Kimberly Vargas Barreto

Antibiotic resistance remains a significant public health concern. One possible solution is to develop a new type of highly accessible test for antibiotic resistance that can be rapidly and easily utilized. As new diagnostics for measuring antibiotic resistance continue to be developed, several key practical, ethical, and social factors must be considered, including the types of tests that might be useful, their potential beneficiaries, and the contexts in which they should be utilized. This study aims to gather insights from key stakeholders regarding the ethical implications, benefits, and potential risks associated with a hypothetical rapid antibiotic resistance test that may also be designed for home use. A total of 32 semi structured interviews were conducted with three stakeholder groups: potential users, medical providers, and ethicists. While prospective users of the test were generally positive about the proposed test, this might reflect public acceptance of point of care/home tests in general, rather than one specifically measuring ABR. Medical providers and experts knowledgeable about the problems of antibiotic overuse quickly pointed out some drawbacks and areas of concern for home testing for ABR, offering helpful guidance on where further research and consideration are needed.

Intersectionality in healthcare ethics has gained some necessary traction in the last five years. Yet, there is still work ahead. In this article, I review some of the recent work on intersectionality in healthcare ethics and argue that any successful account of intersectionality in the field ought to consider three essential amendments: 1) it must hold a relational account of autonomy, 2) center loving narrativity, and 3) demonstrate a commitment to social justice. I argue how these amendments can be pursued and integrated through well-established feminist accounts, like care ethics and narrative ethics. Thus, concluding that feminist accounts of bioethics have laid a stronger foundation than competing accounts for the integration of intersectionality’s core principles into healthcare ethics.

There has been a growing literature on exposome and environmental health-related research, public acceptance, and understanding of ecological health-related testing; however, it has remained underexplored, especially in the context of rapid testing. This study aims to fill this gap by gathering insights into what key stakeholders see as the primary ethical implications, benefits, and possible risks of environment-related tests. 32 interviews were conducted with potential users, medical providers, and ethicists, asking them about their perceptions of environment-related testing, who would benefit most from the research, and if these tests might detract focus from other, directly relevant health-related factors. The study found that the main concerns among these stakeholders include test reliability, the need for tests where the ecological factor being tested has a proven causality for human health, the possibility for individuals or communities to achieve change based on the test results, and the need for tests that foster social justice.

Despite the vast number of cultures and peoples that reside in the West, ethical action in bioethics is determined through the perspective of la Totalidad, which does not include the Other or individuals from the periphery. In my dissertation, I argue that the universalization of U.S. clinical bioethics (la bioética estadounidense) and the coloniality of knowledge that extends from it are, at its core, imperialistic in nature and result in the exclusion of patients with intersectional identities. While clinical bioethics was first conceived as a critical tool for medicine, the acceptance of principlism as the central theory in the field and its moral foundation in the “common morality” has severely reduced the critical aspect of clinical bioethics. Using a case analysis, I demonstrate principlism's weaknesses in addressing the complexities that arise from marginalized identities. Instead, I propose a more comprehensive and suitable framework for clinical bioethics, a feminist and Dusselian Agapean framework, which can address patients at both the center and the periphery of bioethics. Synthesizing the critical work of feminist bioethicists and Latin American philosophers through the ethics of liberation and Intervention Bioethics, I develop a practical approach that is more inclusive and successful than principlism. The Agapean framework holds Dusselian agape as its material principle and maintains the protection of the worst off in society and the prevention of possible harm through the centralization of relational autonomy, playful narrativity, a need for advocacy, and social justice through equal participation. Using this approach, I address the coloniality of power and gender found in our way of producing knowledge in clinical bioethics. This dissertation fills a gap in the field by addressing the colonial aspects of mainstream bioethics and proposing a needed alternative. Moreover, by providing English translations to critical passages from Spanish and Portuguese bioethics texts, it shines a light on voices from the periphery, which have been traditionally invisibilized.