“I will not die that way. Why should I be forced to?” : Brittany Maynard’s story in the campaign for assisted dying, a narrative perspective

Physician-assisted dying in the United States, where a terminally ill person that fulfils certain criteria can be prescribed a substance to end their life, is legal in eight states as well as in Washington D.C. Advocacy organizations have played a central role in getting legislation passed. The state of Oregon, where the practice has been legal for over 20 years, serves as a model for legislation that is being proposed in other states. The advocacy organization Compassion & Choices, based in Portland, Oregon has been central in framing the issue of assisted dying in the United States. In 2014, Compassion & Choices released a video featuring the story of a young woman named Brittany Maynard who was dying of brain cancer. The video went viral and was viewed over 9 million times in the month after being released, making Maynard the face of assisted dying in the United States. In this thesis I examine her story through narrative analysis as it is told in the campaign video and in three other videos released after the first one. Two of the videos in the material were released after Maynard’s death and in them the story is told by Maynard’s husband Dan Diaz, who has actively continued campaigning for assisted dying. The aim of this thesis is to examine how advocacy organizations such as Compassion & Choices use personal stories to get attention for their cause and try to influence policy. The content of Maynard’s personal story, how it is told, and how the story is connected to arguments for assisted dying is analyzed through narrative methods. The results show that family values and an active lifestyle are emphasized in the narrative. The story alternates between statements presented as facts and personal experiences that are more emotional. The main arguments for legalization that are made in the videos are related to autonomy and personal choice and to avoiding unnecessary suffering. The personal experiences of Maynard are related to these arguments through how the story is told through speech, text and pictures. Strategies to frame the policy issue in a certain way and get the audience to identify with Maynard are also employed.Assisterad död (eng. assisted dying) i USA, där en döende person som uppfyller vissa kriterier kan få ett recept på läkemedel för att avsluta sitt liv, är lagligt i åtta delstater samt i Washington D.C. Intresseorganisationer har spelat en central roll i lagstiftningen relaterad till dödshjälp. Oregon, där dödshjälp varit lagligt över 20 år, har fungerat som en modell för lagstiftningen i andra delstater. Intresseorganisationen Compassion & Choices som har sitt huvudkontor i Portland, Oregon, har lyckats väl med att influera hur assisterad död uppfattas i USA. År 2014 publicerade Compassion & Choices en video där en ung kvinna som var döende i cancer, Brittany Maynard, delade sin historia. Videon fick stor uppmärksamhet och sågs inom en månad över 9 millioner gånger. Maynard blev känd i hela USA som en representant för assisterad död. I den här avhandlingen undersöker jag hennes historia genom narrativ analys. Materialet består utöver kampanjvideon av tre andra videon där Maynards historia berättas. Två av dessa videor publicerades efter Maynards död och i dem är det hennes man, Dan Diaz, som berättar hennes historia. Diaz har aktivt efter Maynards bortgång fortsatt kampanjen för att assisterad död ska legaliseras. Målet med denna avhandling är att undersöka hur organisationer som Compassion & Choices använder sig av personliga historier för att skapa uppmärksamhet för sin sak och för att försöka påverka politiskt beslutsfattande. I centrum för analysen, som görs genom narrativa metoder, står innehållet i Maynards historia samt hur historien berättas och hur narrativet anknyts till argument som stöder legalisering. Resultaten visar att familjevärderingar och värderingar om en aktiv livsstil understryks i narrativet. Berättelsen växlar mellan fakta och personliga upplevelser som är mer emotionella. De huvudargument för legalisering som presenteras är argument relaterade till autonomi och rätten att välja samt argument om att undvika onödigt lidande. Maynards personliga upplevelser kopplas till dessa argument genom hur historien berättas i tal, text och bilder. Materialet innehåller också strategier för att framställa den politiska frågan på ett visst sätt och få publiken att känna solidaritet med Maynard

