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Medicin and drugs work at a pharmacological level of chemis-try, but they also work on a level of psychology. How we perceive and react to things, not just emotionally, but also physiologically is affected not only by what the thing is, but by the context in which we con-sume it. This is why wine tastes better if you pour it from a heavier bottle, and almost everything be-comes more desirable if in scarce supply. Here lies an important question. You got two choices, you either say; “This is okay and we should encourage this. What’s the job of a painkiller if not reducing pain. And if you can reduce pain with words and color rather than with chemicals, who’s to say that’s an invalid thing to do.” Or you say;“This is a very self-serving jus-tification and defence of design and marketing.” But wether we like it or not, making someone pay more for a drug that says “For neck pain” will make that drug more effective at treating neck pain. The same thing presented in two different ways can be good, or bad. And this is en-tirely dependent on context, because everything is part pla-cebo. Ethics and morals always comes in question, especially when dealing with placebos. So how do we design ethically and still produce the desired results? This is the perfect metaphor for design and perceived value. The negative attitude is partly due to the fact that we do not understand how it works, despite numerous studies showing that it works. Just like design and perceived value, the value of a placebo is added in a subconscious way. By investigating use of per-ceived value, how its works and why we don’t like it, I aim to create an ethically correct drug concept.

A positive physician-patient relationship is crucial for high quality and effective health care. Yet, cultural and language differences between providers and patients often challenge the establishment of effective physician-patient relationships. These challenges are especially evident in provider-refugee-patient interactions in which patients have experienced loss, torture, and trauma. Understanding of what constitutes a positive doctor-patient relationship is fundamental to diagnosis and treatment and is crucial for the delivery of quality care for diverse patient populations, including refugees. This qualitative, phenomenological case-study focuses on physician-reported experiences caring for refugees in order to identify what experiential factors contribute to effective therapeutic relationships.

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.

As part of a preliminary literature review of research concerning the relationship between medical anthropology and bioethics committees, it became clear that Institutional Review Boards, a foundational component of research, had never been evaluated as a population with a characterizable identity. Some examples of contextual critiques and policy analysis with the goal of procedural efficiency were accessible (Gunsalus 2006; Fitzgerald 2009; Lederman 2006; Ozdemir 2009; Sontag 2012), but qualitative data on the local knowledge of IRBs as a population do not exist. A synthesis of theoretical orientations and methodological planning have been integrated to inform these novel research questions to learn more about the ethical decision-making process of an Institutional Review Board within a research university and hospital. Bioethical reasoning grounded in Western morals creates enough opportunity for cognitive dissonance because of the potential misapplication of ethics, but when decision-making authority is deemed objectively scientific, it can cause a power dynamic by being taken as self-evident. Considering these biomedical frameworks, research with human subjects is grounded in morality, making IRBs a relevant site of praxis for philosophical and scientific research. The overall purpose of this project is to identify the ethical values that define Institutional Review Boards as a population, evaluate the moral implications of biomedical governmentality in clinical research, and define common phenomenological understandings of moral praxis within positions of relative power.

A thoughtful survey of the history of psychiatry sheds light on a rich and intricate story of our evolving understanding, experience, and treatment of mental illness through time. These chronicles are at once a show of human curiosity for the mind-body connection, and an experiment in cruel and unusual treatment of illnesses that have proven difficult to quantify through both ancient and modern scientific means. It is the latter that makes an ethical study of the past so vital in a concerted effort to write a more just future for all patients. This paper provides a survey of the history of mental health and psychiatry from ancient Egypt to modern-day America, highlighting the injustices suffered by patients with mental illness throughout all times with a particular focus on the burden shouldered by vulnerable and underprivileged persons, minorities, and urban populations. Through an analysis of landmark American cases, it examines the establishment of civil rights for psychiatric patients in the areas of: the right to treatment, right to refuse treatment, and civil commitment. Drawing upon these precedents and historical contexts, this paper explores how the principles of bioethics can be applied to the future of psychiatry with respect to emerging trends like the use of social media, telehealth, gene editing, and AI/VR in medicine. By thoughtfully reflecting on the past and applying the lessons we have gleaned to the future, this thesis aims to promote a more ethical and equitable approach to mental healthcare, one that protects and actively fosters the empowerment of all patients, regardless of background, mental status, or socioeconomic status. / Urban Bioethics

Scholars have recognized the importance of illness narratives, and some of this work hastargeted terminal-illness stories, but little has directly addressed what distinguishes them from other illness narratives. In most illness narratives, recovery and life beyond the acute incident are a critical part of the overall experience of a disease. But terminal illness always ends with death. It has no “after.” This difference fundamentally changes how the illness is experienced – and how we should analyze a story told about it. Recognizing this distinction is important not only from a narratological perspective, but also for the study of the ways people live while dying and the models of behavior these stories reveal. I offer four ways to consider the specific genre of terminal-illness stories: the desire to tell, a turn to living dyingly, the alternative triumph, and endings-beyond-endings. These four elements recognize that terminal-illness stories are a distinct subset of illness narratives, and thus they can yield important insights unavailable through existing methods of looking at illness narratives more generally. Beyond the expanded narratological knowledge, this understanding is crucial because close listening is an ethical responsibility both to the individual and to those who come after her. Thinking about how and why people tell these stories and what we can get from them helps us see how they function in the world. That, in turn, gives us more concrete ways to think about the abstract ideas around terminal illness, dying, and death. This awareness will let us think more carefully about our master narratives of death and dying and what models of behavior are available to those who are terminally ill and those who care for them, and it can also offer insight into societal structures of health care. Such insights can further the cultural movement toward supporting a so-called good death, part of a larger shift from a biomedical model to a biocultural one that incorporates a patient’s subjective experience. Recognizing these signals can help a dying person and her caregivers think through treatment options, social support, and other aspects of care. Truly hearing the stories told by people with terminal illness helps us create a better ethic of caregiving and a better dying for all of us.

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