Master of Arts, Miami University, 2024, History

This thesis argues for an interdisciplinary examination of the origins and subsequent appearance of the Wassermann blood test, the first test developed for detecting syphilis, in eugenics initiatives and medicolegal mandates. When this seemingly impartial medical tool intersected with preexisting social and cultural biases regarding syphilis its story became one of blood purity initiatives for the preservation and proliferation of white normativity. Reframing the Wassermann as more than a passive medical tool highlights how ostensibly impartial medical processes can produce institutional violence in masculinized spaces of control. While the Wassermann offered a source of hope for protecting against syphilitic infection, in application, the serodiagnostic tool served as a source of scientific validation when misapplied as a quantifiable method for justifying medicolegal interventions in the 20th century US. This examination traces the bioethical legacy of the Wassermann from its 1906 development in Berlin to its appearance in eugenics-based legal mandates in the US. Through an analysis of scientific publications and court records at archives across the East Coast this paper centers those who didn't benefit from the Wassermann and investigates how scientific authority derived from an imperfect diagnostic test was harnessed to reproduce and reinforce the sociocultural biases that linger today.

Committee: Kimberly Hamlin (Advisor); Madelyn Detloff (Committee Member); Amanda McVety (Committee Member) Subjects: American History; European History; Gender; History; Law; Medical Ethics; Medicine; Public Health; Science History; Technology; Womens Studies

MA, Kent State University, 2024, College of Arts and Sciences / Department of Philosophy

In this thesis, I evaluate substance abuse and the treatment of addicted persons through a lens of care ethics. The current policies in place focus on criminalization, which is largely ineffective at preventing and lowering rates of substance abuse. I use the relational definition of autonomy put forward by Onora O'Neill to analyze how addiction affects autonomy. I appeal to Stephanie Collins' four key claims of care ethics as the best ethical model to treat addiction using harm reduction policies.

Committee: Deborah Barnbaum (Advisor); Daniel Palmer (Committee Member); Polycarp Ikuenobe (Committee Member); Clare Stacey (Other) Subjects: Philosophy

Doctor of Philosophy, Case Western Reserve University, 2024, Bioethics

Clinical ethicists have become increasingly integrated at hospitals across the United States since the 1980s, prompting sustained efforts to professionalize the field of clinical ethics including the introduction of core competencies, a professional code of ethics, and a certification program. Despite these important milestones, the field still lacks a clear, unified scope of practice and discussions about the roles clinical ethicists ought to assume in health care are ongoing. Up until now, discourse has largely focused on what clinical ethicists can contribute to the health care environment; such a utility-based orientation to the efforts of clinical ethicists has resulted in the emotional impact of clinical ethics work on clinical ethicists going largely unrecognized. This dissertation establishes a foundational understanding of the emotional experiences of clinical ethicists, drawing on qualitative interviews with 34 clinical ethicists in the United States conducted between May and September of 2023 as well as a detailed conceptual analysis of burnout, moral injury, and moral distress as studied in other health professions. Results from this research suggest that clinical ethicists are assuming a significant emotional burden as a result of their clinical ethics work stemming from a variety of factors, including their regular exposure to ethically challenging situations, the variety of expectations placed on them by others, the diversity of the roles that they are playing in decisions regarding patient care, and the increasingly therapeutic nature of their work. Furthermore, the experiences of clinical ethicists are not sufficiently captured by existing terminology; this dissertation introduces the concept of secondary moral distress to describe the negative emotional impact that results from assuming a therapeutic role in a morally distressing situation. This work ultimately suggests that the burden assumed by these professionals is reason for significant concer (open full item for complete abstract)

Committee: Monica Gerrek (Committee Chair); Marsha Michie (Committee Member); Esther Bernhofer (Committee Member); Oliver Schirokauer (Committee Member); Mark Aulisio (Committee Member) Subjects: Ethics; Health Care; Medical Ethics; Medicine

Master of Arts, The Ohio State University, 2024, Bioethics

As technologies are developed and implemented at increasingly faster rates, an ethical assessment of human enhancement theory is warranted for the creation and efficacy of public health policy and medical practices. I will begin this assessment with a critique of one popular approach to ethical enhancement through the work of Allen Buchanan, who advocates for an ethics of development based on distributive justice, then I offer an ecofeminist ethics of care as an alternative way forward for the field of healthcare. At the root of an ethics of care is the concept of the human as a socially and ecologically embedded being, with shared dependencies and vulnerabilities. I will explore the implications of such a framing of humanity for the enhancement debate through the works of Chris J. Cuomo and Val Plumwood, then examine in vitro fertilization as a case study for the applicability of ecofeminist theory. In the end, I argue for a collaborative pursuit, despite the differences between these ethical methods, and call for further research in applying an ethics of care in the clinical enhancement setting.

