa Casa de Misericórdia, respectivamente. Para ambos os hospitais, os resultados obtidos na avaliação dos indicadores foram positivos (\"Excelente\" para HU e \"Boa\" para Santa Casa de Misericórdia), porém verificou-se que as duas unidades de saúde pesquisadas apresentam problemas com relação ao gerenciamento dos RSS, sendo a Santa Casa de Misericórdia a que possui mais pontos a serem melhorados. Além disto, com a aplicação do questionário de percepção dos funcionários, observou-se que não há um conhecimento profundo sobre todas as etapas de manejo dos RSS por parte dos funcionários. Portanto, de modo geral, observou-se que os estabelecimentos avaliados precisam melhorar o gerenciamento dos RSS e promover capacitações e treinamentos aos seus funcionários. Por fim, entende-se que os dados levantados foram relevantes visto que os hospitais são grandes geradores dentro do município de São Carlos-SP e que as informações obtidas neste trabalho auxiliarão na melhoria do manejo dos RSS, trazendo benefícios para as unidades de saúde e para o município. / Considering the composition and the potential risk to the environment and public health, Healthcare Waste require special attention to all its management phases. Among the main generators of healthcare waste are hospitals, which are the focus of this study due to the quantity, diversity and hazardousness of the waste they generate. If its management is inefficient, this waste may become a risk to the health of the hospital community and to the population in general. Based on this, the main objective of this study is to evaluate and diagnose the performance of healthcare waste management in two hospitals located in the city of São Carlos-SP, Brazil (Hospital Universitário and Santa Casa de Misericórdia) through a descriptive-exploratory study of multiple cases. Both hospitals were evaluated according to 72 indicators that are classified in four areas: 1 - Solid Waste Management; 2- Occupational Health and Safety; 3- Biosafety; and 4- Management System. The diagnosis was based on local observation, employee reports, interviews and analysis of hospitals documents. In addition, questionnaires were applied to evaluate the employees\' perception regarding the waste generated. Were interviewed 43 and 87 employees involved in the generation of waste of Hospital Universitário (HU) and Santa Casa de Misericórdia, respectively. For both hospitals the results obtained in the evaluation of the indicators were positive (\"Excellent\" for HU and \"Good\" for Santa Casa de Misericórdia). However, it was verified that both hospitals present problems regarding their healthcare waste management, being Santa Casa de Misericórdia the hospital with more areas to improve. Moreover, with the application of the employees\' perception questionnaire, it was observed that the employees do not have an extensive knowledge about all the stages of healthcare waste management. Therefore, in general, the hospitals evaluated need to improve their healthcare waste management and to promote training to its employees. Finally, it is understood that the data collected were relevant since the hospitals are large waste generators within the city of São Carlos-SP and that the information obtained in this work could help to improve the healthcare waste management, bringing benefits to the hospitals and to the city.