Medicine and Health Sciences Commons^™

Conscientious Objection: Understanding When And Why Primary Care Physicians Object To Providing Health Care To Transgender And Gender-Diverse Patients In An Appalachian Medical Center, Mili S. Patel, Kelley A. Jones, Laura Davisson, Elizabeth Miller, Nicole Kahn, Pamela J. Murray, Kacie M. Kidd

Journal of Appalachian Health

Introduction: Transgender and gender-diverse (TGD) individuals face barriers to accessing primary and gender-affirming care, especially in rural regions where a national shortage of medical providers with skills in caring for TGD people is further magnified. This care may also be impacted by individual providers’ strongly held personal or faith beliefs and associated conscientious objection to care.

Purpose: This study assesses the prevalence of conscientious objection to providing care and gender-affirming hormone (GAH) therapy to TGD individuals among physicians in an Appalachian academic medical center.

Methods: An anonymous, online, cross-sectional survey of physicians was distributed to resident and faculty physicians in …

Redefining Paternalistic Practices In Women’S Health: How Dysfunctional Trust Relationships Impact Medical Autonomy Of Female Patients In The Contemporary Clinical Setting, Lauren K. O'Dell

Theses and Dissertations--Philosophy

Utilizing Trudy Govier’s (1997) conception of social trust, this dissertation will provide a framework for understanding trust in healthcare relationships and highlight some of the ways that unequal power distribution and dependency, poorly defined roles, and institutions complicate trust between women and their providers. This framework will also explain how distrust, especially prejudicial distrust, leads to paternalistic attitudes on the part of providers. Paternalism limits patient autonomy because medical autonomy is constitutively relational. This means that insofar as distrust causes paternalism, it also damages autonomy. Through negative outcomes, this lack of autonomy can cause patients to distrust healthcare, which can …

Hospital Nurses' Moral Distress And Coping During Covid-19: A Pilot Study, Abigail Latimer

Theses and Dissertations--Social Work

The COVID-19 pandemic caused a wave of critically ill patients, overwhelming hospitals, and creating unprecedented conditions for hospital employees, particularly bedside nurses. Concerns about the emotional and mental well-being of nurses have already been raised prior to the pandemic and depression, anxiety, and PTSD symptoms among nurses during the pandemic have been observed. Given the increased infection and safety risks, staffing shortages, inadequate personal protective equipment and resources, and hospital restrictions causing many nurses to be patients’ only support, there is also a growing concern about how these institutional and personal restrictions to providing best care and practicing ethically have …

Towards A Holistic Risk Model For Safeguarding The Pharmaceutical Supply Chain: Capturing The Human-Induced Risk To Drug Quality, Heather R. Campbell

Theses and Dissertations--Pharmacy

Counterfeit, adulterated, and misbranded medicines in the pharmaceutical supply chain (PSC) are a critical problem. Regulators charged with safeguarding the supply chain are facing shrinking resources for inspections while concurrently facing increasing demands posed by new drug products being manufactured at more sites in the US and abroad. To mitigate risk, the University of Kentucky (UK) Central Pharmacy Drug Quality Study (DQS) tests injectable drugs dispensed within the UK hospital. Using FT-NIR spectrometry coupled with machine learning techniques the team identifies and flags potentially contaminated drugs for further testing and possible removal from the pharmacy. Teams like the DQS are …

Child And Parent Perceptions Of Participating In Multimethod Research In The Acute Aftermath Of Pediatric Injury, Christine Kindler, Nancy Kassam-Adams, Tia Borger, Meghan L. Marsac

Pediatrics Faculty Publications

Background:

Despite growing evidence that participation in psychological trauma research is well tolerated by children and parents, ethics boards may voice concerns regarding research with families with recent acute trauma exposure. Factors impacting child and parent experiences of research participation are not well documented, particularly for methodologies including observational components.

Objectives:

This study describes child and parent perceptions of research participation involving an observational task following an acute traumatic event and explores potential relationships between research experience and selected demographic factors (race/ethnicity, sex, age, prior trauma exposure), and post-traumatic stress symptoms.