Committee: Martin Fitzgerald (Committee Chair); Donal O'Mathuna (Committee Member); Dana Howard (Committee Member) Subjects: Biomedical Research; Ethics; Health; Health Care; Medical Ethics; Medicine; Philosophy; Public Health; Public Health Education; Public Policy

Doctor of Philosophy, Case Western Reserve University, 2024, Bioethics and Medical Humanities

Family caregivers are influential in medical decision-making for cancer patients, yet little is known regarding how they are included in clinical trial decisions. Clinical trial staff are responsible for informed consent in oncology trials and maintain ongoing contact with patients and caregivers, yet they are also overlooked in clinical trial decision-making research. This study fills this knowledge gap by eliciting perspectives from family caregivers and clinical trial staff, key stakeholders in clinical trial decision-making. The specific aims were: (1) to understand how family caregivers of patients with cancer conceptualize their role in clinical trial decision making, (2) to determine factors influential to family caregivers of patients with cancer during the clinical trial decision-making process, and (3) to identify attitudes, beliefs, and approaches used by clinical trial staff to navigate family caregiver involvement in the informed consent process for clinical trials. I conducted focus groups with 10 clinical trial staff and 9 caregivers of patients with cancer, then 15 caregivers participated in semi-structured interviews. Focus group data were used to refine interview guides for subsequent semi-structured interviews with caregivers. Transcripts were coded, then analyzed with NVivo using content analysis. Caregiver themes included promoting patient autonomy, influential factors, and burdens of trial participation. Trial staff themes were approaches to caregiver inclusion, caregiver utility for consent and adherence, and the need for training. Caregivers viewed their role as supporting patient understanding and deferring to the patient as final decision-maker. Hope for therapeutic benefit, oncologist endorsement, and practical barriers (e.g. cost, distance) were influential. Trial staff viewed caregivers as highly influential and relied on them to enhance patient understanding and adherence to the trial protocol. Staff experienced occasional challenges (open full item for complete abstract)

Committee: Sana Loue (Committee Chair); Jennifer Dorth (Committee Member); Barbara Daly (Committee Member); Mark Aulisio (Committee Member) Subjects: Medical Ethics; Oncology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2024, Philosophy

Advances in biomedical science have provided us with new and potent means of self-betterment that allow us to improve our capacities more quickly and effectively than ever before. I argue that these advances warrant a re-examination of our duties of self-improvement. My discussion of the ethics of enhancement has three primary objectives. First, I describe the duty of self-betterment and explain why biomedical enhancement is exceptionally well-suited to fulfill our duties of self-betterment Secondly, I compare hypothetical forms of biomedical enhancement to the practice of vaccination and argue that the arguments for our duty to be vaccinated are equally applicable to our duty to use other forms biomedical enhancement, especially when such enhancement helps us fulfill our Duty of Easy Rescue. Finally, I consider the impact that biomedical enhancement may have on the value of our achievements and respond to achievement-based objections to the use of biomedical enhancement. Ultimately, I conclude that biomedical enhancement is a reasonable, and sometimes required, means by which we can fulfill our duties of self-betterment, and deserves to be viewed more favorably in the future when considering means by which we might improve our capacities.

Committee: Sara Worley Ph.D. (Committee Chair); Neal Jesse Ph.D. (Other); Brandon Warmke Ph.D. (Committee Member); Michael Weber Ph.D. (Committee Member) Subjects: Ethics; Philosophy

Master of Arts, The Ohio State University, 2023, Bioethics

Biobanking research represents a nexus of forces that greatly complicate the accepted ethical norms and expectations of biomedical research. The longitudinal nature of biobanking research, the uncertainties involved in the research procedures and eventual outcomes and benefits, and the contested legal and ethical status of human biospecimens in research all serve to distinguish this type of research from more traditional research studies. The ethical principles of respect for persons and justice and the concept of trust in the biomedical research enterprise are connected in this research context in a novel way that blurs the barrier between these principles and ultimately affects the equity of outcomes in biobank research. Using John Rawls' original position thought experiment, mechanisms of governance to ensure fairness and equity are examined. Lastly, an examination of the case of Henrietta Lacks demonstrates the effects of research that does not respect participant autonomy and which delivers inequitable benefits and serves as evidence of the interconnectedness of respect for persons, justice, and trust.