Advancing the 3Rs: innovation, implementation, ethics and society

The 3Rs principle of replacing, reducing and refining the use of animals in science has been gaining widespread support in the international research community and appears in transnational legislation such as the European Directive 2010/63/EU, a number of national legislative frameworks like in Switzerland and the UK, and other rules and guidance in place in countries around the world. At the same time, progress in technical and biomedical research, along with the changing status of animals in many societies, challenges the view of the 3Rs principle as a sufficient and effective approach to the moral challenges set by animal use in research. Given this growing awareness of our moral responsibilities to animals, the aim of this paper is to address the question: Can the 3Rs, as a policy instrument for science and research, still guide the morally acceptable use of animals for scientific purposes, and if so, how? The fact that the increased availability of alternatives to animal models has not correlated inversely with a decrease in the number of animals used in research has led to public and political calls for more radical action. However, a focus on the simple measure of total animal numbers distracts from the need for a more nuanced understanding of how the 3Rs principle can have a genuine influence as a guiding instrument in research and testing. Hence, we focus on three core dimensions of the 3Rs in contemporary research: (1) What scientific innovations are needed to advance the goals of the 3Rs? (2) What can be done to facilitate the implementation of existing and new 3R methods? (3) Do the 3Rs still offer an adequate ethical framework given the increasing social awareness of animal needs and human moral responsibilities? By answering these questions, we will identify core perspectives in the debate over the advancement of the 3Rs

Antioxidant airway responses following experimental exposure to wood smoke in man

Background: Biomass combustion contributes to the production of ambient particulate matter (PM) in rural environments as well as urban settings, but relatively little is known about the health effects of these emissions. The aim of this study was therefore to characterize airway responses in humans exposed to wood smoke PM under controlled conditions. Nineteen healthy volunteers were exposed to both wood smoke, at a particulate matter (PM2.5) concentration of 224 +/- 22 mu g/m(3), and filtered air for three hours with intermittent exercise. The wood smoke was generated employing an experimental set-up with an adjustable wood pellet boiler system under incomplete combustion. Symptoms, lung function, and exhaled NO were measured over exposures, with bronchoscopy performed 24 h post-exposure for characterisation of airway inflammatory and antioxidant responses in airway lavages. Results: Glutathione (GSH) concentrations were enhanced in bronchoalveolar lavage (BAL) after wood smoke exposure vs. air (p = 0.025), together with an increase in upper airway symptoms. Neither lung function, exhaled NO nor systemic nor airway inflammatory parameters in BAL and bronchial mucosal biopsies were significantly affected. Conclusions: Exposure of healthy subjects to wood smoke, derived from an experimental wood pellet boiler operating under incomplete combustion conditions with PM emissions dominated by organic matter, caused an increase in mucosal symptoms and GSH in the alveolar respiratory tract lining fluids but no acute airway inflammatory responses. We contend that this response reflects a mobilisation of GSH to the air-lung interface, consistent with a protective adaptation to the investigated wood smoke exposure

Controlled Exposures to Air Pollutants and Risk of Cardiac Arrhythmia

BACKGROUND: Epidemiological studies have reported associations between air pollution exposure and increases in cardiovascular morbidity and mortality. Exposure to air pollutants can influence cardiac autonomic tone and reduce heart rate variability, and may increase the risk of cardiac arrhythmias, particularly in susceptible patient groups. OBJECTIVES: We investigated the incidence of cardiac arrhythmias during and after controlled exposure to air pollutants in healthy volunteers and patients with coronary heart disease. METHODS: We analyzed data from 13 double-blind randomized crossover studies including 282 participants (140 healthy volunteers and 142 patients with stable coronary heart disease) from whom continuous electrocardiograms were available. The incidence of cardiac arrhythmias was recorded for each exposure and study population. RESULTS: There were no increases in any cardiac arrhythmia during or after exposure to dilute diesel exhaust, wood smoke, ozone, concentrated ambient particles, engineered carbon nanoparticles, or high ambient levels of air pollution in either healthy volunteers or patients with coronary heart disease. CONCLUSIONS: Acute controlled exposure to air pollutants did not increase the short-term risk of arrhythmia in participants. Research employing these techniques remains crucial in identifying the important pathophysiological pathways involved in the adverse effects of air pollution, and is vital to inform environmental and public health policy decisions