Methods:

As part of a larger study on the …

Promoting Cognitive Conflict In Health Care Ethics: Moral Reasoning With Boundary Cases, Julia Bursten, Samantha Finkelstein

Philosophy Faculty Publications

As many college students are at a time of tremendous personal and academic growth, introductory philosophy courses have the potential to equip students with practical critical reasoning skills. Despite this, many introductory courses in this domain emphasize students’ learning about pre-existing dialectics in the abstract, rather than over self-reflection and development of personal philosophical perspectives. In doing so, we may be failing to support the needs of pre-professional students looking to prepare themselves for their careers ahead. In this practitioner paper, we report our efforts as a practicing philosophy instructor (Bursten) and a learning scientist (Finkelstein) to iterate on the …

The Human–Hookworm Assemblage: Contingency And The Practice Of Helminthic Therapy, Sophia Anne Strosberg

Theses and Dissertations--Geography

Through a qualitative analysis of the use of intestinal parasites for treating immune system disorders, this research illustrates how contingency emerges in the context of the human relationship to hookworms. The affect of the human–nonhuman relationship is an important part of understanding the direction of evolutionary medicine today, and has implications for the politics of biological health innovations. The shift from the bad parasite to a parasite that at least sometimes heals, discursively and materially, has opened new spaces for patients to change the way they relate to medical knowledge, medical professionals, and pharmaceutical companies. Hookworms are banned by the …

Carrots, Sticks And False Carrots: How High Should Weight Control Wellness Incentives Be? Findings From A Population-Level Experiment, Harald Schmidt

Frontiers in Public Health Services and Systems Research

Employers are increasingly using wellness incentives, including penalties for unhealthy behavior. Survey data suggests that people are willing to accept the principle of penalizing those perceived to take health risks, but the equally relevant question of the magnitude of acceptable penalties is unclear.

While the principle of penalizing overweight and obese people has some support, findings from a population-level experiment (n=1,000) suggest that the acceptable size of penalties is comparatively small, around $50: more than 10-fold below levels favored by advocates. Reward-based incentives are favored over penalty-based ones by a factor of 4. Of two different ways of framing penalty …

Ethics And The 'Seasons Of My Life' As A Dental Educator, David A. Nash

Oral Health Science Faculty Publications

Perhaps the first comprehensive ethics program in American dental schools was created in 1990 at the University of Kentucky by then dean David Nash. Nash recounts the emergence of his personal and professional interest in ethics using the structure of Daniel Levinson's book The Seasons of a Man's Life. Each season brings tasks of evolving and deepening ethical engagement. Being ethical is important; helping others to be so is special. Nash still teaches the course.

Ethics, Empathy, And The Education Of Dentists, David A. Nash

Oral Health Science Faculty Publications

Professional education in dentistry exists to educate good dentists-dentists equipped and committed to helping society gain the benefits of oral health. In achieving this intention, dental educators acknowledge that student dentists must acquire the complex knowledge base and the sophisticated perceptual-motor skills of dentistry. The graduation of knowledgeable and skilled clinicians in dentistry is a necessary, but not sufficient, condition for ensuring quality oral health care. The further requirement is the commitment of graduates to applying their abilities with moral integrity: providing appropriate and quality care in their patients' best interest. Ultimately, good dentistry depends on individuals committed to treating …

"The Profession Of Dentistry:" The University Of Kentucky's Curriculum In Professional Ethics, David A. Nash

Oral Health Science Faculty Publications

Among the most important learning that occurs in our nation's colleges of dentistry is learning to be a professional. While knowledge, perceptual-motor skills, and problem-solving abilities are basic to becoming a dentist, helping aspiring colleagues to apply their newly developing skills with integrity must be a fundamental concern. Increasingly, we are realizing that the quality of health care depends as significantly on the character of the health professional as it does on the individual's knowledge and skills. Concern for character, virtue, and integrity is the domain of ethics. This paper advances a justification for including a curriculum in professional ethics …

Patients As Subjects For Research: Ethical Dilemmas For The Primary Care Clinician-Investigator, Susan F. Slatkoff, Peter Curtis, Ann L. Coker

CRVAW Faculty Journal Articles

Background: Past studies suggested an association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN). In 1987, University of North Carolina (UNC) Hospitals Family Practice Center clinicians were approached for a control population to study this association. Methods: One hundred fives patients attending the UNC Hospitals Neoplasia Clinic with biopsy-proven CIN 2 or 3 and 268 control patients attending the UNC Family Practice Center for a routine Papanicolaou smear were enrolled in this case-control study. Case and control patients consented to having an additional cervical specimen taken and to being interviewed. The cervical specimens were classified by the Southern blot …

Organ Transplantation With An Incompetent Donor: Kentucky Resolves The Dilemma Of Strunk V. Strunk, Joe C. Savage

Kentucky Law Journal

No abstract provided.