Committee: Dana Howard (Advisor); Abraham Graber (Committee Member); Martin Fitzgerald (Committee Member) Subjects: Biomedical Research

Master of Arts, The Ohio State University, 2023, Bioethics

Biomedical progress raises ethical questions concerning the prolongation of life at any cost. This thesis focuses on Orthodox Christian perspectives on hastening patient death in . However, neither scriptures nor Orthodox Church tradition provides clear answers on when and how it is ethically permissible to discontinue medical procedures. Nor do local Orthodox churches' statements clarify these issues definitively. With the application of Orthodox teaching to medicine, life, and death, this study provides an ethical framework for resolving end-of-life issues. The overarching purpose of life according to Orthodoxy is to draw nearer to God and His kingdom, while the significance of physical ailment is the purification of one's heart for spiritual benefit. Moreover, in Orthodoxy, medicine should ultimately be targeted toward helping patients prepare spiritually for eternity, especially near the end of life. To apply such general Christian considerations to specific medical procedures, this thesis analyzes issues of hastening a patient's death through philosophical reflection. It argues that 1) if a health care professional initiates a new pathological path that causes a patient's death, he has killed the patient by active euthanasia; 2) if he refrains from saving a patient's life (by withholding or withdrawing available treatment) with the intention to kill, he kills the patient through passive euthanasia; 3) if he foregoes medically futile and burdensome treatment from a patient whom he judges to be dying, he merely removes a medical obstacle hindering that natural dying process. The crucial difference between forgoing treatment and passive euthanasia is the physician's intention, which may disclose itself via disappointment or relief because of the patient's unexpected survival after discontinuation of treatment. Thus, the general provisions of Orthodox bioethics concerning the hastening of a patient's death include 1) The prohibition against actively causing de (open full item for complete abstract)

Committee: Ryan Nash (Advisor); Matthew Vest (Committee Member); Nicole Shirilla (Committee Member) Subjects: Medical Ethics

Master of Arts, The Ohio State University, 2023, Bioethics

Healthcare professionals, patients, and their surrogates are confronted with situations when it is difficult to decide the right or best moral course of action in the clinical care of patients. The difficulty in resolving such situations leads to moral conflicts, which need to be resolved for the optimal care of patients. However, the optimal care of any patient requires more than just resolving a single conflicting situation because healthcare delivery is a dynamic system, which changes to respond to the changing needs of any patient. This means that providing optimal care for any single patient depends on all the factors necessary to sustain the human and material resources for optimal care. What are these factors? How can they be explored during clinical ethics consultation to achieve an outcome that satisfies the parties? What should be the outcome of clinical ethics consultation? Current literature showed a need for a standard instrument to evaluate the effectiveness of clinical ethics consultation. A conceptual framework for clinical ethics consultation using mediation and an ethical analysis based on respect for the dignity of human life was developed. The framework was compared with the traditional four-topic model recommended by Jonsen et al. for clinical ethics consultation for effectiveness or clarity of outcome. It was hypothesized that: In any clinical setting, an existential and discoverable mutual interest initiated the clinical relationship, and a clear appreciation of that mutual interest by the parties is required to resolve any moral conflict that arises. The discovery of the parties' mutual interest (common good) is the existential basis for a beneficial outcome in clinical ethics consultation. This project proposes a new model in clinical ethics consultation that can better address the challenges that are encountered in the care of patients from the beginning to the end of human life in clinical practice. The main challenges addressed a (open full item for complete abstract)

Committee: Nicole Shirilla MD (Committee Chair); Asma Mobin-Uddin MD (Committee Member); Dana Howard Ph. D. (Committee Co-Chair) Subjects: Medicine; Philosophy

Master of Arts in Medical Ethics and Humanities, Northeast Ohio Medical University, 2023, College of Graduate Studies