Photocatalytic Decomposition of Formic Acid on Mo2C-Containing Catalyst

Soluble components in the peripheral blood from experimental exposure of 14 healthy subjects to filtered air and wood smoke. Samples were collected before (pre), at 24 h and 44 h after exposure, to air and wood smoke. Data are given as medians with interquartile range. (DOCX 62 kb

Epithelial IL-6 trans-signaling defines a new asthma phenotype with increased airway inflammation

Background: Although several studies link high levels of IL-6 and soluble IL-6 receptor (sIL-6R) to asthma severity and decreased lung function, the role of IL-6 trans-signaling (IL-6TS) in asthmatic patients is unclear. Objective: We sought to explore the association between epithelial IL-6TS pathway activation and molecular and clinical phenotypes in asthmatic patients. Methods: An IL-6TS gene signature obtained from air-liquid interface cultures of human bronchial epithelial cells stimulated with IL-6 and sIL-6R was used to stratify lung epithelial transcriptomic data (Unbiased Biomarkers in Prediction of Respiratory Disease Outcomes [U-BIOPRED] cohorts) by means of hierarchical clustering. IL-6TS-specific protein markers were used to stratify sputum biomarker data (Wessex cohort). Molecular phenotyping was based on transcriptional profiling of epithelial brushings, pathway analysis, and immunohistochemical analysis of bronchial biopsy specimens. Results: Activation of IL-6TS in air-liquid interface cultures reduced epithelial integrity and induced a specific gene signature enriched in genes associated with airway remodeling. The IL-6TS signature identified a subset of patients with IL-6TS-high asthma with increased epithelial expression of IL-6TS-inducible genes in the absence of systemic inflammation. The IL-6TS-high subset had an overrepresentation of frequent exacerbators, blood eosinophilia, and submucosal infiltration of T cells and macrophages. In bronchial brushings Toll-like receptor pathway genes were upregulated, whereas expression of cell junction genes was reduced. Sputum sIL-6R and IL-6 levels correlated with sputum markers of remodeling and innate immune activation, in particular YKL-40, matrix metalloproteinase 3, macrophage inflammatory protein 1 beta, IL-8, and IL-1 beta. Conclusions: Local lung epithelial IL-6TS activation in the absence of type 2 airway inflammation defines a novel subset of asthmatic patients and might drive airway inflammation and epithelial dysfunction in these patients.Peer reviewe

Epithelial IL-6 trans-signaling defines a new asthma phenotype with increased airway inflammation

Background: Although several studies link high levels of IL-6 and soluble IL-6 receptor (sIL-6R) with asthma severity and decreased lung function, the role of IL-6 trans-signaling (IL-6TS) in asthma is unclear. Objective: To explore the association between epithelial IL-6TS pathway activation and molecular and clinical phenotypes in asthma. Methods: An IL-6TS gene signature, obtained from air-liquid interface (ALI) cultures of human bronchial epithelial cells stimulated with IL-6 and sIL-6R, was used to stratify lung epithelium transcriptomic data (U-BIOPRED cohorts) by hierarchical clustering. IL-6TS-specific protein markers were used to stratify sputum biomarker data (Wessex cohort). Molecular phenotyping was based on transcriptional profiling of epithelial brushings, pathway analysis and immunohistochemical analysis of bronchial biopsies. Results: Activation of IL-6TS in ALI cultures reduced epithelial integrity and induced a specific gene signature enriched in genes associated with airway remodeling. The IL-6TS signature identified a subset of IL-6TS. High asthma patients with increased epithelial expression of IL-6TS inducible genes in absence of systemic inflammation. The IL-6TS High subset had an overrepresentation of frequent exacerbators, blood eosinophilia, and submucosal infiltration of T cells and macrophages. In bronchial brushings, TLR pathway genes were up-regulated while the expression of tight junction genes was reduced. Sputum sIL-6R and IL-6 levels correlated with sputum markers of remodeling and innate immune activation, in particular YKL-40, MMP3, MIP-1β, IL-8 and IL-1β. Conclusions: Local lung epithelial IL-6TS activation in absence of type 2 airway inflammation defines a novel subset of asthmatics and may drive airway inflammation and epithelial dysfunction in these patients