My thesis explores the concept of dual loyalties among military physicians and proposes a more thorough integration of virtue ethics in the military. The ethical principles and values embodied in virtue ethics theory align with the foundational mission and purpose of the military, but their implementation of the theory remains incomplete. The proposed framework for military medical ethics combines both virtue theory and duty-based ethics, with an emphasis on the former. While duty-based ethics are important, this framework recognizes the importance of virtuous character traits to help military physicians navigate dual loyalties. The aim is to ensure that duties are nested in a way that enables the actualization of moral virtues. By prioritizing the development of virtuous character traits, military physicians can better fulfill their duties in a manner that aligns with virtuous character. The military and medical profession share a commitment to ensuring that military physicians uphold high moral standards by being people of good character. Despite the military's appreciation for virtue ethics, there are instances where its application falls short which may be due to various factors like a lack of emphasis on character development in training or a focus on rules and regulations over virtuous conduct. My thesis seeks to create a more robust ethical framework for military medical ethics that combines duties, rules, and regulations with the development of virtuous character to prevent misconduct and distress among military physicians. By incorporating a more comprehensive virtue ethics theory into military medical ethics education and development, military physicians can develop a deeper understanding of how to act virtuously in challenging situations, even when the duties, rules, and regulations may not explicitly guide their behavior.

Committee: Julie Aultman Ph.D. (Advisor); Brian Harrell (Committee Member); Matthew Arbogast Ph.D. (Committee Member) Subjects: Ethics; Medical Ethics; Military Studies

Master of Arts, The Ohio State University, 2023, Bioethics

The duality of religion and secular ethics has been a recurrent theme for bioethicists and spiritual leaders alike. Numerous works describe a complex interplay between Jewish, Catholic, or Hindu beliefs and concrete bioethical situations. For example, how one treats the dead and dying will differ between those adhering to religious traditions and those who hold secular beliefs. In an attempt to palliate their views of the secular world, many religious bioethicists make the mistake of creating religious principles. Unfortunately, this paints an incomplete picture of the medical decision-making of religious and spiritual individuals and only serves to “ghettoize” religions within the larger sphere of bioethics. Likewise, Dr. Courtney S. Campbell, a member of the Church of Jesus Christ of Latter-day Saints and scholar, attempts to create a “Mormon” bioethics using the principles of love, hospitality, covenant, justice, and moral agency. I argue that this approach is inadequate for genuine ethical deliberation within the LDS community by using H.T. Engelhardt's method of critique. He posits that attempts to abase religion to bioethics do harm to that moral community by stripping it of its content and spiritual meaning. In doing so, I develop a framework that rejects principles and opts-for observations of doctrine and tradition that inform the real-life decisions of those belonging to the LDS faith. These observations stem from the Restoration, the Plan of Salvation, and specific laws and cultural norms like the Word of Wisdom. By the end, I will use LDS moral observations to justify members' decisions and beliefs in practical applications.

Committee: Matthew Vest (Advisor) Subjects: Medical Ethics; Religion

Doctor of Philosophy, The Ohio State University, 2023, Anatomy

Introduction: Human body donors play a crucial role in anatomical education, research, and clinical skills training. Those interested in anatomical donation may choose to bequeath their bodies to body donation programs (BDPs) housed by academic institutions across the country, state anatomical boards, or for-profit willed body programs. These programs rely heavily on the gift of body donors in order to continue to supply students and researchers with an invaluable educational resource. Despite recommendations from anatomical societies about best practices for BDPs, previous research has shown little uniformity or transparency throughout the donation consent process. While the literature contains numerous opinions from anatomists regarding whole body donation, the perspective of registered donors is underrepresented. The aim of this project was to assess current operations of BDPs across the United States and gather input from registered donors on the body donation process. Although previous research has focused on specific elements of donation, the current study focused on a comprehensive view of donation across the country in order to analyze trends, draw comparisons between programs, and evaluate the donor perspective. Methods: The data in this project was gathered through multiple Qualtrics surveys. The first survey was sent to 125 BDPs across the United States in order to gather information about the trends and protocols at these institutions, and 72 program leaders (57%) responded to the questionnaire. Descriptive statistics were analyzed to summarize the similarities and differences between programs. The second survey was sent to 2,145 individuals that were currently enrolled in The Ohio State University's BDP, and responses were received from 862 registered donors (40%). Results were analyzed to compute descriptive statistics and assess the relationship between demographics and survey responses. Results: Results from the first survey showed that collecti (open full item for complete abstract)

Committee: Claudia Mosley (Advisor); Joy Balta (Committee Member); Courtney Thiele (Committee Member); Derek Harmon (Committee Member); Dana Howard (Committee Member); Kirk McHugh (Committee Member) Subjects: Anatomy and Physiology; Ethics

Master of Arts, The Ohio State University, 2022, Bioethics

This project is a critique of the concept of consensus and its relation to secular moral reasoning. Proponents of public deliberation argue that achieving consensus is crucial to informing moral norms in secular pluralist societies. Without a transcendental basis for morality, ascribing authority to moral norms requires a process of deliberation. Many bioethicists are concerned with formulating ways to ensure discourse is tolerant, non-coercive, mutually respectful, and grounded in intersubjective understanding. The problem is that secular discourse is fraught with varying conceptions of human rights, ethical principles, and what constitutes a morally authoritative consensus. Bioethicists acknowledge the tyranny of the majority problem, but secularism lacks a sufficient rationale to identify when a majority is wrong. Since competing visions of the good comprise bioethics and consensus does not necessarily indicate moral truth, moral uncertainty is the logical result of secular pluralism. Some moral scientists argue that science can inform moral norms, but a careful reading of their work suggests that what is being espoused is moral nihilism. From determinism to deep pragmatism, many scientists are inadvertently supporting a view of reality that obliterates the possibility of values. In secular pluralist societies, consensus is required to establish basic norms, but no account of consensus can indicate when moral truth is known. Consensus is necessary to fulfill the visions of moral scientists, but such scientists implicitly endorse nihilism. What secularists are discovering – by their own reasoning – is that moral truth is elusive, science cannot inform human values, and bioethical dilemmas are incapable of being resolved. The conclusion to this project offers an Engelhardtian solution. Not only is the principle of permission the only viable basis for secular pluralism – the principle coincides with moral scientists' own account of human nature.

Committee: Matthew Vest (Advisor); Ryan Nash (Committee Member); Ashley Fernandes (Committee Member) Subjects: Ethics; Philosophy; Philosophy of Science

Master of Science, The Ohio State University, 2022, Anatomy

Utilization of human tissue to enhance anatomical education dates back to 3rd century B.C. However, the work done with human tissue has altered overtime along with the acquisition of deceased human bodies. The establishment of body donation programs has begun an era of body donation and has influenced the work done with human tissue. In this study we aim to investigate the work supported by human body donors at academic institutions in the United States. We analyzed ethical oversight of the utilization of these donors and the preparation methods that these institutions employ to maximize the work completed with human body donors. A questionnaire using Qualtrics was sent to 125 body donation programs in the United States, and 69 institutions completed the questionnaire. The data reveals that these body donation programs across the United States work with human body donors in teaching, clinical skills training, research, and outreach while using a wide range of preparation methods. From this data sample, 91.3% of the institutions utilize a hard fixation preparation method, 34.8% utilize a soft preservation method, and 40.6% work with unembalmed body donors. Amongst the body donors undergoing a hard fixation, 88% are utilized for anatomical teaching whereas unembalmed and soft preserved body donors are primarily utilized for clinical skills training. Lastly, 39% of the institutions allow individuals to work with human body donors to teach the public in outreach and continuing education settings. The institutions represented in this data also provided insight on ethical approval processes established at each institution. The data shows only 60% of the institutions have an ethical approval process for conducting research on human body donors. While only 49.3% of oversight committees amongst these institutions contain individuals outside of the program's faculty and staff. Furthermore, 88% of the surveyed institutions, allow faculty and staff to take photographs of (open full item for complete abstract)

Committee: Joy Balta (Advisor); Eilleen Kalmar (Committee Member); Claudia Mosley (Committee Member) Subjects: Anatomy and Physiology; Education; Ethics

Master of Arts, The Ohio State University, 2021, Bioethics

The medical management of intersex persons focuses primarily on forms over functions, with limited attention paid to the futurity for these individuals through reproductive capabilities and fertility preservation. Some types of intersex conditions preclude reproductive or preservation options, while other impediments to these capacities stem from surgical interventions to address malignancy risks or from sexual assignment procedures. There is clear documentation for general medical management, debates on the ethical implications of sex assignment interventions, as well as some addressment for fertility preservation options for post-pubertal individuals. Absent is inquiry into medicine's relationship with intersex futures, and this paper seeks to delve into the driving influences of socio-cultural norms that direct intersex medical interventions. Specifically, I ask what, if any, obligation does medicine have to intersex futurity. By interrogating conceptions of proxy decision-making on open futures, noting hegemonic norms that direct collective understanding, and challenging these norms through queer, disability, and crip perspectives, I have presented the conversations that are being had as well as highlighting the ones that are still needed. Acceptance of fallibility and contributing unknowns gives space to confront responsibilities and obligations, re-evaluating engagement with the norms behind ethical decision making.