Effect of wood smoke exposure on vascular function and thrombus formation in healthy fire fighters

Background: Myocardial infarction is the leading cause of death in fire fighters and has been linked with exposure to air pollution and fire suppression duties. We therefore investigated the effects of wood smoke exposure on vascular vasomotor and fibrinolytic function, and thrombus formation in healthy fire fighters. Methods: In a double-blind randomized cross-over study, 16 healthy male fire fighters were exposed to wood smoke (~1 mg/m3 particulate matter concentration) or filtered air for one hour during intermittent exercise. Arterial pressure and stiffness were measured before and immediately after exposure, and forearm blood flow was measured during intra-brachial infusion of endothelium-dependent and -independent vasodilators 4–6 hours after exposure. Thrombus formation was assessed using the ex vivo Badimon chamber at 2 hours, and platelet activation was measured using flow cytometry for up to 24 hours after the exposure. Results: Compared to filtered air, exposure to wood smoke increased blood carboxyhaemoglobin concentrations (1.3% versus 0.8%; P &lt; 0.001), but had no effect on arterial pressure, augmentation index or pulse wave velocity (P &gt; 0.05 for all). Whilst there was a dose-dependent increase in forearm blood flow with each vasodilator (P &lt; 0.01 for all), there were no differences in blood flow responses to acetylcholine, sodium nitroprusside or verapamil between exposures (P &gt; 0.05 for all). Following exposure to wood smoke, vasodilatation to bradykinin increased (P = 0.003), but there was no effect on bradykinin-induced tissue-plasminogen activator release, thrombus area or markers of platelet activation (P &gt; 0.05 for all). Conclusions: Wood smoke exposure does not impair vascular vasomotor or fibrinolytic function, or increase thrombus formation in fire fighters. Acute cardiovascular events following fire suppression may be precipitated by exposure to other air pollutants or through other mechanisms, such as strenuous physical exertion and dehydration.Originally included in thesis in manuscript form.</p

Teckenspråkiga barns och ungas kultur i vardagslivet : En fenomenologisk intervjustudie

Teckenspråkig barnkultur och teckenspråkiga barns kulturupplevelser har hittills inte beforskats inom det barnkulturella ämnesfältet. Teckenspråkiga barns rätt till konst, kultur och språk fastslås i flera svenska lagar: barnrättskonventionen, språklagen och bibliotekslagen. Trots det visar tidigare forskning och studier på försvagad eller utebliven implementering av dessa lagar i det offentliga kulturlivet; döva barn och barn med hörselnedsättning ges inte längre möjlighet att lära sig, anända och utveckla svenskt teckenspråk och det offentliga kulturlivet brister i teckenspråkig verksamhet för teckenspråkiga barn och unga och deras familjer. En fenomenologisk intervjustudie har genomförts med tio teckenspråkiga barn / unga vuxna för att undersöka deras egna perspektiv på kulturupplevelser i vardagslivet. Studien visar att teckenspråkiga barn och unga har gemensamt att de väljer kulturella sammanhang och miljöer där jämställda kommunikationsvillkor råder. De upplever med stigande ålder ett successivt ökande utanförskap i talspråkiga miljöer och kultursammanhang. Teckenspråkiga barn intresserar sig för eget kulturutövande men få har kännedom om Kulturskolans verksamhet. Kulturen kan i viss mån möjliggöra möten mellan teckenspråkiga och icke teckenspråkiga barn och vuxna. En grundläggande förutsättning är visuell tillgänglighet och teckenspråkig kommunikation förenat med öppenhet, respekt och intresse för det teckenspråkiga barnet. Med ett multicentriskt perspektiv kan samhället förstå svenskt teckenspråk som en berikande möjlighet.