Committee: Dana Howard (Advisor); Courtney Thiele (Committee Member); Jordan Brown (Committee Member) Subjects: Ethics; Gender Studies

Master of Arts, The Ohio State University, 2020, Bioethics

Secular bioethicists such as Ronit Stahl and Ezekiel Emmanuel (among others) look at controversial issues such as abortion and reproductive health and have declared that consensus has been reached. Those who disagree are told that if they cannot sacrifice their consciences, they should sacrifice their careers. They assert that people who agree to enter the field of medicine are bound by the decisions of various medical societies, even ones they do not belong to. It is those societies alone who will determine what it means to be a physician. But what happens if conscience is removed from the moral equation and ceded to a medical society? While there are limits to conscientious objection where there is imminent risk of injury or death, the cleansing from the practice of medicine of persons who have moral objections would harm not only physicians and the medical profession, but most importantly, harm patients. First, the impact of the removal of conscience will be decidedly negative. Physicians will know that they cannot be trusted based on their own moral values, that even their own medical societies don't trust them. They can be forced to act against their conscience without any evidence than what they were doing is causing anything more than subjective patient disagreement or inconvenience. Stahl and Emmanuel's argument would claim that health care professionals are to do whatever the bureaucracy of medicine tells them to do as long, as it satisfies the demands of the patients. Physicians must submit to the paternalism of external agents. Second, the limitations on conscience in medicine. While the legal protections are beyond the scope of this paper, there needs to be an ethical evaluation of the conditions for limitations. I will defend Daniel Sulmasy's view that treatment should be provided in an emergency as defined as imminent risk of actual illness or injury and, if there are objections to what is provided by the objector, it should be evidence based, n (open full item for complete abstract)

Committee: Ashley Fernandes (Committee Chair); Courtney Thiele (Advisor); Ryan Nash (Committee Member) Subjects: Ethics

Master of Arts, The Ohio State University, 2020, Bioethics

Since the turn of the century, disaster and humanitarian research, as well as the ethics of its conduct, is an increasingly important endeavor. The interdisciplinary knowledge acquired from disaster research concretely contributes to a plethora of societal benefits, such as development of emergency response and preparedness policies, improvement of both physical structures and social infrastructures, and effective distribution of valuable humanitarian aid. Human subject research in the health and human sciences is especially valuable as it highlights the detrimental effects of disasters on individuals and communities who are often made vulnerable or whose existing vulnerabilities or inequities are further exacerbated. It is a unique and intrinsic feature of disasters that, while they can be environmental (i.e., a natural disaster or chemical spill) or humanitarian (i.e., a war conflict or a water crisis), they are ultimately rooted in a human-made cause. With this conceptual framework, disaster research involving human subjects bears an ethical duty to ensure the data contribute beneficially to not only future populations but to surviving individuals, communities, and their social spheres, as well. If the benefits of this research are clear, and the risks of participation can be properly mitigated, then an ethical concern arises when certain populations or individuals are excluded from disaster research, as is the case with children. For despite the increasing amount of disaster research including children, an obvious dearth of studies examining the effects of disasters on children in long-term follow up is evident, particularly concerning what interventions are effective at mitigating negative mental health and well-being consequences. This gap in knowledge does not align with the well-founded fact that disasters, a majority of which are humanitarian crises, uniquely affect children due to their developing capacities and the traumatic nature of these envi (open full item for complete abstract)

Committee: Dana Howard (Advisor); Thiele Courtney (Committee Member); Zadnik Karla (Committee Member) Subjects: Ethics; Health Sciences

Master of Arts, The Ohio State University, 2020, Bioethics

This thesis argues that the right to die should be understood as an attempt to palliate nihilism due to the encounter of an existentially impoverished ontology with death, informing clinical, ethical, and political accounts of physician aid-in-dying. Following Heidegger's critique of technology, contemporary medicine espouses a Nietzschean metaphysic predicated upon reducing its objects into `standing reserves' on call for efficient manipulation. Physicians become passive, anonymous technicians responding to technological frameworks, bodies become resources for maintenance and re-creation, and death appears an obstacle to overcome in this active nihilism. In this context, the birth of bioethics can be appreciated as a response to the hegemony of techno-logic at the end of life. I argue, however, that it has largely failed by capitulating to a similar procedural rationality, at best, and endorsing autonomy as a manifestation of the will to power at worst. After the death of God, ethics must be radically reframed as a human project resembling a cafeteria of lifestyle aesthetics where the moral good easily becomes free choice. The liberated, autonomous individual playing a leading role fits hand in glove with techno-logic. Thus, assisted suicide may appear as a personal `death-style' for fashioning the illusion of meaning and transcendence by the will, particularly in the post-Christian, generic spirituality of hospice and palliative care. Patients with existential or spiritual suffering – lives not worth living – can be relieved of the human condition within liberal politics, signifying new, deceptive rites for the end of life, an ars ad mortem. At the end of the day, however, the choice for suicide is predestined by the techno-logic critiqued in this thesis, suggesting that it may not, in fact, be the triumph of autonomy but rather of a violent nihilism and despair. This critique, then, moves towards clarity in the right to die movement regarding its quasi-religio (open full item for complete abstract)

Committee: Matthew Vest PhD (Advisor); Ryan Nash MD (Committee Member); Dana Howard PhD (Committee Member) Subjects: Medical Ethics; Philosophy; Philosophy of Science

Psy. D., Antioch University, 2020, Antioch Seattle: Clinical Psychology

Stigma toward individuals with eating disorders is common and well-documented. Individuals with eating disorders regularly report experiencing stigma associated with perceptions that they are to blame for their illness, that their illness is trivial compared to other conditions, or that they are engaging in disordered behavior to gain attention. These stigmatizing attitudes toward eating disorders are also reported by the general public and healthcare professionals, including those who treat eating disorders. Treatment of these illnesses at all levels of care often include paternalistic approaches such as coercion and compulsion that can have both adverse and advantageous consequences. While there are ethical, clinical, and legal justifications for these treatment approaches, this study provides a novel exploration of the relationships between stigma toward individuals with eating disorders and coercive and compulsive treatment. This was accomplished using a survey methodology to assess the attitudes and treatment practices of treatment providers across the United States. The results of this study suggest that there is no significant relationship between treatment providers' attitudes toward individuals with eating disorders and coercive or compulsive treatment methods. Implications for clinical practice and future research are discussed and center on the need for additional inquiry to better understand the complexities of these two variables in light of the ongoing debate concerning the risks and v benefits of coercive and compulsive treatment. This dissertation is available open access at AURA, http://aura.antioch.edu and Ohio Link ETD Center, https://etd.ohiolink.edu

Committee: Chris Heffner Psy.D., Ph.D. (Committee Chair); Shannon Albert Psy.D. (Committee Member); Cara Dalbey Psy.D. (Committee Member) Subjects: Behavioral Sciences; Clinical Psychology; Ethics; Health Care; Mental Health; Psychology; Quantitative Psychology; Social Psychology

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2020, Philosophy, Applied

This dissertation puts forth the structured principlist framework, a practicable moral framework for guiding practioners' thinking in a diverse healthcare setting and grounding accepted healthcare practices and policies. This novel moral framework builds upon on the work of Tom Beauchamp and James Childress in Principles of Biomedical Ethics, reorganizing the four primary bioethical principles – respect for autonomy, beneficence, non-maleficence, and justice – into two necessary and jointly-sufficient conditions for the permissibility of an action: The enabling condition, incorporating the deontic principles of respect for autonomy and justice, requires that a proposed action be authorized by the patient or proxy and adhere to current hospital policies & procedures. The favorability condition, incorporating the consequentialist principles of beneficence and non-maleficence, requires that the proposed action be reasonably expected to promote the health of the patient. In normative terms, the structured principlist framework is best described as a pluralistic framework that contains consequentialist considerations yet maintains deontic constraints. This structured framework was developed in response to several criticisms leveled against Beauchamp and Childress's traditional principlist framework, ultimately capturing the benefits of bioethical principlism while providing a simplified, more guiding, and less capricious framework than the traditional framework. I argue for the structured principlist framework by demonstrating its usefulness when working through ethical conflicts at the clinical level as well as when formulating healthcare policies.

Committee: Michael Weber Dr. (Advisor); Lynn Darby Dr. (Other); John Basl Dr. (Committee Member); Molly Gardner Dr. (Committee Member) Subjects: Ethics; Medical Ethics; Philosophy